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Trossaërt M, Falk A, Gautier L, Kragh N, Van Hinloopen O, Varin R. An observational study of haemophilia A patients without inhibitors using the French national claims (SNDS) database. Hematology 2024; 29:2320610. [PMID: 38445826 DOI: 10.1080/16078454.2024.2320610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES To describe clinical characteristics, factor consumption, and events of interest in patients with haemophilia A without inhibitors receiving prophylaxis in France, and the clinical impact of switching to Elocta® in this population. METHODS This retrospective, observational study using the Système National des Données de Santé database, analysed data from patients with haemophilia A without inhibitors using prophylactic factor VIII (FVIII) replacement therapy during 2016-2019. Clinical characteristics, treatment patterns and switches, factor consumption, and rate of events of interest were determined. In a sub-cohort of patients treated with Elocta®, clinical characteristics, factor consumption, and rate of events of interest before and after switching to Elocta® were compared. RESULTS For 545 patients, with mean age (standard deviation [SD]) 25.4 (17.8) years, Elocta® was the most used treatment. Bleeding events and articular non-bleeding events leading to hospitalization occurred in 15.4% and 13.9% of patients, respectively, and 9.9% of patients had surgeries or procedures related to haemophilic arthropathy. The mean (SD) FVIII product consumption was 344 (93) IU/kg/month for extended half-life treatment, and 331 (98) IU/kg/month for standard half-life products. For the sub-cohort of 146 patients, bleeding events (SD) decreased from 0.32 (2.2) to 0.09 (0.42) events/patient/year (p = 0.227) after switching to Elocta®. There was no statistically significant difference in rates of factor consumption or articular non-bleeding events before and after initiation of Elocta®. CONCLUSION This study provides real-world insights that advance the understanding of treatment patterns and events of interest in patients with haemophilia A on prophylactic regimens in France.
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Affiliation(s)
- Marc Trossaërt
- Hemophilia Treatment Centre, University Hospital of Nantes, Nantes, France
| | - Aletta Falk
- Global Medical Affairs and Clinical Science, Sobi, Stockholm, Sweden
| | - Laurène Gautier
- Real World Evidence Data and Analytics, Cerner Enviza, Paris, France
| | - Nana Kragh
- Global Health Economics and Outcomes Research, Sobi, Stockholm, Sweden
| | | | - Remi Varin
- Department of Pharmacy, Rouen University Hospital, Rouen, France
- UNIROUEN, INSERM U1234, Pathophysiology, Autoimmunity, Neuromuscular Diseases and Regenerative THERapies, Normandie University, Rouen, France
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Baldwin J, Udeze C, Li N, Boulmerka L, Dahal L, Pesce G, Quignot N, Jiang H, Galactéros F. Clinical burden and healthcare resource utilization associated with managing transfusion-dependent β-thalassemia in France. Curr Med Res Opin 2024:1-11. [PMID: 38873781 DOI: 10.1080/03007995.2024.2368197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
Objective: This retrospective, real-world claims database analysis aimed to describe the clinical burden and healthcare resource utilization associated with managing transfusion-dependent β-thalassemia (TDT) in France.Methods: We used the French National Health Data System (système national des données de santé) to identify eligible patients from January 1, 2012, to March 1, 2019. Inclusion criteria were a diagnosis of β-thalassemia, ≥8 red blood cell (RBC) transfusion episodes per year in ≥2 consecutive years following the diagnosis, and ≥1 year of follow-up data. Patients were excluded if their medical records showed evidence of sickle cell disease, α-thalassemia, hereditary persistence of fetal hemoglobin, or hematopoietic stem cell transplant. Clinical complications, mortality, treatment use, and healthcare resource utilization were evaluated in the follow-up period.Results: Overall, 331 eligible patients with TDT were identified. The mean age was 26.1 (standard deviation [SD]: 18.0) years, and 50.5% were male. Common clinical complications were endocrine (26.0%), hepatobiliary (22.7%), and cardiopulmonary (18.7%). Fifteen (4.5%) patients died during follow-up, with a mortality rate of 1.16 deaths per 100 person-years (mean age of death: 52.5 years [SD: 22]). Patients had a mean of 13.5 (SD: 5.2) RBC transfusion episodes and 11.2 (SD: 5.3) iron chelation therapy treatments per patient per year. healthcare resource utilization was substantial, with a mean of 14.8 inpatient hospitalizations (including 13.8 mean inpatient day cases) and 16.9 outpatient prescriptions per patient per year.Conclusions: Patients with TDT in France experience significant clinical complications, elevated mortality, and substantial healthcare resource utilization driven by frequent RBC transfusion episodes and inpatient hospitalizations. These results reinforce the need for disease-modifying therapies for this patient population.
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Affiliation(s)
| | - Chuka Udeze
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Nanxin Li
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Lyes Boulmerka
- Formerly of Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Lila Dahal
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | | | | | | | - Frédéric Galactéros
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
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Glezer S, Mercier G, Coursier JM, Petrica N, Pini M, Pg A. Health and Economic Impact of Different Long-Term Oxygen Therapeutic Strategies in Patients with Chronic Respiratory Failure: A French Nationwide Health Claims Database (SNDS) Study. Pulm Ther 2024:10.1007/s41030-024-00259-x. [PMID: 38822956 DOI: 10.1007/s41030-024-00259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/17/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Long-term oxygen therapy (LTOT) is reported to improve survival in patients with chronic respiratory failure. We aimed to describe effectiveness, burden, and cost of illness of patients treated with portable oxygen concentrators (POC) compared to other LTOT options. METHODS This retrospective comparative analysis included adult patients with chronic respiratory insufficiency and failure (CRF) upon a first delivery of LTOT between 2014 and 2019 and followed until December 2020, based on the French national healthcare database SNDS. Patients using POC, alone or in combination, were compared with patients using stationary concentrators alone (aSC), or compressed tanks (CTC) or liquid oxygen (LO2), matched on the basis of age, gender, comorbidities, and stationary concentrator use. RESULTS Among 244,719 LTOT patients (mean age 75 ± 12, 48% women) included, 38% used aSC, 46% mobile oxygen in the form of LO2 (38%) and POC (18%), whereas 9% used CTC. The risk of death over the 72-month follow-up was estimated to be 13%, 15%, and 12% lower for patients in the POC group compared to aSC, CTC, and LO2, respectively. In the POC group yearly mean total costs per patient were 5% higher and 4% lower compared to aSC and CTC groups, respectively, and comparable in the LO2 group. The incremental cost-effectiveness ratio (ICER) of POC was €8895, €6288, and €13,152 per year of life gained compared to aSC, CTC, and LO2, respectively. CONCLUSION Within the POC group, we detected an association between higher mobility (POCs autonomy higher than 5 h), improved survival, lower costs, and ICER - €6 238, compared to lower mobility POCs users.
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Affiliation(s)
| | - Gregoire Mercier
- UMR IDESP INSERM, 641 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Montpellier University Hospital, 191 Av. du Doyen Gaston Giraud, 34295, Montpellier, France
| | | | | | - Maria Pini
- Alira Health, 9 rue Bleue, 75009, Paris, France
| | - Abhijith Pg
- Inogen Inc, 301 Coromar Dr, Goleta, CA, 93117, USA
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Gourdy P, Darmon P, Borget I, Emery C, Bureau I, Detournay B, Bahloul A, Allali N, Mahieu A, Penfornis A. Basal Insulinotherapy in Patients Living with Diabetes in France: The EF-BI Study. Diabetes Ther 2024; 15:1349-1360. [PMID: 38642261 PMCID: PMC11096141 DOI: 10.1007/s13300-024-01577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Second-generation basal insulins like glargine 300 U/mL (Gla-300) have a longer duration of action and less daily fluctuation and interday variability than first-generation ones, such as glargine 100 U/mL (Gla-100). The EF-BI study, a nationwide observational, retrospective study, was designed to compare persistence, acute care complications, and healthcare costs associated with the initiation of such basal insulins (BI) in a real-life setting in France. METHODS This study was conducted using the French healthcare claims database (SNDS). Adult patients living with type 1 or type 2 diabetes mellitus (T1DM or T2DM) initiating Gla-300 or Gla-100 ± other hypoglycemic medications between January 1, 2016 and December 31, 2020, and without any insulin therapy over the previous 6 months were included. Persistence was defined as remaining on the same insulin therapy until discontinuation defined by a 6 month period without insulin reimbursement. Hospitalized acute complications were identified using ICD-10 codes. Total collective costs were established for patients treated continuously with each basal insulin over 1-3 years. All comparisons were adjusted using a propensity score based on initial patient/treatment characteristics. RESULTS A total of 235,894 patients with T2DM and 6672 patients with T1DM were included. Patients treated with Gla-300 were 83% (T1DM) and 44% (T2DM) less likely to discontinue their treatment than those treated with Gla-100 after 24 months (p < 0.0001). The annual incidence of acute hospitalized events in patients with T2DM treated with Gla-300 was 12% lower than with Gla-100 (p < 0.0001) but similar in patients with T1DM. Comparison of overall costs showed moderate but statistically significant differences in favor of Gla-300 versus Gla-100 for all patients over the first year, and in T2DM only over a 3-year follow-up. CONCLUSION Use of Gla-300 resulted in a better persistence, less acute hospitalized events at least in T2DM, and reduced healthcare expenditure. These real-life results confirmed the potential interest of using Gla-300 rather than Gla-100.
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Affiliation(s)
- Pierre Gourdy
- Endocrinology, Diabetology and Nutrition Department, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Patrice Darmon
- Endocrinology, Metabolic Diseases and Nutrition Department, AP-HM (Assistance-Publique Hôpitaux de Marseille), Marseille, France
- INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Isabelle Borget
- Department of Epidemiology and Biostatistics, Gustave Roussy and University Paris Saclay, Villejuif, France
| | - Corinne Emery
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France
| | - Isabelle Bureau
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France.
| | | | | | | | - Alfred Penfornis
- Sud-Francilien Hospital and Université Paris-Saclay, 40, Avenue Serge DASSAULT, 91106, Corbeil-Essonnes Cedex, France
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Aboyans V, Morboeuf O, Grenier B, Jolivel R, Bura-Riviere A. Editor's Choice - Revascularisation for Peripheral Artery Disease in France: Implications for the Implementation of VOYAGER-PAD. Eur J Vasc Endovasc Surg 2024; 67:969-978. [PMID: 38316351 DOI: 10.1016/j.ejvs.2024.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The VOYAGER-PAD trial demonstrated the interest in dual pathway inhibition (DPI) (low dose rivaroxaban plus aspirin) to reduce limb and cardiovascular events after revascularisation for peripheral artery disease (PAD), but its applicability in clinical practice has not yet been assessed. This study aimed to assess the number of patients revascularised in France for PAD and to estimate the proportion of those matching the VOYAGER-PAD trial selection criteria. A secondary objective was to examine the prognosis of revascularised patients in a real world setting. METHODS This observational retrospective study was conducted on the national hospital discharge database and included all patients with PAD who underwent lower extremity revascularisation for PAD (without lower extremity revascularisation in the two years prior to inclusion) from 1 January 2016 to 31 December 2019. Available VOYAGER-PAD selection criteria were then applied to the study population. RESULTS In total, 180 870 patients were included (mean age 72.0 ± 12.2 years, 30.9% female), with approximately 45 000 patients revascularised annually. Among them, 90 379 (50.0%) matched the VOYAGER-PAD trial criteria (VOYAGER-PAD eligible subgroup; mean age 69.8 ± 12.1 years, 29.5% female). In the study population and the VOYAGER-PAD eligible subgroup, 33.9% and 26.6% of patients had diabetes, 28.1% and 19.9% had chronic coronary artery disease, and 14.6% and 5.7% had renal failure, respectively. Overall, 73.1% of study patients were treated by an endovascular approach (75.5% in the VOYAGER-PAD eligible subgroup). In patients with more than one year of follow up, 45.4% of study patients and 36.0% of the VOYAGER-PAD eligible subgroup experienced a limb or cardiovascular event. The median time until the first event and in hospital death was 4.8 months and 7.8 months, respectively (6.7 months and 12.9 months in the VOYAGER-PAD eligible subgroup). CONCLUSION The burden of PAD for revascularisation and secondary events is considerable. One half of revascularised patients in France are eligible for DPI therapy. Those patients are younger, with fewer comorbidities, and better outcomes.
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Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, and EpiMaCT, Inserm 1094/IRD270, Limoges University Hospital, Limoges, France.
| | - Olivier Morboeuf
- Medical Affairs, Bayer HealthCare SAS, La Garenne Colombes, France
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Wargny M, Goronflot T, Rimbert A, Boursier J, Kab S, Henny J, Lainé A, Leux C, Smati S, Hadjadj S, Le May C, Goldberg M, Zins M, Cariou B. Primary hypocholesterolemia is associated with an increased risk of hepatic complications in the general population. J Hepatol 2024; 80:846-857. [PMID: 38331324 DOI: 10.1016/j.jhep.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND & AIMS Beyond cardiovascular disease protection, the health consequences of very low concentrations of low-density lipoprotein-cholesterol (LDL-C) remain a matter of debate. In primary hypobetalipoproteinemia (HBL), liver steatosis and cirrhosis have occasionally been reported. Here, we aimed to investigate the association between HBL and the risk of hepatic complications (cirrhosis complications and/or primary liver cancer) in the general population. METHODS A cohort study was conducted in the French population-based cohort CONSTANCES. Participants with primary HBL (LDL-C <5th percentile for age and sex, [HBL]) were compared with those with normal LDL-C concentrations (40th-60th percentile, [Control]). Participants on lipid-lowering therapies were excluded. For hepatic complications, follow-up events were compared by calculating the incidence density ratio (IDR). The same analyses were replicated in the UK Biobank (UKBB) cohort. RESULTS In the CONSTANCES and UKBB cohorts, 34,653 and 94,666 patients were analyzed, with median ages of 45 and 56 years, mean LDL-C concentrations (HBL vs. control) of 71 vs. 128 mg/dl and 86 vs. 142 mg/dl, and mean follow-up durations of 5.0 and 11.5 years, respectively. The HBL group presented a higher incidence of hepatic complications than the control group: 0.32/ vs. 0.07/1,000 person-years (IDR = 4.50, 95% CI 1.91-10.6) in CONSTANCES, and 0.69/ vs. 0.21/1,000 person-years (IDR = 3.27, 95% CI 2.63-4.06) in the UKBB. This risk proved to be independent of classic risk factors for liver disease (obesity, alcohol consumption, diabetes, viral hepatitis), including in a 5-year landmark analysis excluding early events. Sensitivity analyses based on apoliprotein-B levels (instead of LDL-C levels) or genetically defined HBL showed similar results. CONCLUSIONS HBL is associated with a markedly increased risk of hepatic complications. HBL must be considered as a substantial independent risk factor for liver diseases which justifies specific prevention and screening. IMPACT AND IMPLICATIONS Hypobetalipoproteinemia (HBL) is a lipid disorder characterized by permanent, inherited low levels (below the 5th percentile) of low-density lipoprotein-cholesterol. While HBL is associated with a lower risk of cardiovascular events, some studies suggest that it may be associated with a potential risk of hepatic steatosis and hepatic complications. Here, we studied the association between HBL and hepatic complications (defined as cirrhosis complications and/or primary liver cancer) in two populations of several hundred thousand people, both in France (CONSTANCES cohort) and the United Kingdom (UKBB). The results show that HBL is associated with a significant and independent excess risk of hepatic complications, including primary liver cancer. Thus, in people with HBL, the value of regular liver monitoring must be studied.
