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Rivas Velarde MC, Lovis C, Ienca M, Samer C, Hurst S. Consent as a compositional act - a framework that provides clarity for the retention and use of data. Philos Ethics Humanit Med 2024; 19:2. [PMID: 38443971 PMCID: PMC10916011 DOI: 10.1186/s13010-024-00152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Informed consent is one of the key principles of conducting research involving humans. When research participants give consent, they perform an act in which they utter, write or otherwise provide an authorisation to somebody to do something. This paper proposes a new understanding of the informed consent as a compositional act. This conceptualisation departs from a modular conceptualisation of informed consent procedures. METHODS This paper is a conceptual analysis that explores what consent is and what it does or does not do. It presents a framework that explores the basic elements of consent and breaks it down into its component parts. It analyses the consent act by first identifying its basic elements, namely: a) data subjects or legal representative that provides the authorisation of consent; b) a specific thing that is being consented to; and c) specific agent(s) to whom the consent is given. RESULTS This paper presents a framework that explores the basic elements of consent and breaks it down into its component parts. It goes beyond only providing choices to potential research participants; it explains the rationale of those choices or consenting acts that are taking place when speaking or writing an authorisation to do something to somebody. CONCLUSIONS We argue that by clearly differentiating the goals, the procedures of implementation, and what is being done or undone when one consent, one can better face the challenges of contemporary data-intensive biomedical research, particularly regarding the retention and use of data. Conceptualising consent as a compositional act enhances more efficient communication and accountability and, therefore, could enable more trustworthy acts of consent in biomedical science.
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Affiliation(s)
- Minerva C Rivas Velarde
- Geneva School of Health Science, University of Applied Sciences Geneva HES-SO, Geneva, Switzerland.
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospital of Geneva, Geneva, Switzerland
| | - Marcello Ienca
- Institute for Ethics and History of Medicine, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
- College of Humanities, Swiss Federal Institute of Technology in Lausanne, Lausanne, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities (iEH2), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Abouir K, Samer C, Landry R, Varesio E, Daali Y. Stereoselective separation of omeprazole and 5-hydroxy-omeprazole using dried plasma spots and a heart-cutting 2D-LC approach for accurate CYP2C19 phenotyping. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1232:123962. [PMID: 38096743 DOI: 10.1016/j.jchromb.2023.123962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
Omeprazole (OME) is a widely used gastric proton pump inhibitor, marketed as a racemic mixture comprising (S)- and (R)-enantiomers, with distinct pharmacokinetic profiles. OME is primarily metabolized by the cytochrome P450 enzymes 2C19 (CYP2C19) and 3A4 (CYP3A4). OME is a conventional probe for CYP2C19 phenotyping. Accurate measurement of these enantiomers and their metabolites is essential for pharmacokinetic studies. This article presents a sensitive and accurate two-dimensional liquid chromatography-mass spectrometry (LC-MS/MS) method for the simultaneous quantification of OME enantiomers and its hydroxylated metabolite (5-hydroxyomeprazole) in human plasma. The method involves an online extraction using an achiral Discovery HS C18 trapping column for purification (20 × 2.1 mm ID, 5μm particle size, Supelco) and subsequent forward flush elution onto a chlorinated phenylcarbamate cellulose-based chiral column (150x2mm ID, 3 μm particle size, Lux Cellulose-4, Phenomenex). The assay was fully validated and met international validation criteria for accuracy, precision, and stability and ensured high selectivity and sensitivity within a short runtime (<8 min). Application of this method to clinical samples demonstrated its utility in studying OME enantiomer pharmacokinetics, particularly its potential for phenotyping the activity of the CYP2C19 isoenzyme. This robust analytical approach offers a valuable tool for clinicians and researchers studying OME's pharmacokinetics, providing insights into its metabolism and potential implications for personalized medicine.
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Affiliation(s)
- Kenza Abouir
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland; School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland; School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Romain Landry
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Emmanuel Varesio
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland; School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Terrier J, Gaspar F, Gosselin P, Raboud O, Lenoir C, Rollason V, Csajka C, Samer C, Fontana P, Daali Y, Reny J. Apixaban and rivaroxaban's physiologically-based pharmacokinetic model validation in hospitalized patients: A first step for larger use of a priori modeling approach at bed side. CPT Pharmacometrics Syst Pharmacol 2023; 12:1872-1883. [PMID: 37794718 PMCID: PMC10725260 DOI: 10.1002/psp4.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/21/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
When used in real-world conditions, substantial interindividual variations in direct oral anticoagulant (DOAC) plasma concentrations are observed for a given dose, leading to a risk of over- or under-exposure and clinically significant adverse events. Physiologically-based pharmacokinetic (PBPK) models could help physicians to tailor DOAC prescriptions in vulnerable patient populations, such as those in the hospital setting. The present study aims to validate prospectively PBPK models for rivaroxaban and apixaban in a large cohort of elderly, polymorbid, and hospitalized patients. In using a model of geriatric population integrating appropriate physiological parameters into models first optimized with healthy volunteer data, observed plasma concentration collected in hospitalized patients on apixaban (n = 100) and rivaroxaban (n = 100) were adequately predicted (ratio predicted/observed area under the concentration curve for a dosing interval [AUCtau ] = 0.97 [0.96-0.99] geometric mean, 90% confidence interval, ratio predicted/observed AUCtau = 1.03 [1.02-1.05]) for apixaban and rivaroxaban, respectively. Validation of the present PBPK models for rivaroxaban and apixaban in in-patients represent an additional step toward the feasibility of bedside use.