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Affiliation(s)
- Matthieu Wargny
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France; Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France
| | - Thomas Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France
| | - Antoine Rimbert
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France
| | - Jérôme Boursier
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Hôpital Universitaire d'Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR ICAT 4208, Université d'Angers, Angers, France
| | - Sofiane Kab
- Université Paris Cité, Paris Saclay University, UVSQ, Inserm UMS 011, Villejuif, France
| | - Joseph Henny
- Université Paris Cité, Paris Saclay University, UVSQ, Inserm UMS 011, Villejuif, France
| | - Antoine Lainé
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France
| | - Christophe Leux
- Nantes Université, CHU Nantes, Service d'information médicale, F-44000 Nantes, France
| | - Sarra Smati
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France
| | - Samy Hadjadj
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France
| | - Cédric Le May
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France
| | - Marcel Goldberg
- Université Paris Cité, Paris Saclay University, UVSQ, Inserm UMS 011, Villejuif, France
| | - Marie Zins
- Université Paris Cité, Paris Saclay University, UVSQ, Inserm UMS 011, Villejuif, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, F-44000 Nantes, France.
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Logeart D, Doublet M, Gouysse M, Damy T, Isnard R, Roubille F. Development and validation of algorithms to predict left ventricular ejection fraction class from healthcare claims data. ESC Heart Fail 2024; 11:1688-1697. [PMID: 38438250 PMCID: PMC11098626 DOI: 10.1002/ehf2.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS The use of large medical or healthcare claims databases is very useful for population-based studies on the burden of heart failure (HF). Clinical characteristics and management of HF patients differ according to categories of left ventricular ejection fraction (LVEF), but this information is often missing in such databases. We aimed to develop and validate algorithms to identify LVEF in healthcare databases where the information is lacking. METHODS AND RESULTS Algorithms were built by machine learning with a random forest approach. Algorithms were trained and reinforced using the French national claims database [Système National des Données de Santé (SNDS)] and a French HF registry. Variables were age, gender, and comorbidities, which could be identified by medico-administrative code-based proxies, Anatomical Therapeutic Chemical codes for drug delivery, International Classification of Diseases (Tenth Revision) coding for hospitalizations, and administrative codes for any other type of reimbursed care. The algorithms were validated by cross-validation and against a subset of the SNDS that includes LVEF information. The areas under the receiver operating characteristic curve were 0.84 for the algorithm identifying LVEF ≤ 40% and 0.79 for the algorithms identifying LVEF < 50% and ≥50%. For LVEF ≤ 40%, the reinforced algorithm identified 50% of patients in the validation dataset with a positive predictive value of 0.88 and a specificity of 0.96. The most important predictive variables were delivery of HF medication, sex, age, hospitalization, and testing for natriuretic peptides with different orders of positive or negative importance according to the LVEF category. CONCLUSIONS The algorithms identify reduced or preserved LVEF in HF patients within a nationwide healthcare claims database with high positive predictive value and low rates of false positives.
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Affiliation(s)
- Damien Logeart
- Department of CardiologyParis Cité University, AP‐HP Hôpital Lariboisière, Inserm U9422 rue Ambroise ParéParisFrance
| | | | | | - Thibaud Damy
- Department of Cardiology and French National Reference Centre for Cardiac AmyloidosisHôpitaux Universitaires Henri‐Mondor AP‐HP, IMRB, Inserm, Université Paris‐Est CréteilCréteilFrance
| | | | - François Roubille
- Department of CardiologyINI‐CRT PhyMedExp Inserm CNRS, CHU de Montpellier, Université de MontpellierMontpellierFrance
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Tudorache R, Jaboyedoff M, Gabet A, Olié V, Angoulvant F, Tuppin P, Lesuffleur T, Kossorotoff M. Infection and Pediatric Arterial Ischemic Stroke Presumably Related to Focal Cerebral Arteriopathy: Data From the COVID-19 Pandemic. Stroke 2024; 55:1672-1675. [PMID: 38787929 DOI: 10.1161/strokeaha.123.045632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Infection may trigger pediatric arterial ischemic stroke (PAIS), notably when related to focal cerebral arteriopathy. Community- and individual-level nonpharmaceutical interventions during the COVID-19 pandemic resulted in a major decrease in pediatric viral infections. We explored the consequences on the incidence of PAIS. METHODS Using national public health databases, we identified children hospitalized between 2015 and 2022 with PAIS. Using an age proxy (29 days to 7 years) and excluding patients with cardiac and hematologic conditions, we focused on children with PAIS presumably related to focal cerebral arteriopathy or with no definite cause. Considering the delay between infection and PAIS occurrence, we compared a prepandemic reference period, a period with nonpharmaceutical interventions, and a post-nonpharmaceutical intervention period. RESULTS Interrupted time-series analyses of the monthly incidence of PAIS in this group showed a significant decrease in the nonpharmaceutical intervention period compared with the prepandemic period: -33.5% (95% CI, -55.2%, -1.3%); P=0.043. CONCLUSIONS These data support the association between infection and PAIS presumably related to focal cerebral arteriopathy.
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Affiliation(s)
- Raluca Tudorache
- French Center for Pediatric Stroke, Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris (R.T., M.K.)
- Pediatric Neurology Department, Prof. Dr. A. Obregia Clinical Hospital and C. Davila University of Medicine and Pharmacy, Bucharest, Romania (R.T.)
| | - Manon Jaboyedoff
- Women-Mother-Child Department, Pediatrics, Lausanne University Hospital, University of Lausanne, Switzerland (M.J., F.A.)
| | - Amélie Gabet
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| | - Valérie Olié
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| | - François Angoulvant
- Women-Mother-Child Department, Pediatrics, Lausanne University Hospital, University of Lausanne, Switzerland (M.J., F.A.)
| | - Philippe Tuppin
- Department of Strategy, Studies and Statistics, French National Health Insurance Fund (Caisse Nationale de l'Assurance Maladie), Paris (P.T., T.L.)
| | - Thomas Lesuffleur
- Department of Strategy, Studies and Statistics, French National Health Insurance Fund (Caisse Nationale de l'Assurance Maladie), Paris (P.T., T.L.)
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris (R.T., M.K.)
- Inserm U1266, Paris, France (M.K.)
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Viguier M, Bentayeb M, Azzi J, de Pouvourville G, Gloede T, Langellier B, Massol J, Medina P, Thoma C, Bachelez H. Generalized pustular psoriasis: A nationwide population-based study using the National Health Data System in France. J Eur Acad Dermatol Venereol 2024; 38:1131-1139. [PMID: 38404163 DOI: 10.1111/jdv.19901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND GPP is a rare, chronic, neutrophilic skin disease, with limited real-world data characterizing patients with flares and the impact of flares on disease progression and morbidity. OBJECTIVE Describe the clinical characteristics of patients with GPP, comorbidities, disease epidemiology and frequency and severity of flares, and compare patients with GPP with a matched severe psoriasis population. METHODS In this population-based real-world cohort study an algorithm was developed to identify patients with GPP flares. Three cohorts were identified using the Système National des Données de Santé (SNDS) database covering almost the entire French population; a prevalent cohort (2010-2018), an incident cohort (2012-2015). A severe psoriasis cohort was compared with the GPP incident cohort using propensity score matching. RESULTS The prevalent and incident cohorts comprised 4195 and 1842 patients, respectively. In both cohorts, mean age was 58 years; 53% were male. Comorbidities were significantly more common in the incident cohort versus matched psoriasis cohort, respectively, including hypertension (44% vs. 26%), ischaemic heart disease (26% vs. 18%) and hyperlipidaemia (25% vs. 15%). In the incident cohort, the flare rate was 0.1 flares/person-year and 0.4 flares/person-year among the 569 out of 1842 patients hospitalized with flares. These patients had a mean (±SD) stay of 11.6 ± 10.4 days; 25% were admitted to the intensive care unit. In 2017, the cumulative incidence and cumulative GPP age-sex standardized prevalence were 7.1 and 45.2 per million, respectively. CONCLUSIONS Patients with GPP had a distinct comorbidity profile compared to patients with severe psoriasis, and GPP flares were associated with long hospitalizations.
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Affiliation(s)
- Manuelle Viguier
- Department of Dermatology-Venereology, Hôpital Robert Debré and Université Reims-Champagne Ardenne, IRMAIC, EA 7509, Reims, France
| | | | | | | | - Tristan Gloede
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, USA
| | | | - Jacques Massol
- Aixial Consulting, Boulogne Billancourt, France
- Remede Consulting Group, Paris, France
| | | | | | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
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10
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Maillard O, Bun R, Laanani M, Verga-Gérard A, Leroy T, Gault N, Estellat C, Noize P, Kaguelidou F, Sommet A, Lapeyre-Mestre M, Fourrier-Réglat A, Weill A, Quantin C, Tubach F. Use of the French National Health Data System (SNDS) in pharmacoepidemiology: A systematic review in its maturation phase. Therapie 2024:S0040-5957(24)00065-9. [PMID: 38834394 DOI: 10.1016/j.therap.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/14/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
AIM OF THE STUDY The French National Health Data System (SNDS) comprises healthcare data that cover 99% of the population (over 67 million individuals) in France. The aim of this study was to present an overview of published pharmacoepidemiological studies using the SNDS in its maturation phase. METHODS We conducted a systematic literature review of original research articles in the Pubmed and EMBASE databases from January 2012 until August 2018. RESULTS A total of 316 full-text articles were included, with an annual increase over the study period. Only 16 records were excluded after screening because they did not involve the SNDS but other French healthcare databases. The study design was clearly reported in only 66% of studies of which 57% were retrospective cohorts and 22% cross-sectional studies. The reported study objectives were drug utilization (65%), safety (22%) and effectiveness (9%). Almost all ATC groups were studied but the most frequent ones concerned the nervous system in 149 studies (49%), cardiovascular system drugs in 104 studies (34%) and anti-infectives for systemic use in 50 studies (16%). CONCLUSION The SNDS is of growing interest for studies on drug use and safety, which could be conducted more in specific populations, including children, pregnant women and the elderly, as these populations are often not included in clinical trials.
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Affiliation(s)
- Olivier Maillard
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Department of Public Health and Research, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France; Clinical Investigation Center, INSERM CIC 1410, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France.
| | - René Bun
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Department of Public Health and Research, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France; Clinical Investigation Center, INSERM CIC 1410, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France
| | - Moussa Laanani
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; French National Health Insurance, 75000 Paris, France
| | - Amandine Verga-Gérard
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1433, 54100 Nancy, France
| | - Taylor Leroy
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1433, 54100 Nancy, France
| | - Nathalie Gault
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1425, hôpital Bichat, 75018 Paris, France
| | - Candice Estellat
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de Santé publique, AP-HP, hôpital Pitié-Salpêtrière, département de Santé publique, centre de pharmacoépidémiologie (Cephepi), CIC-1901, 75000 Paris, France
| | - Pernelle Noize
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Université de Bordeaux, INSERM, BPH, U1219, Team AHeaD, CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, 33000 Bordeaux, France
| | - Florentia Kaguelidou
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1426, Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigations Center, hôpital Robert-Debré, 75019 Paris, France; UMR-1123, ECEVE, université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France
| | - Agnès Sommet
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de pharmacologie médicale et clinique, faculté de médecine, CIC 1436, CHU, université de Toulouse, 31000 Toulouse, France
| | - Maryse Lapeyre-Mestre
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de pharmacologie médicale et clinique, faculté de médecine, CIC 1436, CHU, université de Toulouse, 31000 Toulouse, France
| | - Annie Fourrier-Réglat
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Université de Bordeaux, INSERM, BPH, U1219, Team AHeaD, CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, 33000 Bordeaux, France
| | - Alain Weill
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), 93200 Saint-Denis, France
| | - Catherine Quantin
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de biostatistiques et d'information médicale (DIM), CHU Dijon Bourgogne, INSERM, université de Bourgogne, CIC 1432, module épidémiologie clinique, 21000 Dijon, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - Florence Tubach
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de Santé publique, AP-HP, hôpital Pitié-Salpêtrière, département de Santé publique, centre de pharmacoépidémiologie (Cephepi), CIC-1901, 75000 Paris, France
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11
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Havet A, Bouvard C, Moskal A, Chanelière M, Massardier J, Lebrun-Vignes B, Jonville-Bera AP, Payet C, Viprey M. Compliance with the pregnancy prevention program among women initiating isotretinoin treatment between 2014 and 2021: A nationwide cohort study on the French Health Data System (SNDS). J Eur Acad Dermatol Venereol 2024. [PMID: 38764351 DOI: 10.1111/jdv.20073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite the French pregnancy prevention program (PPP), a considerable number of pregnancies are potentially exposed to oral isotretinoin. New measures were taken by the French Medicines Agency, including the restriction of initial isotretinoin prescriptions to dermatology specialists in May 2015 and a new information campaign on teratogenicity in January 2019. OBJECTIVES The aims were to: describe, between 2014 and 2021, compliance with PPP recommendations: isotretinoin use as a second-line treatment, first prescription by a dermatology specialist, monthly prescription renewal and pregnancy testing (PT); assess the effect of the 2015 and 2019 measures on PT compliance; and identify the determinants of PT noncompliance. METHODS A retrospective cohort study was conducted among women aged 11-50 years initiating isotretinoin between 2014 and 2021 using the French Health Data System. PT compliance corresponded to pregnancy test completion and specific delays between prescription and dispensation. Time series analyses were performed to evaluate the effect of the 2015 and 2019 measures on PT compliance, and log-binomial and Poisson multivariate regression models were used to identify the determinants of PT noncompliance. RESULTS Isotretinoin was prescribed as a second-line treatment in 64% of initiations, mainly by dermatology specialists (92%). A new monthly prescription was observed in 98% of dispensations. PT compliance reached 61%, 72% and 25% at initiation, renewals and end of treatment, respectively. The 2015 measure was associated with better PT compliance at initiation and renewals. The 2019 measure had no significant effect on PT compliance at the initiation or end of treatment but was associated with a decrease in PT compliance at renewals. Age, low socioeconomic level, initiation by a nondermatology specialist and during summer were associated with PT noncompliance. CONCLUSIONS Understanding factors associated with PT noncompliance could help to target specific subpopulations of women treated with isotretinoin.
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Affiliation(s)
- A Havet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
| | - C Bouvard
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - A Moskal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - M Chanelière
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Lyon 1, Villeurbanne, France
| | - J Massardier
- Service de Gynécologie-Obstétrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, France
| | - B Lebrun-Vignes
- Service de Pharmacologie, Centre Régional de Pharmacovigilance, Hôpital Pitié-Salpêtrière, AP-HP, GH Sorbonne Université, Paris, France
| | - A-P Jonville-Bera
- Centre Régional de Pharmacovigilance, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - C Payet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
| | - M Viprey
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service Des Données de Santé, Lyon, France
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12
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Fernandez J, Babin C, Thomassin C, Pelon F, Kelley S, Cochat P, Galbraith M, Berdaï D, Pariente A, Salvo F, Vanier A. Can requests for real-world evidence by the French HTA body be planned? An exhaustive retrospective case-control study of medicinal products appraisals from 2016 to 2021. Int J Technol Assess Health Care 2024; 40:e33. [PMID: 38757153 DOI: 10.1017/s0266462324000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES In France, decisions for pricing and reimbursement for medicinal products are based on appraisals performed by the National authority for health (Haute Autorité de Santé (HAS)). During the appraisal process, additional real-world evidence can be requested as "Post-Registration Studies" (PRS) when there are uncertainties in evidence that could be resolved by additional data collection. To facilitate PRS planning, a retrospective exploratory analysis was conducted to identify the characteristics of medicinal products associated with a PRS request. METHODS This analysis encompassed all appraisals finalized between January 1, 2016 and December 31, 2021 and compared products for which the appraisal led to a PRS request with those that did not. RESULTS Six hundred positive opinions for reimbursement were identified, with a PRS request present in 17 percent (n = 103) of cases. The independent characteristics associated with a PRS request were a mild or moderate clinical benefit score, a major to moderate or minor clinical added value score, previous availability under an early access program, and certain therapeutic areas (neurology, pulmonology, and endocrinology). These findings suggest two different profiles of PRS requests: (i) products for which there is uncertainty in the size of the clinical benefit and (ii) innovative products for which a substantial benefit is expected but uncertainties persist. CONCLUSIONS These results will assist health technology developers to better anticipate data generation to promptly address uncertainties identified by HAS. It may also help HAS and other assessment agencies to work together to improve postlaunch evidence generation according to the characteristics of the medicinal products.
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Affiliation(s)
- Judith Fernandez
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Céleste Babin
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Camille Thomassin
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Floriane Pelon
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Sophie Kelley
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Pierre Cochat
- Scientific Board and Chairman of the Transparency Committee, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | | | - Driss Berdaï
- CHU de Bordeaux, Pharmacoepidemiology and Appropriate use of Medicine Team, Public Health Department, Clinical Pharmacology Unit Bordeaux, Nouvelle-Aquitaine, France
| | - Antoine Pariente
- CHU de Bordeaux, Pharmacoepidemiology and Appropriate use of Medicine Team, Public Health Department, Clinical Pharmacology Unit Bordeaux, Nouvelle-Aquitaine, France
- University of Bordeaux, INSERM, BPH, U1219, Team AHeaD Talence, Aquitaine, France
| | - Francesco Salvo
- University of Bordeaux, INSERM, BPH, U1219, Team AHeaD Talence, Aquitaine, France
- CHU de Bordeaux, Regional center for pharmacovigilance Public Health Department, Clinical Pharmacology Unit Bordeaux, Nouvelle-Aquitaine, France
| | - Antoine Vanier
- HTA Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
- Université de Tours, UMR U1246 Sphere, Inserm Tours, Centre-Val de Loire, France
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13
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Brouard C, Schwager M, Expert A, Drewniak N, Laporal S, de Lagasnerie G, Lot F. Impact of Public Policy and COVID-19 Pandemic on Hepatitis C Testing and Treatment in France, 2014-2021. Viruses 2024; 16:792. [PMID: 38793673 PMCID: PMC11125660 DOI: 10.3390/v16050792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Given the World Health Organization's target to eliminate the hepatitis C virus (HCV) by 2030, we assessed the impact of French public policies and the COVID-19 pandemic on HCV testing and initiation of direct-antiviral agents (DAAs). Using the French National Health Data System, we identified individuals living in metropolitan France with at least one reimbursement for an anti-HCV test and those with a first delivery of DAAs between 1 January 2014 and 31 December 2021. During this period, the annual number of people tested increased each year between 3.3 (in 2015) and 9.3% (in 2021), except in 2020, with a drop of 8.3%, particularly marked in April (-55.0% compared to February 2020). A return to pre-pandemic testing levels was observed in 2021. The quarterly number of patients initiating DAAs presented an upward trend from Q1-2014 until mid-2017, with greater increases in Q1-2015, and Q1- and Q2-2017, concomitant with DAA access policies and availability of new therapies. Then, quarterly numbers decreased. A 65.5% drop occurred in April compared to February 2020. The declining DAA initiations since mid-2017, despite new measures improving access and screening efforts, could be due to the shrinking pool of patients requiring treatment and a need to increase awareness among undiagnosed infected people. Further action is needed to eliminate HCV in France.
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Affiliation(s)
- Cécile Brouard
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | - Manon Schwager
- Caisse Nationale de l’Assurance Maladie, 75986 Paris, France; (M.S.); (A.E.); (G.d.L.)
| | - Aude Expert
- Caisse Nationale de l’Assurance Maladie, 75986 Paris, France; (M.S.); (A.E.); (G.d.L.)
| | - Nicolas Drewniak
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | - Stella Laporal
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | | | - Florence Lot
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
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14
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Petit P, Chamot S, Al-Salameh A, Cancé C, Desailloud R, Bonneterre V. Farming activity and risk of treated thyroid disorders: Insights from the TRACTOR project, a nationwide cohort study. ENVIRONMENTAL RESEARCH 2024; 249:118458. [PMID: 38365059 DOI: 10.1016/j.envres.2024.118458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Epidemiological data regarding thyroid diseases are lacking, in particular for occupationally exposed populations. OBJECTIVES To compare the risk of hypothyroidism and hyperthyroidism between farming activities within the complete population of French farm managers (FMs). METHODS Digital health data from retrospective administrative databases, including insurance claims and electronic health/medical records, was employed. This cohort data spanned the entirety of French farm managers (FMs) who had undertaken work at least once from 2002 to 2016. Survival analysis with the time to initial medication reimbursement as timescale was used to examine the association (hazard ratio, HR) between 26 specific farming activities and both treated hypothyroidism and hyperthyroidism. A distinct model was developed for each farming activity, comparing FMs who had never engaged in the specific farming activity between 2002 and 2016 with those who had. All analyses were adjusted for potential confounders (e.g., age), and sensitivity analyses were conducted. RESULTS Among 1088561 FMs (mean age 46.6 [SD 14.1]; 31% females), there were 31834 hypothyroidism cases (75% females) and 620 hyperthyroidism cases (67% females), respectively. The highest risks were observed for cattle activities for both hyperthyroidism (HR ranging from 1.75 to 2.42) and hypothyroidism (HR ranging from 1.41 to 1.44). For hypothyroidism, higher risks were also observed for several animal farming activities (pig, poultry, and rabbit), as well as fruit arboriculture (HR = 1.22 [1.14-1.31]). The lowest risks were observed for activities involving horses. Sex differences in the risk of hypothyroidism were observed for eight activities, with the risk being higher for males (HR = 1.09 [1.01-1.20]) than females in viticulture (HR = 0.97 [0.93-1.00]). The risk of hyperthyroidism was two times higher for male dairy farmers than females. DISCUSSION Our findings offer a comprehensive overview of thyroid disease risks within the FM community. Thyroid ailments might not stem from a single cause but likely arise from the combined effects of various causal agents and triggering factors (agricultural exposome). Further investigation into distinct farming activities-especially those involving cattle-is essential to pinpoint potential risk factors that could enhance thyroid disease monitoring in agriculture.
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Affiliation(s)
- Pascal Petit
- CHU Grenoble Alpes, Centre Régional de Pathologies Professionnelles et Environnementales, 38000, Grenoble, France; Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France.
| | - Sylvain Chamot
- Regional Center for Occupational and Environmental Diseases of Hauts-de-France, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80000, Amiens, France; Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Abdallah Al-Salameh
- Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, Chemin du Thil, 80025, Amiens, France; Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054, Amiens, France
| | - Christophe Cancé
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France
| | - Rachel Desailloud
- Péritox (UMR_I 01), UPJV/INERIS, University of Picardy Jules Verne, Chemin du Thil, 80025, Amiens, France; Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, 1 rond point du Pr Christian Cabrol, 80054, Amiens, France
| | - Vincent Bonneterre
- CHU Grenoble Alpes, Centre Régional de Pathologies Professionnelles et Environnementales, 38000, Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000, Grenoble, France
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15
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Depond CC, Zouaoui S, Darlix A, Rigau V, Mathieu-Daudé H, Bauchet F, Khettab M, Trétarre B, Figarella-Branger D, Taillandier L, Boetto J, Pallud J, Zemmoura I, Roche PH, Bauchet L. Descriptive epidemiology of 30,223 histopathologically confirmed meningiomas in France: 2006-2015. Acta Neurochir (Wien) 2024; 166:214. [PMID: 38740641 DOI: 10.1007/s00701-024-06093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Meningioma is one of the most common neoplasm of the central nervous system. To describe the epidemiology of meningioma operated in France and, to assess grading and histopathological variability among the different neurosurgical centres. METHODS We processed the French Brain Tumour Database (FBTDB) to conduct a nationwide population-based study of all histopathologically confirmed meningiomas between 2006 and 2015. RESULTS 30,223 meningiomas cases were operated on 28,424 patients, in 61 centres. The average number of meningioma operated per year in France was 3,022 (SD ± 122). Meningioma was 3 times more common in women (74.1% vs. 25.9%). The incidence of meningioma increased with age and, mean age at surgery was 58.5 ± 13.9 years. Grade 1, 2, and 3 meningiomas accounted for 83.9%, 13.91% and, 2.19% respectively. There was a significant variability of meningioma grading by institutions, especially for grade 2 which spanned from 5.1% up to 22.4% (p < 0.001). Moreover, the proportion of grade 2 significantly grew over the study period (p < 0.001). There was also a significant variation in grade 1 subtypes diagnosis among the institutions (p < 0.001). 89.05% of the patients had solely one meningioma surgery, 8.52% two and, 2.43% three or more. The number of surgeries was associated to the grade of malignancy (p < 0.001). CONCLUSION The incidence of meningioma surgery increased with age and, peaked at 58.5 years. They were predominantly benign with meningothelial subtype being the most common. However, there was a significant variation of grade 1 subtypes diagnosis among the centres involved. The proportion of grade 2 meningioma significantly grew over the study time, on contrary to malignant meningioma proportion, which remained rare and, stable over time around 2%. Likewise, there was a significant variability of grade 2 meningioma rate among the institutions.
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Affiliation(s)
- Charles Champeaux Depond
- Department of Neurosurgery, Hôpital Privé Clairval - Ramsay Santé, 317 Bd de Redon, 13009, Marseille, France.
| | - Sonia Zouaoui
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295, Montpellier cedex 5, France
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
| | - Amélie Darlix
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
- Medical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, 34298, Montpellier, France
| | - Valérie Rigau
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
- Department of Pathology, Gui-de-Chauliac Hospital, Montpellier University Medical Center, 34295, Montpellier cedex 5, France
| | - Hélène Mathieu-Daudé
- Department of Epidemiology, French Brain Tumour Database, GNOLR, Registre Des Tumeurs de L'Hérault, ICM, 34298, Montpellier cedex 5, France
| | - Fabienne Bauchet
- Department of Epidemiology, French Brain Tumour Database, GNOLR, Registre Des Tumeurs de L'Hérault, ICM, 34298, Montpellier cedex 5, France
| | - Mohamed Khettab
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
- Medical Oncology Unit, CHU de La Réunion, Université de La Réunion, 97410, Saint Pierre, France
| | - Brigitte Trétarre
- Registre Des Tumeurs de L'Hérault, ICM, 34298, Montpellier cedex 5, France
| | - Dominique Figarella-Branger
- Institut de Neurophysiopathologie, Service d'Anatomie Pathologique Et de Neuropathologie, Aix-Marseille University, APHM, CNRS, INP, CHU Timone, 13005, Marseille, France
| | - Luc Taillandier
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Julien Boetto
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295, Montpellier cedex 5, France
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
- Paris Brain Institute, Sorbonne Université, CRICM INSERM U1127 CNRS UMR 7225, 75013, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie Et Neurosciences, Site Sainte Anne, 75014, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, 75014, Paris, France
| | - Ilyess Zemmoura
- Neurosurgery Department, CHRU de Tours, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Pierre-Hugues Roche
- Neurosurgery Department, CHRU de Tours, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- Service de Neurochirurgie de L'hôpital Nord, APHM - AMU, Marseille, France
| | - Luc Bauchet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295, Montpellier cedex 5, France
- Institut de Génomique Fonctionnelle (IGF), University of Montpellier, CNRS, INSERM, 34094, Montpellier, France
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Hoisnard L, Meyer A, Dray-Spira R, Weill A, Zureik M, Sbidian E. Risk of Gastrointestinal Perforation in Patients With Rheumatic Diseases Exposed to Janus Kinase Inhibitors Versus Adalimumab: A Nationwide Cohort Study. Arthritis Rheumatol 2024. [PMID: 38699822 DOI: 10.1002/art.42862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/20/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To compare the risk of gastrointestinal perforation (GIP), a rare but serious adverse event, in patients who a JAK inhibitor (JAKi; tofacitinib, baricitinib, upadacitinib, or filgotinib) versus adalimumab (tumor necrosis factor inhibitor) among a comprehensive real-world population of patients with rheumatic diseases. METHODS We conducted a nationwide population-based cohort study of the French national health data system, the exposed group that received a JAKi and the comparison group adalimumab. We included all individuals with a rheumatic disease who had their first dispensation of these treatments from July 2017 to December 2021. The primary endpoint was the occurrence of GIP (end of follow-up May 2022). Weighted hazard ratios (wHRs) were estimated with the inverse probability of treatment weighting method to account for confounding factors. Concomitant administration of systemic glucocorticoids, nonsteroidal anti-inflammatory drugs, and proton-pump inhibitors were time-varying variables. RESULTS The cohort included 39,758 patients: 12,335 and 27,423 in the groups that received a JAKi and adalimumab (mean age 58.2 and 47.3 years; female 76% and 58%; rheumatoid arthritis 85.3% and 27.3%, and psoriatic arthritis/axial spondyloarthritis 14.7% and 72.7%), respectively. During follow-up, 38 and 42 GIPs occurred in the groups that received a JAKi and adalimumab groups; incidence rates were 2.1 (95% confidence interval [CI] 1.5-2.8) and 1.1 (95% CI 0.8-1.5) per 1,000 person-years, respectively. Rates of GIP did not differ between the groups that received a JAKi and adalimumab: wHR 1.1 (95% CI 0.7-1.9; P = 0.65). Despite the lack of power in some subgroup analyses, results were consistent whatever the subgroup of a type of JAKi received or subgroup with a type of rheumatic disease. CONCLUSION In this nationwide cohort study, the rates of GIPs did not differ between groups of patients who received JAKi and adalimumab treatment. These results need to be confirmed in other observational studies.