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Affiliation(s)
- Jean Terrier
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Frédéric Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Pauline Gosselin
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
| | - Olivier Raboud
- Center for Research and Innovation in Clinical Pharmaceutical SciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Camille Lenoir
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Victoria Rollason
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Chantal Csajka
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
- Institute of Pharmaceutical Sciences of Western SwitzerlandUniversity of Geneva, University of LausanneGeneva, LausanneSwitzerland
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
- School of Pharmaceutical SciencesUniversity of GenevaGenevaSwitzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Angiology and HaemostasisGeneva University HospitalsGenevaSwitzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Jean‐Luc Reny
- Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
- Geneva Platelet Group, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
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Skalafouris C, Blanc AL, Grosgurin O, Marti C, Samer C, Lovis C, Bonnabry P, Guignard B. Development and retrospective evaluation of a clinical decision support system for the efficient detection of drug-related problems by clinical pharmacists. Int J Clin Pharm 2023; 45:406-413. [PMID: 36515779 PMCID: PMC10147748 DOI: 10.1007/s11096-022-01505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical decision support systems (CDSS) can help identify drug-related problems (DRPs). However, the alert specificity remains variable. Defining more relevant alerts for detecting DRPs would improve CDSS. AIM Develop electronic queries that assist pharmacists in conducting medication reviews and an assessment of the performance of this model to detect DRPs. METHOD Electronic queries were set up in CDSS using "triggers" from electronic health records: drug prescriptions, laboratory values, medical problems, vital signs, demographics. They were based on a previous study where 315 patients admitted in internal medicine benefited from a multidisciplinary medication review (gold-standard) to highlight potential DRPs. Electronic queries were retrospectively tested to assess performance in detecting DRPs revealed with gold-standard. For each electronic query, sensitivity, specificity, positive and negative predictive value were computed. RESULTS Of 909 DRPs, 700 (77.8%) were used to create 366 electronic queries. Electronic queries correctly detected 77.1% of DRPs, median sensitivity and specificity reached 100.0% (IQRs, 100.0%-100.0%) and 99.7% (IQRs, 97.0%-100.0%); median positive predictive value and negative predictive value reached 50.0% (IQRs, 12.5%-100.0%) and 100.0% (IQRs, 100.0%-100.0%). Performances varied according to "triggers" (p < 0.001, best performance in terms of predictive positive value when exclusively involving drug prescriptions). CONCLUSION Electronic queries based on electronic heath records had high sensitivity and negative predictive value and acceptable specificity and positive predictive value and may contribute to facilitate medication review. Implementing some of these electronic queries (the most effective and clinically relevant) in current practice will allow a better assessment of their impact on the efficiency of the clinical pharmacist.
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Affiliation(s)
- Christian Skalafouris
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Bertrand Guignard
- Pharmacy, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Skalafouris C, Samer C, Stirnemann J, Grosgurin O, Eggimann F, Grauser D, Reny JL, Bonnabry P, Guignard B. Electronic monitoring of potential adverse drug events related to lopinavir/ritonavir and hydroxychloroquine during the first wave of COVID-19. Eur J Hosp Pharm 2023; 30:113-116. [PMID: 33832918 PMCID: PMC9986913 DOI: 10.1136/ejhpharm-2020-002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/04/2022] Open
Abstract
During Switzerland's first wave of COVID-19, clinical pharmacy activities during medical rounds in Geneva University Hospitals were replaced by targeted remote interventions. We describe using the electronic PharmaCheck system to screen high-risk situations of adverse drug events (ADEs), particularly targeting prescriptions of lopinavir/ritonavir (LPVr) and hydroxychloroquine (HCQ) in the presence of contraindications or prescriptions outside institutional guidelines. Of 416 patients receiving LPVr and/or HCQ, 182 alerts were triggered for 164 (39.4%) patients. The main associated risk factors of ADEs were drug-drug interactions, QTc interval prolongation, electrolyte disorder and inadequate LPVr dosage. Therapeutic optimisation recommended by a pharmacist or proposals for additional monitoring were accepted in 80% (n=36) of cases. Combined with pharmacist contextualisation to the clinical context, PharmaCheck made it possible to successfully adapt clinical pharmacist activities by switching from a global to a targeted analysis mode in an emergency context.
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Affiliation(s)
- Christian Skalafouris
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of pharmaceutical sciences, University of Geneva, Geneva, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jerome Stirnemann
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - François Eggimann
- Information Systems Department, Geneva University Hospitals, Geneva, Switzerland
| | - Damien Grauser
- Information Systems Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- General Internal Medicine Division, Geneva University Hospitals, Geneve, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of pharmaceutical sciences, University of Geneva, Geneva, Switzerland
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Bosmani C, Carboni S, Samer C, Lovis C, Perneger T, Huttner A, Hirschel B. REPRESENT: REPresentativeness of RESearch data obtained through the 'General Informed ConsENT'. BMC Med Ethics 2023; 24:10. [PMID: 36782161 PMCID: PMC9926654 DOI: 10.1186/s12910-022-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND We assessed potential consent bias in a cohort of > 40,000 adult patients asked by mail after hospitalization to consent to the use of past, present and future clinical and biological data in an ongoing 'general consent' program at a large tertiary hospital in Switzerland. METHODS In this retrospective cohort study, all adult patients hospitalized between April 2019 and March 2020 were invited to participate to the general consent program. Demographic and clinical characteristics were extracted from patients' electronic health records (EHR). Data of those who provided written consent (signatories) and non-responders were compared and analyzed with R studio. RESULTS Of 44,819 patients approached, 10,299 (23%) signed the form. Signatories were older (median age 54 [IQR 38-72] vs. 44 years [IQR 32-60], p < .0001), more comorbid (2614/10,299 [25.4%] vs. 4912/28,676 [17.1%] with Charlson comorbidity index ≤ 4, p < .0001), and more often of Swiss nationality (6592/10,299 [64%] vs. 13,813/28,676 [48.2%], p < .0001). CONCLUSIONS Our results suggest that actively seeking consent creates a bias and compromises the external validity of data obtained via 'general consent' programs. Other options, such as opt-out consent procedures, should be further assessed.
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Affiliation(s)
- Cristina Bosmani
- Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Sonia Carboni
- grid.150338.c0000 0001 0721 9812Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Caroline Samer
- grid.150338.c0000 0001 0721 9812Clinical Pharmacology and Toxicology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- grid.150338.c0000 0001 0721 9812Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- grid.150338.c0000 0001 0721 9812Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Angela Huttner
- grid.150338.c0000 0001 0721 9812Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Bernard Hirschel
- Health Department of the Canton of Geneva, Geneva Cantonal Ethics Commission, Geneva, Switzerland
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Terrier J, Lenoir C, Samer C. CYP450 3A4/5 Containment During SARS-CoV-2 Infection. Clin Pharmacol Ther 2022; 113:218. [PMID: 36076327 PMCID: PMC9538688 DOI: 10.1002/cpt.2725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Jean Terrier
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland,Division of General Internal MedicineGeneva University HospitalsGenevaSwitzerland
| | - Camille Lenoir
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care DepartmentGeneva University HospitalsGenevaSwitzerland
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Abouir K, Gosselin P, Guerrier S, Daali Y, Desmeules J, Grosgurin O, Reny JL, Samer C, Calmy A, Ing Lorenzini KR. Dexamethasone exposure in normal-weight and obese hospitalized COVID-19 patients: An observational exploratory trial. Clin Transl Sci 2022; 15:1796-1804. [PMID: 35706350 PMCID: PMC9283739 DOI: 10.1111/cts.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/16/2022] [Accepted: 04/24/2022] [Indexed: 12/15/2022] Open
Abstract
During the latest pandemic, the RECOVERY study showed the benefits of dexamethasone (DEX) use in COVID‐19 patients. Obesity has been proven to be an independent risk factor for severe forms of infection, but little information is available in the literature regarding DEX dose adjustment according to body weight. We conducted a prospective, observational, exploratory study at Geneva University Hospitals to assess the impact of weight on DEX pharmacokinetics (PK) in normal‐weight versus obese COVID‐19 hospitalized patients. Two groups of patients were enrolled: normal‐weight and obese (body mass index [BMI] 18.5–25 and >30 kg/m2, respectively). All patients received the standard of care therapy of 6 mg DEX orally. Blood samples were collected, and DEX concentrations were measured. The mean DEX AUC0–8 and Cmax were lower in the obese compared to the normal‐weight group (572.02 ± 258.96 vs. 926.92 ± 552.12 ng h/ml and 138.67 ± 68.03 vs. 203.44 ± 126.30 ng/ml, respectively). A decrease in DEX AUC0–8 of 4% per additional BMI unit was observed, defining a significant relationship between weight and DEX AUC0–8 (p = 0.004, 95% CI 2–7%). In women, irrespective of the BMI, DEX AUC0–8 increased by 214% in comparison to men (p < 0.001, 95% CI 154–298%). Similarly, the mean Cmax increased by 205% in women (p < 0.001, 95% CI 141–297%). Conversely, no significant difference between the obese and normal‐weight groups was observed for exploratory treatment outcomes, such as the length of hospitalization. BMI, weight, and gender significantly affected DEX AUC. We conclude that dose adjustment would be needed if the aim is to achieve the same exposures in normal‐weight and obese patients.
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Affiliation(s)
- Kenza Abouir
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Pauline Gosselin
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Guerrier
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Swiss Centre for Applied Human Toxicology (SCAHT), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Swiss Centre for Applied Human Toxicology (SCAHT), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Grosgurin
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Swiss Centre for Applied Human Toxicology (SCAHT), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandra Calmy
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Kuntheavy Roseline Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Busse JW, Vankrunkelsven P, Zeng L, Heen AF, Merglen A, Campbell F, Granan LP, Aertgeerts B, Buchbinder R, Coen M, Juurlink D, Samer C, Siemieniuk RAC, Kumar N, Cooper L, Brown J, Lytvyn L, Zeraatkar D, Wang L, Guyatt GH, Vandvik PO, Agoritsas T. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ 2021; 374:n2040. [PMID: 34497062 DOI: 10.1136/bmj.n2040] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CLINICAL QUESTION What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes? CURRENT PRACTICE Chronic pain is common and distressing and associated with considerable socioeconomic burden globally. Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce use of opioids; however, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries. RECOMMENDATION The guideline expert panel issued a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain. HOW THIS GUIDELINE WAS CREATED An international guideline development panel including patients, clinicians with content expertise, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel applied an individual patient perspective. THE EVIDENCE This recommendation is informed by a linked series of four systematic reviews summarising the current body of evidence for benefits and harms, as well as patient values and preferences, regarding medical cannabis or cannabinoids for chronic pain. UNDERSTANDING THE RECOMMENDATION The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain. It reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms. Shared decision making is required to ensure patients make choices that reflect their values and personal context. Further research is warranted and may alter this recommendation.