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Affiliation(s)
- Lea Hoisnard
- Henri Mondor Hospital, INSERM, and Paris Est Créteil University, Créteil, France
| | - Antoine Meyer
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France, and Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Rosemary Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Alain Weill
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Emilie Sbidian
- Henri Mondor Hospital, Créteil, France, INSERM, Créteil, France, Paris Est Créteil University, Créteil, France, French National Agency for Medicines and Health Products Safety, Saint-Denis, France, Le Kremlin Bicêtre, France
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Lam L, Carrieri P, Hejblum G, Bellet J, Bourlière M, Carrat F. Real-world economic burden of hepatitis C and impact of direct-acting antivirals in France: A nationwide claims data analysis. Liver Int 2024; 44:1233-1242. [PMID: 38375961 DOI: 10.1111/liv.15872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/04/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS The economic impact of managing patients with hepatitis C virus (HCV) infection remains unknown. This study aimed to assess the economic burden of chronic HCV infection from a national health insurance perspective and the impact of direct-acting antivirals (DAAs) using nationwide real-world data. METHODS Patients with chronic HCV infection were identified from the French Health Insurance Claims Databases (SNDS) and matched for age and sex to the general population. Health resource utilization and reimbursements were summarized according to healthcare expenditure items from 2012 to 2021. The economic burden attributable to chronic HCV infection was evaluated over a 10-year period. Finally, the impact of DAAs was estimated using economic data derived from the SNDS. RESULTS A total of 145 187 patients with chronic HCV infection were identified. Among the patients eligible for DAA therapy, 81.5% had received DAA by the end of 2021. Over a 10-year period, managing patients with chronic HCV infection resulted in an additional cost of €9.71 billion (95% confidence interval [CI]: €9.66-€9.78 billion) or €9191 (95% CI: €9134-€9252) per patient per year compared to the general population. After DAA therapy, patients with chronic HCV infection had a higher economic burden than the general population, with an additional cost of €5781 (95% CI: €5540-€6028) per patient at the fifth-year post-DAA therapy. CONCLUSIONS A significant economic burden persists among patients with HCV infection after DAA treatment. The high proportion of patients not treated with DAA therapy supports reinforcing policies for universal access.
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Affiliation(s)
- Laurent Lam
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Patrizia Carrieri
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Gilles Hejblum
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Jonathan Bellet
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
- INSERM, UMR 1252 IRD SESSTIM, Aix Marseille Université, Marseille, France
| | - Fabrice Carrat
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
- Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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18
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Prost P, Duraes M, Georgescu V, Rebel L, Mercier G, Rathat G. Impact of Ovarian Cancer Surgery Volume on Overall and Progression-Free Survival: A Population-Based Retrospective National French Study. Ann Surg Oncol 2024; 31:3269-3279. [PMID: 38393461 DOI: 10.1245/s10434-024-15050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Data are limited on the relationship between ovarian cancer surgery volume and outcomes in France. METHODS For this retrospective, population-based study, patients with ovarian cancer that was diagnosed between January 1, 2012 and December 31, 2016 were identified from the French National Health Data System (SNDS). Hospitals were classified in function of their ovarian cancer surgery volume. Patient, tumor, hospital, and hospital stay characteristics also were evaluated. The hospital procedure volume effect on 5-year overall survival (OS) and recurrence-free survival (RFS) was determined with Cox-proportional hazards models. RESULTS This study included 8429 patients and 53.4% underwent cytoreductive surgery in hospitals with procedure volume < 20 cases/year. The 5-year OS rates were 63% and 60% in hospitals with procedure volume ≥ 20 and < 20 cases/year (p = 0.02). In multivariate analysis, OS and RFS were significantly increased when surgery was performed in hospitals doing ≥ 20 surgeries/year (vs. < 20) (hazard ratio HR = 1.18, 95% CI = 1.08-1.29 and HR = 1.10, 95% CI = 1.03-1.17). In the volume subgroup analysis, a difference was observed mainly between hospitals with < 10 surgeries/year and the other hospitals (HR = 1.27, 95% CI = 1.14-1.41 and HR = 1.14, 95% CI = 1.05-1.23). The patients' age and comorbidities, tumor stage, and hospital stay (duration, first cytoreduction surgery) were associated with OS. CONCLUSIONS Ovarian cancer surgery volume ≥ 20 cases/year was significantly associated with improved OS and RFS but only with a limited clinical benefit. The biggest differences in OS and RFS were observed between hospitals with procedure volume < 10 cases/year and all the other hospitals.
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Affiliation(s)
- Pauline Prost
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
| | - Martha Duraes
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Vera Georgescu
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Lucie Rebel
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Grégoire Mercier
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Gauthier Rathat
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
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Joassard O, Kerveillant AL, Sellal C, Coatantiec E, Jabbour V, Desjeux G, Braithwaite B, Elias A, Fauconnier A. Evaluation of Elastic Venous Compression Device dispensation in pregnant and post-partum women using the French National Health Insurance Claims Database: The ProFIL retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 296:342-348. [PMID: 38531180 DOI: 10.1016/j.ejogrb.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES To describe the real-world use of Elastic Venous Compression Devices (EVCDs) during pregnancy and post-partum using data from a representative subset of the French National Health Insurance Claims Database (the Echantillon Généraliste des Bénéficiaires, EGB). STUDY DESIGN Women aged 15-49 who were pregnant between 1st July 2017 and 15th June 2018 were identified in the EGB using pregnancy-specific acts (certain prenatal examinations or deliveries). Subgroups were defined by age, presence of Venous Thrombo-Embolism (VTE) risk factors, history of VTE, delivery type and time period. EVCD dispensations (format, prescriber, and date) were identified among those for "standard orthotics" using their unique reimbursement tariffs. Dispensation rates were computed for all subgroups, overall and by format and were compared. RESULTS 15,528 pregnant women were included: 7,252 [46.7 %] deliveries (5,796 vaginal [79.9 %], 482 planned cesarean sections (C-sections) [6.7 %] and 974 unplanned C-Sections [13.4 %]), 2,734 (17.6 %) terminations and 5,542 (35.7 %) unknown outcomes. Overall, 4,919 (31.7 %) women were dispensed at least one EVCD. Ante-partum dispensation occurred in 43.1 % (n = 3,122) of women whose pregnancy led to a delivery. Dispensation rates were 17.3 % (n = 1,005), 46.7 % (n = 225) and 44.1 % (n = 430) after vaginal delivery, planned C-sections or unplanned C-sections, respectively. Overall, dispensation rates significantly increased with age, the presence of VTE risk factors, and a history of VTE (p < 0.01). EVCD dispensation was most frequent (17.0 %) during the 5th month of pregnancy. Among pregnant women who were dispensed at least one EVCD during ante- or post-partum, 69.0 % had one or two units of compression (27.1 % [one unit], 41.9 % [two units]). Stockings (48.6 %, n = 6,038) were dispensed significantly more frequently than socks (36.9 %, n = 4,586) and tights (14.5 %, n = 1,806) (p < 0.01). The main contributors to mechanical VTE prophylaxis were gynecologists (26.3 % of dispensations, n = 2,280), general practitioners (20.2 %, n = 1,749) and midwives (15.1 %, n = 1,314). CONCLUSIONS Low observed dispensation rates highlight a discrepancy between the French National Authority for Health (Haute Autorité de Santé, HAS), recommending EVCDs use during pregnancy and after delivery, and the real-life use of EVCD. Prescription sensitization combined with targeted information campaigns for pregnant women would be beneficial to contribute to the prevention of VTE, a health problem for pregnant women.
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Affiliation(s)
- Olivier Joassard
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | | | - Claire Sellal
- Midwife practice, 14 Rue du Chapeau Rouge, 44000 Nantes, France.
| | - Erwana Coatantiec
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Violaine Jabbour
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Guillaume Desjeux
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Ben Braithwaite
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Antoine Elias
- Department of Vascular Medicine, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France; Clinical research department, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France.
| | - Arnaud Fauconnier
- Obstetrics and Gynecology department, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, BP 3082, 78303 Poissy CEDEX, France; Paris-Saclay university, UVSQ, research unit 7285 "Risk and safety in clinical medicine for women and perinatal health (RISCQ), 2 Avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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20
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Pierret C, Mainguy M, Leray E. Prevalence of multiple sclerosis in France in 2021: Data from the French health insurance database. Rev Neurol (Paris) 2024; 180:429-437. [PMID: 38423846 DOI: 10.1016/j.neurol.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND France is among the countries with high prevalence of multiple sclerosis (MS). The most recent estimates are from 2012 and need to be updated because MS prevalence has increased worldwide. OBJECTIVE To estimate MS prevalence in France on December 31, 2021 and to describe the characteristics of the French MS population using data from the French national health insurance database (SNDS). MATERIAL AND METHODS Persons with MS (PwMS) were identified in the SNDS database (99% of national coverage) using an algorithm with three criteria: long-term disease status, hospitalizations, and MS-specific drug reimbursements. Crude and sex- and age-stratified prevalence rates were calculated with their 95% confidence intervals as well as the standardized prevalence stratified on the region of residence. RESULTS In total, 134,062 PwMS were identified (71.8% of women, median age 53.0±14.8years) yielding a prevalence of 197.6 per 100,000 (95% CI [196.5-198.7]). Prevalence rates in women and men were respectively 274.9 (95% CI [273.2-276.6]) and 115.2 (95% CI [114.0-116.4]). In metropolitan France, the highest prevalence rates were observed in the northeastern regions (e.g.>230 PwMS per 100,000 in Grand Est and Hauts-de-France), and the lowest rates in the southwestern regions (∼180 PwMS per 100,000 in Nouvelle-Aquitaine and Occitanie). Overall, 32.1% of PwMS had another long-term disease and 51.8% received at least one MS-specific drug in 2021. CONCLUSION MS prevalence in France has increased by ∼30% in the last 10years. This increase is probably linked to population ageing, longer survival of PwMS, and the long observation period. The part attributable to a possible increase in MS risk remains to be determined with incidence studies.
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Affiliation(s)
- C Pierret
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France.
| | - M Mainguy
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | - E Leray
- Rennes University, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
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Arlet JB, Herquelot E, Lamarsalle L, Raguideau F, Bartolucci P. Impact of hospitalized vaso-occlusive crises in the previous calendar year on mortality and complications in adults with sickle cell disease: a French population-based study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100901. [PMID: 38596356 PMCID: PMC11002849 DOI: 10.1016/j.lanepe.2024.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
Background Historically, sickle cell disease (SCD) patients experiencing frequent hospitalized vaso-occlusive crises (HVOC) have been associated with increased mortality, yet recent data reflecting the widespread use of hydroxyurea and advancements in disease management remain limited. Our study aims to assess the association between HVOC and mortality or severe complications in patients with SCD in this new treatment landscape. Methods This was a retrospective observational cohort study using the French national health data system. Between 01-01-2012 and 12-31-2018, all SCD patients ≥16 years old (ICD-10 codes D57.0-2) were included and followed until 12-31-2018. HVOC was defined as a hospitalization of ≥1 night with primary diagnosis of SCD with crisis, following an emergency room visit. The association between HVOC and severe complications was assessed with a Cox proportional hazards model. Findings In total, 8018 patients (56.6% females; 4538/8018) were included. The 2018 SCD standardized one-year period prevalence was 17.9 cases/100,000 person-years [17.4; 18.3]. The mean rate was 0.84 (1.88) HVOC/person-year. In 2018, 70% (5323/7605), 22% (1671/7605), and 8% (611/7605) of patients experienced 0, 1-2, or 3+ HVOCs, respectively. The median survival time between HVOCs was 415 days [386; 439]. Overall, 312 patients died (3.9%) with a mean age of 49.8 (19.4). Compared to patients without HVOC, the hazard ratios of death in patients with 1-2 or 3+ HVOCs the year prior to death were 1.67 [1.21; 2.30] and 3.70 [2.30; 5.93], respectively. Incidence of acute chest syndrome, pulmonary embolism, osteonecrosis, and sepsis increased with the HVOCs category, but not stroke. In 2018, 29.5% (180/611) of patients with 3+ HVOCs did not take hydroxyurea. Interpretation Patients must be closely monitored during their hospitalizations to intensify treatment and check treatment compliance. Innovative therapies are also required. Funding The study was funded by Novartis.