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Affiliation(s)
- Jason W Busse
- Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada
| | - Patrick Vankrunkelsven
- Belgian Centre for Evidence Based Medicine (CEBAM), Leuven, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteiti Leuven, Leuven, Belgium
| | - Linan Zeng
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Pharmacy Department/Evidence-based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anja Fog Heen
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Arnaud Merglen
- Division of General Pediatrics, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fiona Campbell
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Lars-Petter Granan
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bert Aertgeerts
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven
- CEBAM, Belgian Centre for Evidence-Based Medicine, Cochrane Belgium
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - David Juurlink
- Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Departments of Medicine and Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals
- Faculty of Medicine, University of Geneva, Switzerland
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nimisha Kumar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lynn Cooper
- Canadian Injured Workers' Alliance, Thunder Bay, ON, Canada
| | - John Brown
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Li Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Per O Vandvik
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
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10
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Fernandez S, Lenoir C, Samer C, Rollason V. Drug interactions with apixaban: A systematic review of the literature and an analysis of VigiBase, the World Health Organization database of spontaneous safety reports. Pharmacol Res Perspect 2021; 8:e00647. [PMID: 32881416 PMCID: PMC7507549 DOI: 10.1002/prp2.647] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023] Open
Abstract
Apixaban, a direct oral anticoagulant, has emerged over the past few years because it is considered to have a low risk of drug‐drug interactions compared to vitamin K antagonists. To better characterize these interactions, we systematically reviewed studies evaluating the drug‐drug interactions involving apixaban and analyzed the drug‐drug interactions resulting in an adverse drug reaction reported in case reports and VigiBase. We systematically searched Medline, Embase, and Google Scholar up to 20 August 2018 for articles that investigated the occurrence of an adverse drug reaction due to a potential drug interacting with apixaban. Data from VigiBase came from case reports retrieved up to the 2 January 2018, where identification of potential interactions is performed in terms of two drugs, one adverse drug reaction triplet and potential signal detection using Omega, a three‐way measure of disproportionality. We identified 15 studies and 10 case reports. Studies showed significant variations in the area under the curve for apixaban and case reports highlighted an increased risk of hemorrhage or thromboembolic events due to a drug‐drug interaction. From VigiBase, a total of 1617 two drugs and one adverse drug reaction triplet were analyzed. The most reported triplet were apixaban—aspirin—gastrointestinal hemorrhage. Sixty‐seven percent of the drug‐drug interactions reported in VigiBase were not described or understood. In the remaining 34%, the majority were pharmacodynamic drug‐drug interactions. These data suggest that apixaban has significant potential for drug‐drug interactions, either with CYP3A/P‐gp modulators or with drugs that may impair hemostasis. The most described adverse drug reactions were adverse drug reactions related to hemorrhage or thrombosis, mostly through pharmacodynamic interactions. Pharmacokinetic drug‐drug interactions seem to be poorly detected.
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Affiliation(s)
- Silvia Fernandez
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Camille Lenoir
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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11
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Samer C, Lacombe K, Calmy A. Cyber harassment of female scientists will not be the new norm. The Lancet Infectious Diseases 2021; 21:457-458. [PMID: 33357516 PMCID: PMC7758174 DOI: 10.1016/s1473-3099(20)30944-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
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12
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Barbolini L, Terrier J, Marti C, Samer C, Daali Y, Fontana P, Reny JL. Mixing Drugs and Genetics: A Complex Hemorrhagic Cocktail. Am J Med 2021; 134:e211-e212. [PMID: 32858019 DOI: 10.1016/j.amjmed.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Laura Barbolini
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland.
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Division of Angiology and Haemostasis, Geneva University Hospitals, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland
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13
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Vernaz N, Agoritsas T, Calmy A, Gayet-Ageron A, Gold G, Perrier A, Picard F, Prendki V, Reny JL, Samer C, Stirnemann J, Vetter P, Zanella MC, Zekry D, Baggio S. Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs. Swiss Med Wkly 2020; 150:w20446. [PMID: 33382449 DOI: 10.4414/smw.2020.20446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.
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Affiliation(s)
- Nathalie Vernaz
- Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland / Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland
| | - Angèle Gayet-Ageron
- CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Gabriel Gold
- Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland
| | - Arnaud Perrier
- Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Fabienne Picard
- Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Jean-Luc Reny
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland
| | | | - Dina Zekry
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Stéphanie Baggio
- Division of Prison Health, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland / Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
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Suppan M, Beckmann TS, Gercekci C, Sigrist T, Savoldelli GL, Fournier R, Samer C. Development and validation of LoAD Calc, a mobile app for calculating the maximum safe single dose of local anesthetics (Preprint). JMIR Form Res 2020. [DOI: 10.2196/26274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Rollason V, Lloret-Linares C, Lorenzini KI, Daali Y, Gex-Fabry M, Piguet V, Besson M, Samer C, Desmeules J. Evaluation of Phenotypic and Genotypic Variations of Drug Metabolising Enzymes and Transporters in Chronic Pain Patients Facing Adverse Drug Reactions or Non-Response to Analgesics: A Retrospective Study. J Pers Med 2020; 10:E198. [PMID: 33121061 PMCID: PMC7711785 DOI: 10.3390/jpm10040198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022] Open
Abstract
This retrospective study evaluates the link between an adverse drug reaction (ADR) or a non-response to treatment and cytochromes P450 (CYP), P-glycoprotein (P-gp) or catechol-O-methyltransferase (COMT) activity in patients taking analgesic drugs for chronic pain. Patients referred to a pain center for an ADR or a non-response to an analgesic drug between January 2005 and November 2014 were included. The genotype and/or phenotype was obtained for assessment of the CYPs, P-gp or COMT activities. The relation between the event and the result of the genotype and/or phenotype was evaluated using a semi-quantitative scale. Our analysis included 243 individual genotypic and/or phenotypic explorations. Genotypes/phenotypes were mainly assessed because of an ADR (n = 145, 59.7%), and the majority of clinical situations were observed with prodrug opioids (n = 148, 60.9%). The probability of a link between an ADR or a non-response and the genotypic/phenotypic status of the patient was evaluated as intermediate to high in 40% and 28.2% of all cases, respectively. The drugs in which the probability of an association was the strongest were the prodrug opioids, with an intermediate to high link in 45.6% of the cases for occurrence of ADRs and 36.0% of the cases for non-response. This study shows that the genotypic and phenotypic approach is useful to understand ADRs or therapeutic resistance to a usual therapeutic dosage, and can be part of the evaluation of chronic pain patients.
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Affiliation(s)
- Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Célia Lloret-Linares
- Ramsay Générale de Santé, Hôpital Privé Pays de Savoie, Maladies Nutritionnelles et Métaboliques, 74000 Annemasse, France;
| | - Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Marianne Gex-Fabry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, 1226 Thônex, Switzerland;
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
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16
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Foufi V, Ing Lorenzini K, Goldman JP, Gaudet-Blavignac C, Lovis C, Samer C. Automatic Classification of Discharge Letters to Detect Adverse Drug Reactions. Stud Health Technol Inform 2020; 270:48-52. [PMID: 32570344 DOI: 10.3233/shti200120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adverse drug reactions (ADRs) are frequent and associated to significant morbidity, mortality and costs. Therefore, their early detection in the hospital context is vital. Automatic tools could be developed taking into account structured and textual data. In this paper, we present the methodology followed for the manual annotation and automatic classification of discharge letters from a tertiary hospital. The results show that ADRs and causal drugs are explicitly mentioned in the discharge letters and that machine learning algorithms are efficient for the automatic detection of documents containing mentions of ADRs.
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Affiliation(s)
- Vasiliki Foufi
- Division of Medical Information Sciences, Geneva University Hospitals & University of Geneva, Switzerland
| | | | - Jean-Philippe Goldman
- Division of Medical Information Sciences, Geneva University Hospitals & University of Geneva, Switzerland
| | | | - Christian Lovis
- Division of Medical Information Sciences, Geneva University Hospitals & University of Geneva, Switzerland
| | - Caroline Samer
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland
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17
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Rochat J, Gaudet-Blavignac C, Del Zotto M, Ruiz Garretas V, Foufi V, Issom D, Samer C, Hurst S, Lovis C. Citizens' Participation in Health and Scientific Research in Switzerland. Stud Health Technol Inform 2020; 270:1098-1102. [PMID: 32570551 DOI: 10.3233/shti200332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding motivation and resistance factors affecting citizen participation in health and scientific research allows to find solutions to improve citizen engagement and interest in science. Through a survey, we identified the main factors influencing citizens' participation in scientific research, and their wishes to be more informed. Results show that the respondents' reasons to participate in research were altruistic motivations, in line with other studies carried out in developed countries. The main factor influencing the non-participation is the lack of opportunity, highlighting the importance to better inform citizens about ongoing studies.
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Affiliation(s)
| | | | - Marzia Del Zotto
- Division of medical information sciences, University Hospitals of Geneva, Switzerland
| | - Victor Ruiz Garretas
- Division of medical information sciences, University Hospitals of Geneva, Switzerland
| | - Vasiliki Foufi
- Faculty of medicine, University of Geneva, Switzerland.,Division of medical information sciences, University Hospitals of Geneva, Switzerland
| | - David Issom
- Division of medical information sciences, University Hospitals of Geneva, Switzerland
| | - Caroline Samer
- Faculty of medicine, University of Geneva, Switzerland.,Division of clinical pharmacology and toxicology, University Hospitals of Geneva, Switzerland
| | - Samia Hurst
- Faculty of medicine, University of Geneva, Switzerland
| | - Christian Lovis
- Faculty of medicine, University of Geneva, Switzerland.,Division of medical information sciences, University Hospitals of Geneva, Switzerland
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18
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Bosilkovska M, Magliocco G, Desmeules J, Samer C, Daali Y. Interaction between Fexofenadine and CYP Phenotyping Probe Drugs in Geneva Cocktail. J Pers Med 2019; 9:jpm9040045. [PMID: 31581637 PMCID: PMC6963818 DOI: 10.3390/jpm9040045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022] Open
Abstract
Drug metabolic enzymes and transporters are responsible for an important variability in drug disposition. The cocktail approach is a sound strategy for the simultaneous evaluation of several enzyme and transporter activities for a personalized dosage of medications. Recently, we have demonstrated the reliability of the Geneva cocktail, combining the use of dried blood spots (DBS) and reduced dose of phenotyping drugs for the evaluation of the activity of six cytochromes and P-glycoprotein (P-gp). As part of a study evaluating potential drug–drug interactions between probe drugs of the Geneva cocktail, the present paper focuses on the impact of cytochromes (CYP) probe drugs on the disposition of fexofenadine, a P-gp test drug. In a randomized four-way Latin-square crossover study, 30 healthy volunteers (15 men and 15 women) received caffeine 50 mg, bupropion 20 mg, flurbiprofen 10 mg, omeprazole 10 mg, dextromethorphan 10 mg, midazolam 1 mg, and fexofenadine 25 mg alone (or as part of a previously validated combination) and all together (Geneva cocktail). The determination of drug concentrations was performed in DBS samples and pharmacokinetic parameters were calculated. Fexofenadine AUC0–8 h and Cmax decreased by 43% (geometric mean ratio: 0.57; CI 90: 0.50–0.65; p < 0.001) and 49% (geometric mean ratio: 0.51; CI 90: 0.44–0.59; p < 0.001), respectively, when fexofenadine was administered as part of the Geneva cocktail in comparison to fexofenadine alone. Consequently, the apparent oral clearance (Cl/F) increased 1.7-fold (CI 90: 1.49–1.93; p < 0.001). There was no interaction between the remaining probes. In conclusion, an unexpected interaction occurred between fexofenadine and one or several of the following substances: caffeine, bupropion, flurbiprofen, omeprazole, dextromethorphan, and midazolam. Further studies are necessary to elucidate the mechanism of this interaction.