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Affiliation(s)
- Jean-Benoît Arlet
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, Paris-Cité University and European Georges Pompidou University Hospital (AP–HP), 75015, Paris, France
| | | | | | | | - Pablo Bartolucci
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Henri-Mondor Hospital (AP-HP), Créteil, France
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de Germay S, Pambrun E, Pariente A, Grenet G, Bezin J, Faillie JL. Use of sodium-glucose cotransporter-2 inhibitors in France: Analysis of French nationwide health insurance database. Diabetes Obes Metab 2024; 26:1678-1686. [PMID: 38288619 DOI: 10.1111/dom.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/09/2024]
Abstract
AIM Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been commercialized in France for type 2 diabetes since April 2020 and later for heart and renal diseases. Given the recent developments in treating diabetes and the widening of SGLT-2i indications, we aimed to study changes in the use of glucose-lowering drugs in France and to characterize SGLT-2i new users. METHODS We performed a nationwide utilization study using the French health insurance database. Trends in incidence and prevalence of glucose-lowering drug use were assessed by a repeated cross-sectional study in 2019 and 2021. A cohort study of incident SGLT-2i users was then conducted to describe patient characteristics and the strategy for treating diabetes. RESULTS The prevalence of SGLT-2i use gradually reached 0.1% in the third quarter of 2021 and increased more significantly to 0.2% thereafter. SGLT-2i became the second most prescribed glucose-lowering drug class after metformin at the end of 2021 (0.1%). Among the cohort of 125 387 SGLT-2i new users (mean age 65.0 years; 60.1% of men), 87.6% presented a diabetic comorbidity. The patient profile changed over the study period with an increasing proportion of patients with cardiovascular (28.7% in 2020 vs. 40.2% in 2021) or renal (7.7% in 2020 vs. 11.8% in 2021) comorbidities at initiation. The main combinations used at SGLT-2i initiation were metformin (12.5%) and metformin plus dipeptidyl peptidase-4 inhibitors (8.1%). One-year probability of SGLT-2i persistence was estimated to be 55%. CONCLUSION The expansion of indications for SGLT-2i and the broadening of the target population make it essential to assess the reasons for discontinuation and review their safety profile.
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Affiliation(s)
- Sibylle de Germay
- Univ. Bordeaux, INSERM, BPH, U1219 Team AHeaD, Bordeaux, France
- Department of Medical Pharmacology, CHU de Bordeaux, Bordeaux, France
| | - Elodie Pambrun
- Univ. Bordeaux, INSERM, BPH, U1219 Team AHeaD, Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, INSERM, BPH, U1219 Team AHeaD, Bordeaux, France
- Department of Medical Pharmacology, CHU de Bordeaux, Bordeaux, France
| | - Guillaume Grenet
- Department of Medical Pharmacotoxicology, Hospices Civils de Lyon, Lyon, France
| | - Julien Bezin
- Univ. Bordeaux, INSERM, BPH, U1219 Team AHeaD, Bordeaux, France
- Department of Medical Pharmacology, CHU de Bordeaux, Bordeaux, France
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, CHU Montpellier; Univ Montpellier, IDESP INSERM, Montpellier, France
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Durel CA, Thervet ES, Chauveau D, Schmidt A, Terrier B, Bataille PM. Evolution of therapeutic management of patients with ANCA associated vasculitis in France after licensing Rituximab use. BMC Rheumatol 2024; 8:16. [PMID: 38679737 PMCID: PMC11056056 DOI: 10.1186/s41927-024-00385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION In 2013, rituximab was approved in France for the treatment of ANCA-associated vasculitis (AAV). The aim of the study was to compare the treatment and health events of adult incident patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), included before rituximab approval (over 2010-2012, Group 1) and those included after rituximab approval (over 2014-2017, Group 2). METHOD Data were extracted from the French National Health Insurance database (SNDS) including outpatient health care consumption and hospital discharge forms. Comparisons between inclusion periods were performed using Wilcoxon and χ² tests. Kaplan-Meier method was used to model the duration of treatment induction, maintenance, and off-drug periods. Fine and Gray tests were used to compare treatment phase durations. RESULTS A total of 694 GPA and 283 MPA patients were included in Group 1, while 668 GPA and 463 MPA patients were included in Group 2. Between the two inclusion periods, the proportions of patients treated with rituximab increased in the induction and maintenance phases whereas treatment with azathioprine declined. These proportions remained stable in the case of methotrexate, cyclophosphamide, and glucocorticoid-treated patients. Frequency of first-time hospitalized infections, diabetes and renal failure during the first year after inclusion increased for both groups. LIMITATIONS OF THE STUDY This is a retrospective study based on claims data including only 76% of people covered by health insurance in France. The period studied includes the learning phase of using rituximab. This study lacks biological data and precise quantitative analysis for the use of steroids, therefore the criteria for establishing diagnosis and therapeutic choice were unknown. CONCLUSIONS Introduction of rituximab reduced the use of azathioprine without affecting the use of glucocorticoids or cyclophosphamide.
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Boudet-Berquier J, Demattei C, Guldner L, Gallay A, Manouvrier S, Botton J, Philippat C, Delva F, Bloch J, Semaille C, Odent S, Perthus I, Randrianaivo H, Babajko S, Barjat T, Beneteau C, Brennetot N, Garne E, Haddad G, Hocine M, Lacroix I, Leuraud K, Mench M, Morris J, Patrier S, Sartelet A, Verloes A, Bonaldi C, Le Barbier M, Gagnière B, Pépin P, Ollivier R, Bitoun M, King L, Guajardo-Villar A, Gomes E, Desenclos JC, Regnault N, Benachi A. A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France. Eur J Epidemiol 2024:10.1007/s10654-024-01125-5. [PMID: 38671254 DOI: 10.1007/s10654-024-01125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas. METHODS The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use. RESULTS After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed. DISCUSSION Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred.
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Affiliation(s)
- Julie Boudet-Berquier
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France.
| | - Christophe Demattei
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), Centre Hospitalier Universitaire de Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Laurence Guldner
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | - Anne Gallay
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Sylvie Manouvrier
- Reference Centre of Developmental Anomalies and Defect Syndromes, RADEME Maladies Rares du Développement Et du Métabolisme, Université Lille, 7364, Lille, EA, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Claire Philippat
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, France
| | - Fleur Delva
- INSERM, BPH, UMR1219, EPICENE Team, University of Bordeaux, Bordeaux, France
- Environmental and Occupational Health Department, Bordeaux University Hospital, 33000, Bordeaux, France
| | | | | | - Sylvie Odent
- Reference Centre of Developmental Anomalies and Defect Syndromes, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- La Réunion registry of congenital anomalies, Centre Hospitalier Universitaire de La Réunion, Île de la Réunion, France
| | - Sylvie Babajko
- Molecular Oral Pathophysiology Laboratory, Centre de Recherche des Cordeliers, INSERM UMRS, Université Paris Cité, Sorbonne Université, 1138, Paris, France
- Fédération Hospitalo-Universitaire DDS-ParisNet, INSERM, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- UR2496, Biomedical Research in Odontology, Université Paris Cité, Montrouge, France
| | - Tiphaine Barjat
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
| | - Claire Beneteau
- Department of Human Genetics, University Hospital Hôtel Dieu, Nantes, France
| | - Naima Brennetot
- French National Reference for Children Limb Defect, Hôpitaux de Saint-Maurice, Saint Maurice, France
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Mounia Hocine
- Conservatoire National des Arts et Métiers, Paris, France
| | - Isabelle Lacroix
- REGARDs Network, Pharmacologie Médicale et Clinique, CERPOP INSERM UMR 1295-SPHERE team, Faculté de Médecine Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Klervi Leuraud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Michel Mench
- INRAE, BIOGECO, UMR 1202, University of Bordeaux, F‑33615, Pessac, France
| | - Joan Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Arnaud Sartelet
- Clinical Department of Ruminant, University of Liège, 4000, Liège, Belgium
| | - Alain Verloes
- Genetics Department, APHP, Robert-Debré University Hospital, Paris, France
| | - Christophe Bonaldi
- Methodology and Biostatistics Department, Santé Publique France, Saint Maurice, France
| | - Mélina Le Barbier
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | | | - Philippe Pépin
- Cellule Auvergne-Rhône-Alpes, Santé Publique France, Clermont-Ferrand, France
| | - Ronan Ollivier
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Monique Bitoun
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Lisa King
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | | | - Eugenia Gomes
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | | | - Nolwenn Regnault
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des femmes et des nouveau-nés, Hopital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Clamart, France
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25
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Tran PT, Lapeyre-Mestre M, Berangere B, Lanteri-Minet M, Palmaro A, Donnet A, Micallef J. Triptan use in elderly over 65 years and the risk of hospitalization for serious vascular events. J Headache Pain 2024; 25:68. [PMID: 38671362 PMCID: PMC11055320 DOI: 10.1186/s10194-024-01770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Several studies have focused on the use of triptan and the risk of acute vascular events but the existence of such association is still debated and has never been quantified in patients over 65 years. To assess whether triptan use among older is associated with an increased risk of hospitalization for acute vascular events. METHODS A propensity score-matched cohort study was designed using the French national health insurance database linked to hospital stays. Patients aged ≥ 65 years, newly treated by triptans between 2011 and 2014, were included… The primary event was hospitalization for an acute ischemic vascular event within de 90 days following triptan initiation. Association with triptan exposure was investigated through cox regression model, considering exposure at inclusion, and with exposure as a time-varying variable A case-crossover (CCO) and a self-controlled case series (SCCS) analyses were also conducted to address potential residual confounding. RESULTS The cohort included 24, 774 triptan users and 99 096 propensity matched controls (mean (SD) age: 71 years (5.9), 74% of women). Within 90 days after cohort entry, 163 events were observed in the triptan group, and 523 in the control group (0.66% vs. 0.53%, adjusted hazard ratio (aHR) exposed/not exposed 1.25 95%CI [1.05-1.49]; aHR time-varying 8.74 [5.21-14.66]). The association was significant (CCO) for all events (adjusted odds ratio (aOR1.63 [1.22-2.19]) with a more consistent association with cerebral events (aOR 2.14 [1.26-3.63]). The relative incidence (RI) for all events was 2.13 [1.76-2.58] in the SCCS, for cardiac (RI: 1.67 [1.23-2.27]) and for cerebral events (RI: 3.20, [2.30-4.45]). CONCLUSION The incidence of acute vascular events was low among triptan users. We found that triptan use among older may be associated with a low increased risk for acute vascular events, which may be more marked for cerebral events such as stroke, than for cardiac events.
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Affiliation(s)
- Phuong Thao Tran
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre d'Investigation Clinique Inserm (CIC 1436), Université de Toulouse, Toulouse, France
| | - Baricault Berangere
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre d'Investigation Clinique Inserm (CIC 1436), Université de Toulouse, Toulouse, France
| | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
- Département d'évaluation et de traitement de la douleur, CHU de Nice, FHU InovPain Université Côte Azur, Nice, France
| | - Aurore Palmaro
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
| | - Anne Donnet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
- Centre d'Evaluation et de Traitement de la douleur, FHU InovPain Pôle Neurosciences Cliniques, APHM, Marseille, France
| | - Joëlle Micallef
- service de pharmacologie clinique & pharmacosurveillance, centre régional de pharmacovigilance, Aix-Marseille université, Inserm, UMR 1106, Assistance publique-Hôpitaux de Marseille, Hopital Sainte Marguerite 270, boulevard sainte Marguerite, Marseille, 13009, France.
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26
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Dufour L, Grave C, Bonaldi C, Joly P, Andler R, Quatremere G, Nguyen-Thanh V, Olié V, Gabet A. Hemorrhagic Strokes Attributable to Chronic Alcohol Consumption and Heavy Episodic Drinking in France. Neurology 2024; 102:e209228. [PMID: 38527250 DOI: 10.1212/wnl.0000000000209228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES To estimate the number of cases and deaths related to hemorrhagic stroke (HS) attributable to a chronic alcohol consumption and to heavy episodic drinking (HED) in France. METHODS A population-attributable fraction (PAF) estimation approach was used. Relative risks for HS with alcohol consumption were extracted from the INTERSTROKE study. Levels of alcohol consumption in the French population were collected from the 2017 Health Barometer. Data on HS morbidity and mortality were extracted from the French National Health Data System (SNDS). RESULTS We estimated that 7.2% (n = 2,100) and 6.6% (n = 1,900) of cases with HS were attributable to chronic alcohol consumption and HED, respectively. PAFs were higher in men than in women with 11.5% vs 2.6% for a chronic consumption and 10.7% vs 2.1% for HED, respectively. We estimated that 7.0% of HS deaths (n = 1,100) were attributable to chronic alcohol consumption and 5.1% attributable to HED (n = 800). Finally, 16.3% of patients with HS (n = 4,700) and 14.1% of HS deaths (n = 2,300) were attributable to overall chronic alcohol consumption or to monthly HED. DISCUSSION These results remind the importance of alcohol consumption in the occurrence of HS and the importance of implementing primary and secondary prevention measures, particularly among young people, where HED is most common.
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Affiliation(s)
- Lucas Dufour
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Clémence Grave
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Christophe Bonaldi
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Pierre Joly
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Raphaël Andler
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Guillemette Quatremere
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Viêt Nguyen-Thanh
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Valérie Olié
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Amélie Gabet
- From the French Public Health Agency (L.D., C.G., C.B., P.J., R.A., G.Q., V.N.-T., V.O., A.G.), Saint-Maurice; and Univ. Bordeaux (P.J.), ISPED, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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27
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Gombault-Datzenko E, Costa N, Mounié M, Tavassoli N, Mathieu C, Roussel H, Lagarrigue JM, Berard E, Rolland Y, Molinier L. Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study. BMC Geriatr 2024; 24:353. [PMID: 38641801 PMCID: PMC11027376 DOI: 10.1186/s12877-024-04946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). METHODS This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. RESULTS Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. CONCLUSIONS Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
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Affiliation(s)
- E Gombault-Datzenko
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France.
| | - N Costa
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - M Mounié
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - N Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - C Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
- CREAI-ORS Occitanie, Toulouse, France
| | - H Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, Toulouse, 31082, France
| | - J M Lagarrigue
- MSA Midi-Pyrénées Nord, 180 Avenue Marcel Unal, Montauban, 82000, France
| | - E Berard
- INSERM, UMR 1295, Toulouse, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Y Rolland
- INSERM, UMR 1295, Toulouse, France
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - L Molinier
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
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28
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Baudot FO. Impact of benzodiazepine use on the risk of occupational accidents. PLoS One 2024; 19:e0302205. [PMID: 38626122 PMCID: PMC11020385 DOI: 10.1371/journal.pone.0302205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
Benzodiazepines (BZDs) are drugs commonly used for treating insomnia and anxiety. Although they are known to induce cognitive and psychomotor impairments, their effect on the risk of causing accidents at work remains understudied. The objective of this study is to estimate this risk by differentiating between the recommended use and overuse of these drugs (i.e., uninterrupted use for four months). The data come from the French National Health Data System, which provide a population composed of French people who had at least one work accident (WA) from 2017 to 2019 (approximately 2.5 million people). A linear probability model with two-way fixed effects is used to deal with time-constant heterogeneity and the time effect independent of individuals. The results show a reduction in the risk of WA after a short period of BZD use (one month) compared with no use at all, but the risk of WA increases when treatment exceeds the recommended duration. The intensity of use results in a greater risk of WAs: a 1% increase in BZD use (expressed as the amount reimbursed) leads to a 4.4% (p<0.001) increase in the monthly risk of WAs. Moreover, we see an increase in risk in the month following the treatment discontinuation (+3.6%, p<0.001), which could be due to rebounding and catch-up effects. Health professionals and BZD users should be made aware of the WA risk induced by the use of BZDs, particularly after prolonged use and after discontinuation of treatment. This study provides more evidence for the need to limit the duration of BZD treatment.
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Affiliation(s)
- François-Olivier Baudot
- ERUDITE, Université Paris-Est Créteil, Créteil, France
- Caisse Nationale de l’Assurance Maladie, Paris, France
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Atramont A, Martin GL, Singer M, Tajahmady A, Agamaliyev E, Harhay MO, Leone M, Legrand M. One-Year Survival and Hospital-free Days in Critical Illness After Viral Pneumonia. Am J Respir Crit Care Med 2024; 209:1019-1022. [PMID: 38285911 DOI: 10.1164/rccm.202310-1771le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Affiliation(s)
| | | | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | | | | | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, PAIR (Palliative and Advanced Illness Research) Center & Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc Leone
- Department of Anesthesia and Intensive Care Unit, Assistance Publique Hôpitaux de Marseille, Hospital Nord, Aix-Marseille University, Marseille, France
| | - Matthieu Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; and
- INI-CRCT Network, Nancy, France
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30
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Dumas E, Grandal Rejo B, Gougis P, Houzard S, Abécassis J, Jochum F, Marande B, Ballesta A, Del Nery E, Dubois T, Alsafadi S, Asselain B, Latouche A, Espie M, Laas E, Coussy F, Bouchez C, Pierga JY, Le Bihan-Benjamin C, Bousquet PJ, Hotton J, Azencott CA, Reyal F, Hamy AS. Concomitant medication, comorbidity and survival in patients with breast cancer. Nat Commun 2024; 15:2966. [PMID: 38580683 PMCID: PMC10997660 DOI: 10.1038/s41467-024-47002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Between 30% and 70% of patients with breast cancer have pre-existing chronic conditions, and more than half are on long-term non-cancer medication at the time of diagnosis. Preliminary epidemiological evidence suggests that some non-cancer medications may affect breast cancer risk, recurrence, and survival. In this nationwide cohort study, we assessed the association between medication use at breast cancer diagnosis and survival. We included 235,368 French women with newly diagnosed non-metastatic breast cancer. In analyzes of 288 medications, we identified eight medications positively associated with either overall survival or disease-free survival: rabeprazole, alverine, atenolol, simvastatin, rosuvastatin, estriol (vaginal or transmucosal), nomegestrol, and hypromellose; and eight medications negatively associated with overall survival or disease-free survival: ferrous fumarate, prednisolone, carbimazole, pristinamycin, oxazepam, alprazolam, hydroxyzine, and mianserin. Full results are available online from an interactive platform ( https://adrenaline.curie.fr ). This resource provides hypotheses for drugs that may naturally influence breast cancer evolution.
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Affiliation(s)
- Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
| | - Beatriz Grandal Rejo
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Sophie Houzard
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Judith Abécassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- INRIA, Paris-Saclay University, CEA, Palaiseau, 91120, France
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marande
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
| | - Annabelle Ballesta
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
| | - Elaine Del Nery
- Département de Recherche Translationnelle - Plateforme Biophenics, PICT-IBISA, PSL Research University, Paris, France
| | - Thierry Dubois
- Institut Curie - PSL Research University Translational Research Department Breast Cancer Biology Group 26 rue d'Ulm, 75005, Paris, France
| | - Samar Alsafadi
- Institut Curie, PSL Research University, Uveal Melanoma Group, Translational Research Department, Paris, France
| | | | - Aurélien Latouche
- INSERM, U900, 75005, Paris, France
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210, Saint-Cloud, France
- Conservatoire National des Arts et Métiers, Paris, France
| | - Marc Espie
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Enora Laas
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Clémentine Bouchez
- Breast diseases Center Hôpital saint Louis APHP, Université Paris Cité, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
| | - Christine Le Bihan-Benjamin
- Health Data and Assessment, Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | - Philippe-Jean Bousquet
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Équipe Labellisée Ligue Contre le Cancer, 13005, Marseille, France
- Health Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 92100, Boulogne-Billancourt, France
| | | | - Chloé-Agathe Azencott
- INSERM, U900, 75005, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006, Paris, France
- Institut Curie, PSL Research University, Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France.
- Department of Surgical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France.
- Department of Surgery, Institut Jean Godinot, Reims, France.
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Université Paris Cité, F-75005, Paris, France
- Department of Medical Oncology, Université Paris Cité, Institut Curie, 75005, Paris, France
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Grave C, Gabet A, Iliou MC, Cinaud A, Tuppin P, Blacher J, Olié V. Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities. Arch Cardiovasc Dis 2024; 117:234-243. [PMID: 38458957 DOI: 10.1016/j.acvd.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
| | | | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, 75020 Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
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Loubet P, Fernandes J, de Pouvourville G, Sosnowiez K, Elong A, Guilmet C, Omichessan H, Bureau I, Fagnani F, Emery C, Abou Chakra CN. Respiratory syncytial virus-related hospital stays in adults in France from 2012 to 2021: A national hospital database study. J Clin Virol 2024; 171:105635. [PMID: 38215557 DOI: 10.1016/j.jcv.2023.105635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes lower respiratory tract infections (LRTI) that may lead to hospitalization or death. The present study aimed to assess the burden of RSV infections in hospitalized adults. METHODS RSV-related hospitalizations were identified from the nationwide hospital claims database in France (PMSI) from 2012 to 2021 using ICD-10 codes J12.1, J20.5, J21.0 or B97.4, and outcomes assessment focused on 2016-2020. In-hospital outcomes included length of stay, need for intensive care (ICU) and in-hospital all-cause mortality. Post-discharge outcomes included 30-day readmission for decompensation, 90-day RSV-related readmission, and 30 and 60-day in-hospital mortality. RESULTS A cumulated number of 17 483 RSV-related stays were identified representing a rate of 72.0 cases per million stays. The outcomes assessment included 12,987 patients: 55.8 % were females and the mean age was 74.1 ± 16.4 years, with 57 % ≥ 75 years. Most of patients (78.6 %) had at least one comorbidity, mainly chronic respiratory (56.3 %) and cardiovascular diseases (41.3 %), or diabetes (23.5 %). A co-infection was found in 22.4 %, primarily bacterial (12 %). The mean length of stay was 12.3 ± 13.1 days. Overall, 10.9 % were admitted to an ICU and in-hospital mortality was 7.3 %. In-hospital outcomes were higher in cases of co-infection. Among 12 033 patients alive at discharge from the index stay, 6.5 % were readmitted with RSV within 90 days, 8.1 % for decompensation within 30 days, and 5.6 % died within 60-day. CONCLUSION This study demonstrated the high burden of RSV infections in older adults and those with chronic conditions, and the need for preventive strategies.
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Affiliation(s)
- Paul Loubet
- Service des Maladies Infectieuses et Tropicales, CHU Nîmes Carémeau, Université de Montpellier, Nîmes, France.
| | | | | | - Katia Sosnowiez
- Department of Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Anne Elong
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Caroline Guilmet
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Hanane Omichessan
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
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Delorme T, Cottenet J, Abo-Alhassan F, Bernard A, Ortega-Deballon P, Quantin C. Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis. Hernia 2024; 28:419-426. [PMID: 37770815 DOI: 10.1007/s10029-023-02885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Incisional hernias are associated with a reduced quality of life. Mesh reinforcement of the abdominal wall is the current standard for incisional hernia repair (IHR), since it reduces the risk of recurrence. The best position for the mesh remains controversial, and each position has advantages and disadvantages. OBJECTIVE In this nationwide population-based study, we aimed to determine whether IHR with intraperitoneal mesh is associated with an increased risk of bowel obstruction. PATIENTS AND METHODS Using the French hospital database (PMSI), which collects data from all public and private hospitals, two patient cohorts were created and compared. Patients having undergone a laparoscopic IHR with intraperitoneal mesh (IPOM) in 2013 or 2014 due to a laparotomy performed in the 4 previous years were the IPOM group. Patients hospitalized for any other acute disease (i.e., without IHR) in 2013 and 2014, but having a similar laparotomy in the 4 previous years were the control group. Both cohorts were followed until 2019 in search of any episode of bowel obstruction. RESULTS A total of 815 patients were included in the IPOM group and matched to 1630 control patients. The 5 year bowel obstruction rate was 7.36% in the IPOM group and 4.42% in the control group (p < 0.01). In the multivariate analysis, after adjustment on age and obesity, incisional hernia repair with laparoscopic IPOM increased the risk of bowel obstruction in the 5 years following surgery (HR = 1.712; 95% CI 1.208-2.427; p = 0.0025). CONCLUSIONS Patients having undergone laparoscopic IPOM have an increased risk of bowel obstruction compared with patients who have a similar surgical history but no IHR.
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Affiliation(s)
- Théophile Delorme
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France
| | - Jonathan Cottenet
- Department of Medical Information, Dijon University Hospital, Dijon, France
| | - Fawaz Abo-Alhassan
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France.
- INSERM, Université de Bourgogne, CHU Dijon Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.
| | - Catherine Quantin
- Department of Medical Information, Dijon University Hospital, Dijon, France
- INSERM, Université de Bourgogne, CHU Dijon Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
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Auvin S, Guillo S, de Rycke Y, Tran D, Tubach F. Benzodiazepines for pediatric epilepsies and their risks in a cohort within the French health care data. Epilepsia 2024; 65:900-908. [PMID: 38353414 DOI: 10.1111/epi.17906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The management of antiseizure treatment in patients with epilepsy relies on the benefit-risk ratio. Data on antiseizure medication (ASM) use in children are limited. We described antiseizure medication use in children with epilepsy (CwE) in France, with a focus on the chronic use of benzodiazepines and related implications. METHODS We conducted a 5-year cohort study from January 2012, using data from the French national health care data system (Système National des Données de Santé). We included CwE identified through International Classification of Diseases, 10th Revision codes and medications from January 2012 to December 2015 and followed them until December 2016. We described ASMs and assessed whether the risk of initiating a polytherapy after a bitherapy depends on whether benzodiazepine was included in the bitherapy. RESULTS We identified 62 885 CwE. Valproate was the most reimbursed ASM (40%), followed by lamotrigine (17.6%), levetiracetam (9.3%), clobazam (6.1%), and carbamazepine (5.8%). Prescriptions were initiated at the hospital in 74.5% of CwE. We observed a decrease in the number of CwE with at least one benzodiazepine reimbursement from 15.3% in 2013 to 10.1% in 2016 (p < .0001). The prevalence of CwE with levetiracetam reimbursements increased, whereas that of CwE with valproate decreased. A switch from a bitherapy to a polytherapy was more likely when the bitherapy included a benzodiazepine (subdistribution hazard ratio [sHR] = 1.20 [1.03-1.39]). SIGNIFICANCE The prevalence of CwE with at least one benzodiazepine reimbursement decreased during the study period. Benzodiazepines were associated with an increased use of subsequent ASM polytherapy.
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Affiliation(s)
- Stéphane Auvin
- INSERM NeuroDiderot, Université Paris Cité, Paris, France
- Pediatric Neurology Department, CRMR Epilepsies Rares, EpiCARE member, AP-HP, Robert Debré University Hospital, Paris, France
- Institut Universitaire de France, Paris, France
| | - Sylvie Guillo
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Yann de Rycke
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
- Département de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Diep Tran
- Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Florence Tubach
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
- Département de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
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Espitia O, Del Giudice C, Hartung O, Herquelot E, Schmidt A, Sapoval M, Sobocinski J. Editor's Choice -- Survival, Limb Salvage, and Management of Patients with Lower Limb Acute Ischaemia: A French National Retrospective Observational Study. Eur J Vasc Endovasc Surg 2024; 67:631-642. [PMID: 37926151 DOI: 10.1016/j.ejvs.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The aim was to describe the baseline characteristics of French patients referred with acute limb ischaemia (ALI), and their clinical management and outcome (death, amputation). METHODS This retrospective observational cohort study used the National Health Data System. All adults hospitalised for ALI who underwent revascularisation with an endovascular or open surgical approach between 1 January 2015 and 31 December 2020 were included and followed up until death or the end of the study (31 December 2021). A one year look back period was used to capture patients' medical history. The risks of death, and major and minor amputations were described using Kaplan-Meier and Aalen-Johansen estimators. A Cox model was used to report the adjusted association between groups and risk of death and Fine-Gray models for the risk of amputations considering the competing risk of death. RESULTS Overall, 51 390 patients (median age 70 years, 69% male) were included and had a median follow up of 2.7 years: 39 411 (76.7%) were treated with an open approach and 11 979 (23.3%) with a percutaneous endovascular approach. The preferred approach for the revascularisation varied between French regions. The one year overall survival was 78.0% and 85.2% in the surgery and endovascular groups, respectively. The surgery group had a higher risk of death (hazard ratio [HR] 1.17, 95% CI 1.12 - 1.21), a higher risk of major amputation (sub-distribution HR 1.20, 95% CI 1.10 - 1.30) and lower risk of minor amputation (sub-distribution HR 0.66, 95% CI 0.60 - 0.71) than the endovascular group. Diabetes and dialysis increased the risk of major amputation by 52% and 78%, respectively. Subsequent ALI was the third most common cause of hospital re-admission within one year. CONCLUSION ALI remains a condition at high risk of death and amputation. Individual risk factors and ALI severity need to be considered to choose between approaches. Continued prevention efforts, improved management, and access to the most suitable approach are necessary.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, F-44000 Nantes, France.
| | | | - Olivier Hartung
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Nord, Marseille, France
| | | | | | - Marc Sapoval
- Radiologie interventionnelle, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jonathan Sobocinski
- Chirurgie vasculaire et endovasculaire, Centre Hospitalier Universitaire de Lille, Lille, France
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Daveluy A, Bryan MC, Miremont-Salamé G, Lassalle R, Lacueille C, Grelaud A, Floccia M, Haramburu F, Lapeyre-Mestre M, Micallef J, Salvo F. Analgesic switching in chronic users of dextropropoxyphene in France. Fundam Clin Pharmacol 2024; 38:389-397. [PMID: 37864449 DOI: 10.1111/fcp.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The combination dextropropoxyphene/paracetamol (DXP/P) was the most prescribed opioid analgesic until its withdrawal in 2011. OBJECTIVES This study investigated dispensations of analgesics in chronic users of DXP/P during the 18 months following its withdrawal. METHODS A cross-sectional study repeated yearly was conducted by using the French reimbursement database from 2006 to 2015. Chronic DXP/P users were defined as patients who received at least 40 boxes of DXP/P in the year prior to withdrawal. Data on analgesic dispensing were analyzed at DXP/P withdrawal (T0) and then every 6 months for 18 months. RESULTS A total of 63 671 subjects had a DXP/P reimbursement in the year prior to its discontinuation, of whom 7.1% were identified as chronic users (mean age: 71.5 years, women: 68.7%). Among the patients taking DXP/P alone at T0 (74.6%), one fourth switched to a peripheral analgesic, one fourth to a combination of peripheral analgesic/opioid, one fourth to another opioid, and the others mainly discontinued their treatment (14.1%) or died. During the following 12 months, most of the subjects taking only peripheral analgesics continued this treatment, while half of the subjects with a combination of opioid/peripheral analgesic or taking only an analgesic remained on this type of treatment. CONCLUSION Eighteen months after DXP/P withdrawal, more than 10% of patients stopped taking an analgesic. Vigilance is required regarding any change in analgesics by regularly reassessing patients' pain and, in the case of opioid treatments, by monitoring the risk of use disorders.