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Affiliation(s)
- Marija Bosilkovska
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Gaelle Magliocco
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
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19
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Coleman JJ, Samer C, Zeitlinger M, van Agtmael M, Rongen GA, Marquet P, Simon T, Singer D, Manolopoulos VG, Böttiger Y. The European Association for Clinical Pharmacology and Therapeutics—25 years’ young and going strong. Eur J Clin Pharmacol 2019; 75:743-750. [DOI: 10.1007/s00228-019-02690-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
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20
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Samer C, Daali Y, Marsousi N, Desmeules JA. Predictive performance of Simcyp default models of 8 cytochrome P450 modulators in different clinical senarios. Drug Metab Pharmacokinet 2019. [DOI: 10.1016/j.dmpk.2018.09.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Bovet L, Samer C, Daali Y. Preclinical Evaluation of Safety of Fucoidan Extracts From Undaria pinnatifida and Fucus vesiculosus for Use in Cancer Treatment. Integr Cancer Ther 2019; 18:1534735419876325. [PMID: 31522564 PMCID: PMC7242795 DOI: 10.1177/1534735419876325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Luc Bovet
- Geneva University Hospitals, Geneva, Switzerland
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22
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Storelli F, Samer C, Reny JL, Desmeules J, Daali Y. Complex Drug-Drug-Gene-Disease Interactions Involving Cytochromes P450: Systematic Review of Published Case Reports and Clinical Perspectives. Clin Pharmacokinet 2018; 57:1267-1293. [PMID: 29667038 DOI: 10.1007/s40262-018-0650-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Drug pharmacokinetics (PK) is influenced by multiple intrinsic and extrinsic factors, among which concomitant medications are responsible for drug-drug interactions (DDIs) that may have a clinical relevance, resulting in adverse drug reactions or reduced efficacy. The addition of intrinsic factors affecting cytochromes P450 (CYPs) activity and/or expression, such as genetic polymorphisms and diseases, may potentiate the impact and clinical relevance of DDIs. In addition, greater variability in drug levels and exposures has been observed when such intrinsic factors are present in addition to concomitant medications perpetrating DDIs. This variability results in poor predictability of DDIs and potentially dramatic clinical consequences. The present review illustrates the issue of complex DDIs using systematically searched published case reports of DDIs involving genetic polymorphisms, renal impairment, cirrhosis, and/or inflammation. Current knowledge on the impact of each of these factors on drug exposure and DDIs is summarized and future perspectives for the management of such complex DDIs in clinical practice are discussed, including the use of advanced Computerized Physician Order Entry (CPOE) systems, the development of model-based dose optimization strategies, and the education of healthcare professionals with respect to personalized medicine.
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Affiliation(s)
- Flavia Storelli
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Geneva-Lausanne School of Pharmacy, University of Geneva, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Swiss Center for Applied Human Toxicology, Geneva, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Geneva-Lausanne School of Pharmacy, University of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Swiss Center for Applied Human Toxicology, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
- Geneva-Lausanne School of Pharmacy, University of Geneva, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Swiss Center for Applied Human Toxicology, Geneva, Switzerland.
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Ing Lorenzini K, Lloret-Linares C, Desmeules J, Samer C. Absorption des médicaments lors de syndrome du grêle court. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blanc AL, Guignard B, Desnoyer A, Grosgurin O, Marti C, Samer C, Bonnabry P. Prevention of potentially inappropriate medication in internal medicine patients: A prospective study using the electronic application PIM-Check. J Clin Pharm Ther 2018; 43:860-866. [PMID: 29978537 DOI: 10.1111/jcpt.12733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/10/2018] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN Potentially inappropriate medication (PIM) is a risk factor for drug-related problems (DRPs) and an important inpatient safety issue. PIM-Check is a screening tool designed to detect PIM in internal medicine patients. OBJECTIVE This study aimed to determine whether PIM-Check could help to identify and reduce DRPs. METHOD Prospective interventional study conducted on patients admitted to internal medicine wards in a university hospital between 1 September 2015 and 30 October 2015. Adult patients were included if they were hospitalized for more than 48 hours. Patients received either usual care (period 1 = control) or usual care plus medication screening by the wards' chief residents using PIM-Check (period 2 = intervention). An expert panel, composed of a clinical pharmacist, a clinical pharmacologist and two attending physicians in internal medicine, blinded to patient groups, identified DRPs. RESULTS A total of 297 patients were included (intervention: 109). The groups' demographic parameters were similar. The expert panel identified 909 DRPs (598: control; 311: intervention). The mean number of DRPs per patient was similar in the control (3.2; 95% CI: 2.9-3.5) and intervention groups (2.9; 95% CI: 2.4-3.3) (P = .12). PIM-Check displayed 33.4% of the 311 DRPs identified in the intervention group. WHAT IS NEW AND CONCLUSION In this study, PIM-Check had limited value, as the average number of DRPs per person was similar in both groups. Although one-third of DRPs counted in intervention group had been identified by PIM-Check, this did not lead to a reduction in DRPs. This lack of impact of PIM-Check on drug prescription may be explained by the number of alerts displayed by the application and hospital physicians' reluctance to modify the treatments for chronic conditions previously prescribed by general practitioners.