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Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | | | - Ghada Miremont-Salamé
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Clémentine Lacueille
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Marie Floccia
- Centre d'Etude et de Traitement de la Douleur, University Hospital of Bordeaux, Bordeaux, France
| | - Françoise Haramburu
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | | | - Joëlle Micallef
- AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Aix-Marseille University, Marseille, France
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Khnaisser C, Looten V, Lavoie L, Burgun A, Ethier JF. Building ontology-based temporal databases for data reuse: An applied example on hospital organizational structures. Health Informatics J 2024; 30:14604582241259336. [PMID: 38848696 DOI: 10.1177/14604582241259336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Keeping track of data semantics and data changes in the databases is essential to support retrospective studies and the reproducibility of longitudinal clinical analysis by preventing false conclusions from being drawn from outdated data. A knowledge model combined with a temporal model plays an essential role in organizing the data and improving query expressiveness across time and multiple institutions. This paper presents a modelling framework for temporal relational databases using an ontology to derive a shareable and interoperable data model. The framework is based on: OntoRela an ontology-driven database modelling approach and Unified Historicization Framework a temporal database modelling approach. The method was applied to hospital organizational structures to show the impact of tracking organizational changes on data quality assessment, healthcare activities and data access rights. The paper demonstrated the usefulness of an ontology to provide a formal, interoperable, and reusable definition of entities and their relationships, as well as the adequacy of the temporal database to store, trace, and query data over time.
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Affiliation(s)
| | - Vincent Looten
- Association des Centres Médicaux et Sociaux (ACMS), Suresnes, France
| | - Luc Lavoie
- Université de Sherbrooke, Département d'informatique, Sherbrooke, QC, Canada
| | - Anita Burgun
- Université de Sherbrooke, Sherbrooke, QC, Canada; Université Paris Cité, Paris, France; Hôpital Européen Georges-Pompidou, Paris, France
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Bastard L, Claudepierre P, Penso L, Sbidian E, Pina Vegas L. Risk of serious infection associated with different classes of targeted therapies used in psoriatic arthritis: a nationwide cohort study from the French Health Insurance Database (SNDS). RMD Open 2024; 10:e003865. [PMID: 38485454 PMCID: PMC10941117 DOI: 10.1136/rmdopen-2023-003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To assess the risk of serious infection associated with different targeted therapies for psoriatic arthritis (PsA) in real-world settings. METHODS This nationwide cohort study used the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database to identify all adults with PsA who were new users of targeted therapies (adalimumab, etanercept, golimumab, certolizumab pegol, infliximab, secukinumab, ixekizumab, ustekinumab, and tofacitinib) from 1 January 2015 to 30 June 2021. The primary outcome was a serious infection (ie, requiring hospitalisation), in a time-to-event analysis using propensity score-weighted Cox models, with adalimumab as the comparator, estimating weighted HRs (wHRs) and their 95% CIs. RESULTS A total of 12 071 patients were included (mean age 48.7±12.7 years; 6965 (57.7%) women). We identified 367 serious infections (3.0% of patients), with a crude incidence rate of 17.0 per 1000 person-years (95% CI, 15.2 to 18.7). After inverse propensity score weighting and adjustment for time-dependent covariates and calendar year, risk of serious infection was significantly lower for new users of etanercept (wHR 0.72; 95% CI, 0.53 to 0.97) or ustekinumab (wHR, 0.57; 95% CI, 0.35 to 0.93) than adalimumab new users. This risk was not statistically modified with the other targeted therapies. CONCLUSIONS The incidence of serious infection was low for PsA patients who were new users of targeted therapies in real-world settings. Relative to adalimumab new users, this risk was lower among new users of etanercept and ustekinumab and unmodified for the other molecules.
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Affiliation(s)
- Léa Bastard
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
| | - Pascal Claudepierre
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
| | - Laetitia Penso
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
| | - Emilie Sbidian
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Dermatology, Hospital Henri Mondor, Créteil, France
- Clinical Investigation Center 1430, INSERM, Créteil, France
| | - Laura Pina Vegas
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), University Paris-Est Créteil Val de Marne, Créteil, France
- Rheumatology, Hospital Henri Mondor, Créteil, France
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Jourdain H, Hoisnard L, Sbidian E, Zureik M. Persistence and safety of anti-TNF biosimilars versus originators in immune-mediated inflammatory diseases: an observational study on the French National Health Data System. RMD Open 2024; 10:e003531. [PMID: 38453213 PMCID: PMC10921511 DOI: 10.1136/rmdopen-2023-003531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/20/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Biosimilar-originator equivalence has been demonstrated in phase 3 trials in a few indications of infliximab, etanercept and adalimumab. The objective of our study was to compare the persistence and safety of biosimilars versus originators in all the licensed indications of these molecules. METHODS We used data from the French National Health Data System (SNDS), covering 99% of the French population, to identify infliximab, etanercept and adalimumab initiators from biosimilar launch (January 2015, May 2016 and October 2018, respectively) to 30 June 2021. Patients were then followed for 1 year. Treatment persistence (duration without treatment discontinuation or modification) and safety (including severe infections, all-cause hospitalisation and death) were compared between originator and biosimilar users by Cox regressions weighting the populations on the inverse probability of treatment. Analyses were performed by molecule, by disease and by biosimilar product. RESULTS From January 2015 to June 2021, 86 776 patients were included in the study: 22 670, 24 442 and 39 664 patients had initiated infliximab, etanercept and adalimumab, respectively; 49 752 (53%) were biosimilar initiators. We did not find any risk of discontinuation (HRs were below or around 1, here all pathologies and products together: infliximab 0.88 (0.80-0.97), etanercept 0.85 (0.81-0.90) and adalimumab 0.96 (0.91-1.00)) or safety event (infection: infliximab 0.97 (0.78-1.21), etanercept 1.04 (0.81-1.33) and adalimumab 0.98 (0.83-1.16); hospitalisation: infliximab 1.08 (0.96-1.23), etanercept 0.99 (0.87-1.11) and adalimumab 0.91 (0.83-0.99)) associated with biosimilar versus originator use. CONCLUSIONS Our study shows reassuring results regarding the persistence and safety of biosimilar tumour necrosis factor-alpha inhibitors compared with originators in all licensed indications.
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Affiliation(s)
- Hugo Jourdain
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Léa Hoisnard
- Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
- Centre d'Investigation Clinique 1430, INSERM, Créteil, France
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
| | - Emilie Sbidian
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
- Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
- Centre d'Investigation Clinique 1430, INSERM, Créteil, France
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Mahmoud Zureik
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
- Anti-Infective Evasion and Pharmacoepidemiology, CESP, University Paris-Saclay - UVSQ, Montigny le Bretonneux, France
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Guion M, Mandereau-Bruno L, Goria S, Cosson E, Fosse-Edorh S. Eleven-year trends in socioeconomic inequalities in the prevalence and incidence of pharmacologically treated type 2 diabetes in France, 2010-2020. DIABETES & METABOLISM 2024; 50:101509. [PMID: 38216030 DOI: 10.1016/j.diabet.2024.101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024]
Abstract
AIM This study aimed to describe the association between socioeconomic inequalities and the prevalence and incidence of pharmacologically-treated type 2 diabetes in European France over the 2010-2020 period. METHODS Diabetes cases were identified using a validated algorithm from the French National Health Data System. Analysis was restricted to adults aged 45 years and older to focus on type 2 diabetes. Socioeconomic inequalities were measured for all years in European France using the French deprivation index (FDep, 2015 version), which is an area-based deprivation indicator using population-weighted quintiles (Q1 corresponds to the least deprived municipalities). The relative risks of diabetes prevalence and incidence associated with FDep quintiles (Q1 as the reference) were estimated by sex using a log-linear Poisson model adjusted for year, age and French department. The study population was the French health consumers aged 45 years and over (from 24,228,526 in 2010 to 29,772,928 in 2020). RESULTS A positive gradient was observed in the relative risks of type 2 diabetes prevalence and incidence by FDep quintiles over the study period. The strength of the estimated associations increased over the last decade for prevalence among men and women and for incidence among men in the two most deprived quintiles. CONCLUSION Thus, type 2 diabetes prevention should include a proportionate universalism approach, proposing actions of greater intensity in the most deprived areas.
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Affiliation(s)
- Marie Guion
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France; Recherche en Epidémiologie Nutritionnelle (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France.
| | | | - Sarah Goria
- Data science division, Santé Publique France, Saint-Maurice, France
| | - Emmanuel Cosson
- Recherche en Epidémiologie Nutritionnelle (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France; Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, University of Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, AP-HP, Bobigny, France
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
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Leye E, Delory T, El Karoui K, Espagnacq M, Khlat M, Le Coeur S, Lapidus N, Hejblum G. Direct and indirect impact of the COVID-19 pandemic on the survival of kidney transplant recipients: A national observational study in France. Am J Transplant 2024; 24:479-490. [PMID: 37898317 DOI: 10.1016/j.ajt.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
During the pandemic period, health care systems were substantially reorganized for managing COVID-19 cases. Corresponding consequences on persons with chronic diseases remain insufficiently documented. This observational cohort study investigated the direct and indirect impact of the pandemic period on the survival of kidney transplant recipients (KTR). Using the French National Health Data System, incident persons with end-stage kidney disease between 2015 and 2020, and who received a kidney transplant during this period were included and followed up from their transplantation date to December 31, 2021. The survival of KTR during the prepandemic and pandemic periods was investigated using Cox models with time-dependent covariates. There were 10 637 KTR included in the study, with 324 and 430 deaths observed during the prepandemic and pandemic periods, respectively. The adjusted risk of death during the pandemic period was similar to that observed during the prepandemic period (hazard ratio [HR] [95% confidence interval]: 0.92 [0.77-1.11]), COVID-19-related hospitalization was associated with an increased risk of death (HR: 10.62 [8.46-13.33]), and a third vaccine dose was associated with a lower risk of death (HR: 0.42 [0.30-0.57]). The pandemic period was not associated with an indirect higher risk of death in KTR with no COVID-19-related hospitalization.
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Affiliation(s)
- Elhadji Leye
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
| | - Tristan Delory
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France; Centre Hospitalier Annecy-Genevois, Epagny Metz-Tessy, France; French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
| | - Khalil El Karoui
- Sorbonne Université, INSERM U1155, AP-HP, Hôpital Tenon, Service de Néphrologie, Paris, France
| | - Maude Espagnacq
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Myriam Khlat
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
| | - Sophie Le Coeur
- French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France
| | - Nathanaël Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Gilles Hejblum
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
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Gaillard F, Bachelet D, Couchoud C, Laouenan C, Peoc'h K, Simon Q, Charles N, Jourde-Chiche N, Daugas E. Lupus activity and outcomes in lupus patients undergoing maintenance dialysis. Rheumatology (Oxford) 2024; 63:780-786. [PMID: 37338593 DOI: 10.1093/rheumatology/kead293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Lupus activity has long been considered to decline after initiation of maintenance dialysis (MD). This assumption is based on limited historical data. We aimed to describe the natural history of lupus in patients undergoing MD. METHODS We assembled a national retrospective cohort of lupus patients who started dialysis between 2008 and 2011, included in the REIN registry with a 5-year follow-up. We analysed healthcare consumption from the National Health Data System. We evaluated the proportion of patients 'off-treatment' (i.e. receiving 0-5 mg/d of corticosteroids, without any immunosuppressive therapy) after the start of MD. We describe the cumulative incidences of non-severe and severe lupus flares, cardiovascular events, severe infections, kidney transplantation and survival. RESULTS We included 137 patients (121 females and 16 males), with a median age of 42 years. The proportion of patients 'off-treatment' at dialysis initiation was 67.7% (95% CI: 61.8, 73.8%), and increased to 76.0% (95% CI: 73.3, 78.8) at 1 year and 83.4% (95% CI: 81.0, 85.9%) at 3 years, with a lower proportion in younger patients. Lupus flares mainly occurred in the first year after MD initiation, and at 12 months 51.6% of patients had presented a non-severe lupus flare and 11.6% a severe lupus flare. In addition, 42.2% (95% CI: 32.9, 50.3%) and 23.7% (95% CI: 16.0, 30.7%) of patients at 12 months had been hospitalized for cardiovascular events or infections, respectively. CONCLUSION The proportion of lupus patients off-treatment increases after MD initiation, but non-severe and severe lupus flares continue to occur, mainly during the first year. This calls for the continued follow-up of lupus patients by lupus specialists after dialysis initiation.
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Affiliation(s)
- François Gaillard
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Delphine Bachelet
- Department of Biostatistical Epidemiology and Clinical Research, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM CIC-EC 1425, Paris, France
| | - Cécile Couchoud
- REIN, Agence de la Biomédecine, Saint Denis la Plaine, Saint Denis, France
| | - Cédric Laouenan
- Department of Biostatistical Epidemiology and Clinical Research, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM CIC-EC 1425, Paris, France
| | - Katell Peoc'h
- Laboratoire d'Excellence GR-Ex, Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, Paris, France
- Service de Biochimie, Hôpital Bichat, DMU BIOGEM, AP-HP, Paris, France
| | - Quentin Simon
- Laboratoire d'Excellence Inflamex, Université Paris Cité; Centre de Recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Paris, France
| | - Nicolas Charles
- Laboratoire d'Excellence Inflamex, Université Paris Cité; Centre de Recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Paris, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Eric Daugas
- Laboratoire d'Excellence Inflamex, Université Paris Cité; Centre de Recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Paris, France
- Department of Nephrology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
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Allain S, Naouri D, Deroyon T, Costemalle V, Hazo JB. Income and professional inequalities in chronic diseases: prevalence and incidence in France. Public Health 2024; 228:55-64. [PMID: 38306754 DOI: 10.1016/j.puhe.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status. STUDY DESIGN Descriptive retrospective cohort study. METHODS This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016-2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016-2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013-2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex. RESULTS For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease. CONCLUSIONS Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
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Affiliation(s)
- Samuel Allain
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Diane Naouri
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Thomas Deroyon
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Vianney Costemalle
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Jean-Baptiste Hazo
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
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Vanorio-Vega I, Constantinou P, Bret V, Gentile S, Finne P, Sautenet B, Tuppin P, Couchoud C. Effect of comorbidities on healthcare expenditures for patients on kidney replacement therapy considering the treatment modality and duration in a French cohort. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:269-279. [PMID: 37004630 DOI: 10.1007/s10198-023-01585-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
End-stage kidney disease (ESKD) is associated with a substantial economic burden. In France, the cost of care for such patients represents 2.5% of the total French healthcare expenditures but serves less than 1% of the population. These patients' healthcare expenditures are high because of the specialized and complex treatment needed as well as the presence of multiple comorbidities. This study aims to describe and assess the effect of comorbidities on healthcare expenditures (direct medical cost and non-medical costs including transportation and compensatory allowances) for patients with ESKD in France while considering the modality and duration of renal replacement therapy (RRT). This study included adults who started RRT for the first time between 2012 and 2014 in France and were followed for 5 years. Generalized linear models were built to predict mean monthly cost (MMC) by integrating first the time duration in the cohort, then patient characteristics and finally the duration of use of each treatment modalities. Comorbidities with the highest effect on MMC were inability to walk (+ 1435€), active cancer (+ 593€), HIV positivity (+ 507€) and diabetes (+ 396€). These effects vary according to age or treatment modalities. This study confirms the importance of considering patient characteristics, comorbidities and type of RRT when assessing healthcare expenditures for patients with ESKD.
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Affiliation(s)
- Isabella Vanorio-Vega
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France.
- Agence de la Biomédecine, 1 Avenue du Stade de France, 93212, Saint-Denis, France.
| | - Panayotis Constantinou
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Victor Bret
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Stéphanie Gentile
- School of Medicine-La Timone Medical Campus, EA 3279: CEReSS-Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bénédicte Sautenet
- MCU-PH Service Néphrologie-Hypertension Artérielle, Dialyses, Transplantation Rénale INSERM U1246 SPHERE, Nantes, France
| | - Philippe Tuppin
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Cécile Couchoud
- Agence de la Biomédecine, 1 Avenue du Stade de France, 93212, Saint-Denis, France
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Maquet J, Lafaurie M, Michel M, Lapeyre-Mestre M, Moulis G. Drug-induced immune hemolytic anemia: detection of new signals and risk assessment in a nationwide cohort study. Blood Adv 2024; 8:817-826. [PMID: 37782770 PMCID: PMC10874903 DOI: 10.1182/bloodadvances.2023009801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
ABSTRACT More than 130 drugs have been suspected to induce immune hemolytic anemia. Comparative studies measuring the risk of drug-induced immune hemolytic anemia (DIIHA) are lacking. We aimed (1) to detect new signals of DIIHA, excluding vaccines, and (2) to assess the association between all suspected drugs and the occurrence of immune hemolytic anemia in a nationwide comparative study. The new signals were identified using a disproportionality study (case/noncase design) in the World Pharmacovigilance Database, Vigibase, among the cases of adverse drug reactions reported up to February 2020 (>20 million). We then conducted a comparative study in the French National health database that links sociodemographic, out-of-hospital, and hospital data for the entire population (67 million individuals). Associations between exposure to drugs (those already reported as DIIHA, plus new signals identified in Vigibase) and incident cases of immune hemolytic anemia (D59.0 and D59.1 diagnosis codes of the International Classification of Diseases, version 10) from 2012 to 2018 were assessed with case-control and case-crossover designs. In Vigibase, 3371 cases of DIIHA were recorded. Fifty-nine new signals were identified resulting in a final list of 112 drugs marketed in France and measurable in the nationwide cohort (n = 4746 patients with incident immune hemolytic anemia included in the case-control analysis matched with 22 447 controls from the general population). We identified an association between immune hemolytic anemia occurrence and some antibiotics, antifungal drugs, ibuprofen, acetaminophen, furosemide, azathioprine, and iomeprol.
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Affiliation(s)
- Julien Maquet
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Marc Michel
- Department of Internal Medicine, National Reference Center for Adult Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hopitaux de Paris, University Paris-Est Créteil, Créteil, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center 1436, Team PEPSS Pharmacologie en Population, Toulouse University Hospital, Toulouse, France
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Chaput J, Becquet V, Bithorel PL, Baril E, de La Rochebrochard E, Mazuy M. Medication abortion during the COVID-19 pandemic in France: A research based on the French national health insurance database. PLoS One 2024; 19:e0295336. [PMID: 38324546 PMCID: PMC10849394 DOI: 10.1371/journal.pone.0295336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES During the COVID-19 pandemic in France, abortion was recognized as an essential service that cannot be delayed, and such care was therefore presumed to be maintained. The aim is to analyze the changes in the practice of abortion in 2020 to identify the consequences of the two lockdowns and the effects of the extension of the legal time limit. METHODS We analyzed the data collected by the French national health insurance system, which covers 99% of the population. All women who had an elective abortion, either surgical or with medication, in France in 2019 and 2020 were included in the study. Trend changes in abortions were analyzed by comparing the ratio of the weekly number of abortions in 2020 with the weekly number in 2019. RESULTS Both 2020 lockdowns were followed by a drop in abortions, particularly after the first and stricter lockdown. This may be explained not by an abrupt shutdown of access to abortion services, but rather by a decrease in conceptions during the lockdown weeks. The decrease was more marked for surgical abortions than for medication abortions in a hospital setting, and less so for medication abortions in non-hospital settings. Moreover, the proportion of the latter type of abortions continued to increase, showing the reinforcement of a previous trend. CONCLUSIONS Our findings indicate that expanding the legal time limit for abortion, diversifying the settings where abortions can be performed and the range of abortion providers help to facilitate access to this fundamental reproductive care.
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Affiliation(s)
- Justine Chaput
- Institut national d’études démographiques (INED), Aubervilliers, France
- CRIDUP, Université Paris 1 Panthéon-Sorbonne, Aubervilliers, France
- Ecole des hautes études en démographie (HED), Paris, France
| | - Valentine Becquet
- Institut national d’études démographiques (INED), Aubervilliers, France
| | | | - Elodie Baril
- Institut national d’études démographiques (INED), Aubervilliers, France
| | - Elise de La Rochebrochard
- Institut national d’études démographiques (INED), Aubervilliers, France
- CESP U1018, Institut national de la santé et de la recherche médicale (INSERM), Villejuif, France
| | - Magali Mazuy
- Institut national d’études démographiques (INED), Aubervilliers, France
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Poucineau J, Khlat M, Lapidus N, Espagnacq M, Chouaïd C, Delory T, Le Coeur S. Impact of the COVID-19 Pandemic on COPD Patient Mortality: A Nationwide Study in France. Int J Public Health 2024; 69:1606617. [PMID: 38362309 PMCID: PMC10868525 DOI: 10.3389/ijph.2024.1606617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives: We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. Methods: COPD patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates. Results: All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years). Conclusion: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.
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Affiliation(s)
- Jonas Poucineau
- Institut National d’Études Démographiques (INED), Paris, France
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Myriam Khlat
- Institut National d’Études Démographiques (INED), Paris, France
| | - Nathanaël Lapidus
- Faculté de Santé, Sorbonne Université, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Hôpital Saint-Antoine, Paris, France
| | - Maude Espagnacq
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Christos Chouaïd
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Hospital Center Intercommunal De Créteil, Créteil, France
| | - Tristan Delory
- Institut National d’Études Démographiques (INED), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Sophie Le Coeur
- Institut National d’Études Démographiques (INED), Paris, France
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Luu VP, Fiorini M, Combes S, Quemeneur E, Bonneville M, Bousquet PJ. Challenges of artificial intelligence in precision oncology: public-private partnerships including national health agencies as an asset to make it happen. Ann Oncol 2024; 35:154-158. [PMID: 37769849 DOI: 10.1016/j.annonc.2023.09.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- V P Luu
- Epidemiology and innovation Unit, Artificial Intelligence and Cancers Association, Paris, France.
| | - M Fiorini
- Artificial Intelligence and Cancers Association, Paris, France
| | | | - E Quemeneur
- France Biotech, Paris, France; Transgene S.A., Illkirch-Graffenstaden, France
| | - M Bonneville
- Alliance pour la Recherche et l'Innovation des Industries de Santé, Paris, France; Institut Mérieux, Lyon, France
| | - P J Bousquet
- Health Survey, Data-Science, Assessment Division, Institut National du Cancer, Boulogne Billancourt, France; Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
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49
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Pina Vegas L, Drouin J, Weill A, Dray-Spira R. Pregnancy outcomes in women with rheumatoid arthritis: an 11-year French nationwide study. RMD Open 2024; 10:e003762. [PMID: 38242551 PMCID: PMC10806509 DOI: 10.1136/rmdopen-2023-003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) can affect women of childbearing age. The management of patients with RA during pregnancy has evolved over the past decades, especially with the availability of new therapeutic molecules. OBJECTIVES To describe pregnancy in women with RA, to compare pregnancy outcomes with those of women in the general population and to compare pregnancy outcomes in women with active and inactive RA. METHODS Using the French National Health Data System, we identified all pregnancies ending between 2010 and 2020 in patients with and without RA. Characteristics were described. Active RA was defined by conventional synthetic/biological/targeted synthetic disease-modifying antirheumatic drug initiation, systemic or intra-articular corticosteroid administration and/or RA-related hospitalisation. Pregnancy outcomes were compared computing multivariable logistic marginal regression model using generalised estimating equation (GEE). RESULTS We included 11 792 RA and 10 413 681 non-RA pregnancies. Among RA pregnancies, 74.5% ended in live births and 0.4% in stillbirths. RA pregnancies resulted more frequently in preterm births (adjusted OR (ORa) 1.84; 95% CI 1.69 to 2.00) and very preterm births (ORa 1.43; 95% CI 1.20 to 1.71), low birth weight (ORa 1.65; 95% CI: 1.52 to 1.90), caesarean section (ORa 1.46; 95% CI 1.38 to 1.55) and pregnancy-related hospitalisation (ORa 1.30; 95% CI 1.22 to 1.39). Disease activity decreased during pregnancy. Active RA had higher rates of prematurity (ORa 2.02; 95% CI 1.71 to 2.38), small for gestational age (ORa 1.53; 95% CI 1.28 to 1.83) and caesarean section (ORa 1.25; 95% CI 1.11 to 1.40) than non-active RA. CONCLUSION Pregnancies in women with RA were associated with more adverse outcomes, especially if the disease was active. These findings should encourage physicians to closely monitor RA during this crucial period.
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Affiliation(s)
- Laura Pina Vegas
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
| | - Jérôme Drouin
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Alain Weill
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Rosemary Dray-Spira
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
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Blin P, Joubert M, Jourdain P, Zaoui P, Guiard E, Sakr D, Dureau-Pournin C, Bernard MA, Lassalle R, Thomas-Delecourt F, Bineau S, Moore N, Droz-Perroteau C. Cardiovascular and renal diseases in type 2 diabetes patients: 5-year cumulative incidence of the first occurred manifestation and hospitalization cost: a cohort within the French SNDS nationwide claims database. Cardiovasc Diabetol 2024; 23:22. [PMID: 38195491 PMCID: PMC10777660 DOI: 10.1186/s12933-023-02101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal diseases (CVRD) manifestations for type 2 diabetes. The objective was to estimate the incidence of the first occurring CVRD manifestation and cumulative hospitalization costs of each CVRD manifestation for type 2 diabetes without CVRD history. METHODS A cohort study of all type 2 diabetes free of CVRD as of January 1st 2014, was identified and followed-up for 5 years within the French SNDS nationwide claims database. The cumulative incidence of the first occurring CVRD manifestation was estimated using the cumulative incidence function, with death as a competing risk. Cumulative hospitalization costs of each CVRD manifestations were estimated from the perspective of all payers. RESULTS From 2,079,089 type 2 diabetes without cancer or transplantation, 76.5% were free of CVRD at baseline with a mean age of 65 years, 52% of women and 7% with microvascular complications history. The cumulative incidence of a first CVRD manifestation was 15.3% after 5 years of follow-up with a constant linear increase over time for all CVRD manifestations: The most frequent was CKD representing 40.6% of first occurred CVRD manifestation, followed by HF (23.0%), then PAD (13.5%), stroke (13.2%) and MI (9.7%). HF and CKD together reached about one patient out of ten after 5 years and represented 63.6% of first CVRD manifestations. The 5-year global cost of all CVRD hospitalizations was 3.9 billion euros (B€), i.e. 2,450€ per patient of the whole cohort, with an exponential increase over time for each specific CVRD manifestation. The costliest was CKD (2.0 B€), followed by HF (1.2 B€), then PAD (0.7 B€), stroke (0.6 B€) and MI (0.3 B€). CONCLUSIONS/INTERPRETATION While MI, stroke and PAD remain classic major risks of complications for CVRD-free type 2 diabetes, HF and CKD nowadays represent individually a higher risk and cost than each of these classic manifestations, and jointly represents a risk and a cost twice as high as these three classic manifestations all together. This should encourage the development of specific HF and CKD preventive strategies.
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Affiliation(s)
- Patrick Blin
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France.
| | - Michael Joubert
- Diabetes Care Unit, Caen University Hospital, UNICAEN, Caen, 14033, France
| | | | | | - Estelle Guiard
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Dunia Sakr
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Caroline Dureau-Pournin
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Marie-Agnès Bernard
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Régis Lassalle
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | | | | | - Nicholas Moore
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
| | - Cécile Droz-Perroteau
- Univ. Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, Bordeaux, 33000, 33076, France
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