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Affiliation(s)
- A-L Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - B Guignard
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Department, Geneva University Hospitals, Geneva, Switzerland
| | - A Desnoyer
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Pharmacy, University Paris-Saclay, Châtenay-Malabry, France
| | - O Grosgurin
- Internal Medicine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland
| | - C Marti
- Internal Medicine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland
| | - C Samer
- Clinical Pharmacology and Toxicology Department, Geneva University Hospitals, Geneva, Switzerland
| | - P Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Amstutz U, Mlakar V, Curtis PHD, Samer C, Baumann P, Bühlmann RP, Meier-Abt P, Meyer UA, van Schaik RHN, Ansari M. Creation of the Swiss group of Pharmacogenomics and personalised Therapy (SPT). Drug Metab Pers Ther 2017; 32:173-174. [PMID: 29267167 DOI: 10.1515/dmpt-2017-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ursula Amstutz
- University Institute of Clinical Chemistry, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vid Mlakar
- CANSEARCH Research Laboratory, Geneva University Medical School, Geneva, Switzerland
| | | | - Caroline Samer
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Baumann
- Department of Psychiatry (DP-CHUV), University of Lausanne, Prilly, Switzerland
| | | | | | - Urs A Meyer
- Biozentrum, University of Basel, Basel, Switzerland
| | | | - Marc Ansari
- CANSEARCH Research Laboratory, Geneva University Medical School, Geneva, Switzerland
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Baumann P, Amstutz U, Bühlmann RP, Meier-Abt P, Meyer UA, Samer C, Ansari M. [Not Available]. Rev Med Suisse 2017; 13:1544-1545. [PMID: 28876714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Pierre Baumann
- Département de psychiatrie (DP-CHUV), 1008 Prilly-Lausanne
| | - Ursula Amstutz
- Institut universitaire de chimie clinique, Inselspital, Hôpital Universitaire de Berne, Université de Berne, 3010 Berne
| | | | - Peter Meier-Abt
- Swiss Academy of Medical Sciences, Laupenstrasse 7, 3001 Berne
| | | | - Caroline Samer
- Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
| | - Marc Ansari
- Département de l'enfant et de l'adolescent, unité d'onco-hématologie pédiatrique, HUG, 1211 Genève 14 et CANSEARCH research laboratory, University of Geneva, Medical School, 1211 Geneva
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Desnoyer A, Blanc AL, Pourcher V, Besson M, Fonzo-Christe C, Desmeules J, Perrier A, Bonnabry P, Samer C, Guignard B. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. BMJ Open 2017; 7:e016070. [PMID: 28760793 PMCID: PMC5642656 DOI: 10.1136/bmjopen-2017-016070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. DESIGN Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. SETTING 22 University and general hospitals from Canada, Belgium, France and Switzerland. PARTICIPANTS 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). PRIMARY AND SECONDARY OUTCOME MEASURES Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. RESULTS 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (p<0.001). The final checklist includes 160 statements in 17 medical domains and 56 pathologies. An algorithm of approximately 31 000 lines was developed including comorbidities and medications variables to create the electronic tool. CONCLUSION PIM-Check is the first electronic prescription-screening checklist designed to detect PIM in internal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety.
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Affiliation(s)
- Aude Desnoyer
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne-Laure Blanc
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Hôpitaux de l’Est Lémanique, Vevey, Switzerland
| | - Valérie Pourcher
- Department of Infectious and Tropical Diseases, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- UMR996—Inflammation, Chemokines and Immunopathology, Inserm, Clamart, France
| | - Marie Besson
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Jules Desmeules
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pascal Bonnabry
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Caroline Samer
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Bertrand Guignard
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Ing Lorenzini K, Daali Y, Fontana P, Desmeules J, Samer C. Rivaroxaban-Induced Hemorrhage Associated with ABCB1 Genetic Defect. Front Pharmacol 2016; 7:494. [PMID: 28066243 PMCID: PMC5165251 DOI: 10.3389/fphar.2016.00494] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/02/2016] [Indexed: 01/03/2023] Open
Abstract
We report a patient who presented a non-ST segment elevation myocardial infarction in the context of severe normocytic hypochromic anemia related to gastrointestinal bleeding, 3 months after switching anticoagulant from the vitamin K antagonist acenocoumarol to the direct oral anticoagulant rivaroxaban. High levels of both anti-Xa activity and rivaroxaban plasma concentrations were measured despite rivaroxaban withdrawal, suggesting reduced elimination/drug clearance. Estimated half-life was 2–3 times longer than usually reported. The patient is a homozygous carrier of ABCB1 variant alleles, which could have participated to reduced elimination of rivaroxaban. Furthermore, CYP3A4/5 phenotyping showed moderately reduced enzyme activity. Drug-drug interaction with simvastatin may have contributed to decreased rivaroxaban elimination. Although in the present case moderate acute renal failure probably played a role, more clinical data are required to elucidate the impact of ABCB1 polymorphism on rivaroxaban pharmacokinetics and bleeding complications.
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Affiliation(s)
- Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva Geneva, Switzerland
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Amstutz C, Samer C, Plan PA. [Not Available]. Rev Med Suisse 2016; 12:1342-1345. [PMID: 28671780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Cédric Amstutz
- FMH médecine interne générale, Impasse Jardin du Cerf 1, 1470 Estavayer-le-Lac
| | - Caroline Samer
- FMH en pharmacologie et toxicologie clinique, Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
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Calmy A, van Delden C, Giostra E, Junet C, Rubbia Brandt L, Yerly S, Chave JP, Samer C, Elkrief L, Vionnet J, Berney T. HIV-Positive-to-HIV-Positive Liver Transplantation. Am J Transplant 2016; 16:2473-8. [PMID: 27109874 DOI: 10.1111/ajt.13824] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 01/25/2023]
Abstract
Most countries exclude human immunodeficiency virus (HIV)-positive patients from organ donation because of concerns regarding donor-derived HIV transmission. The Swiss Federal Act on Transplantation has allowed organ transplantation between HIV-positive donors and recipients since 2007. We report the successful liver transplantation from an HIV-positive donor to an HIV-positive recipient. Both donor and recipient had been treated for many years with antiretroviral therapy and harbored multidrug-resistant viruses. Five months after transplantation, HIV viremia remains undetectable. This observation supports the inclusion of appropriate HIV-positive donors for transplants specifically allocated to HIV-positive recipients.
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Affiliation(s)
- A Calmy
- HIV Unit, Geneva University Hospitals, Geneva, Switzerland
| | - C van Delden
- Transplant Infectious Diseases Unit, Geneva University Hospitals, Geneva, Switzerland
| | - E Giostra
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | - C Junet
- Private Practice, Geneva, Switzerland
| | - L Rubbia Brandt
- Division of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - S Yerly
- Virology Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - J-P Chave
- Private Practice, Lausanne, Switzerland
| | - C Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - L Elkrief
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | - J Vionnet
- Division of Gastroenterology and Division of Transplantation, CHUV, Lausanne, Switzerland
| | - T Berney
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
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Lloret-Linares C, Rollason V, Lorenzini KI, Samer C, Daali Y, Gex-Fabry M, Aubry JM, Desmeules J, Besson M. Screening for genotypic and phenotypic variations in CYP450 activity in patients with therapeutic problems in a psychiatric setting, a retrospective study. Pharmacol Res 2016; 118:104-110. [PMID: 27378571 DOI: 10.1016/j.phrs.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/23/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This retrospective study aimed to assess to what extent an adverse drug reaction (ADR), an abnormal therapeutic drug monitoring (TDM) or a non-response, was attributable to an abnormal cytochrome P450 activity in a psychiatric setting. METHOD We collected the results of investigations performed in these situations related to psychotropic drugs between January 2005 and November 2014. Activities of different cytochrome P450 were assessed by genotyping and/or phenotyping. Two experienced clinical pharmacologists assessed independently the possible association between the event and the results of the investigations. RESULTS One hundred and thirty eight clinical or biological situations had a complete assessment of all major metabolic pathways of the target drug. A majority of clinical or biological situations were observed with antidepressants (n=93, 67.4%), followed by antipsychotics (n=28, 20.3%), benzodiazepines and hypnotics (n=13, 9.4%), and psychostimulants (n=4, 2.9%). Genotype and/or phenotype determination was mainly performed because of ADRs (n=68, 49.3%) or non-response (n=46, 33.3%). Inter-rate reliability of the scoring system between the pharmacologists was excellent (kappa=0.94). The probability of an association between ADR, TDM or non-response and metabolic status was rated as intermediate to high in 34.7% of all cases, with proportions of 30.4% and 36.7%, for non-response and ADR respectively. CONCLUSION When indicated by clinical pharmacologists, ADR, TDM or non-response may be attributable to a variation of the metabolic status with an intermediate to high probability in 34.7% of patients, based on the congruent assessment made by two clinical pharmacologists. Further studies assessing the clinical relevance of prospective explorations and clarifying the appropriate method according to the clinical context are needed.
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Affiliation(s)
- Célia Lloret-Linares
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland; INSERM UMR-S1144, Paris, France
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marianne Gex-Fabry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Bosilkovska M, Samer C, Déglon J, Thomas A, Walder B, Desmeules J, Daali Y. Evaluation of Mutual Drug-Drug Interaction within Geneva Cocktail for Cytochrome P450 Phenotyping using Innovative Dried Blood Sampling Method. Basic Clin Pharmacol Toxicol 2016; 119:284-90. [PMID: 27009433 DOI: 10.1111/bcpt.12586] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/14/2016] [Indexed: 01/01/2023]
Abstract
Cytochrome P450 (CYP) activity can be assessed using a 'cocktail' phenotyping approach. Recently, we have developed a cocktail (Geneva cocktail) which combines the use of low-dose probes with a low-invasiveness dried blood spots (DBS) sampling technique and a single analytical method for the phenotyping of six major CYP isoforms. We have previously demonstrated that modulation of CYP activity after pre-treatment with CYP inhibitors/inducer could be reliably predicted using Geneva cocktail. To further validate this cocktail, in this study, we have verified whether probe drugs contained in the latter cause mutual drug-drug interactions. In a randomized, four-way, Latin-square crossover study, 30 healthy volunteers received low-dose caffeine, flurbiprofen, omeprazole, dextromethorphan and midazolam (a previously validated combination with no mutual drug-drug interactions); fexofenadine alone; bupropion alone; or all seven drugs simultaneously (Geneva cocktail). Pharmacokinetic profiles of the probe drugs and their metabolites were determined in DBS samples using both conventional micropipette sampling and new microfluidic device allowing for self-sampling. The 90% confidence intervals for the geometric mean ratios of AUC metabolite/AUC probe for CYP probes administered alone or within Geneva cocktail fell within the 0.8-1.25 bioequivalence range indicating the absence of pharmacokinetic interaction. The same result was observed for the chosen phenotyping indices, that is metabolic ratios at 2 hr (CYP1A2, CYP3A) or 3 hr (CYP2B6, CYP2C9, CYP2C19, CYP2D6) post-cocktail administration. DBS sampling could successfully be performed using a new microfluidic device. In conclusion, Geneva cocktail combined with an innovative DBS sampling device can be used routinely as a test for simultaneous CYP phenotyping.
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Affiliation(s)
- Marija Bosilkovska
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,Swiss Center for Applied Human Toxicology, Geneva, Switzerland
| | - Julien Déglon
- Unit of Toxicology, University Center of Legal Medicine, Geneva, Switzerland.,DBS System, Gland, Switzerland
| | - Aurélien Thomas
- Unit of Toxicology, University Center of Legal Medicine, Geneva, Switzerland
| | - Bernhard Walder
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,Swiss Center for Applied Human Toxicology, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,Swiss Center for Applied Human Toxicology, Geneva, Switzerland
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Wagner N, Wyler-Lazarevic C, Yerly S, Samer C, Peytavin G, Posfay-Barbe K, Calmy A, Ambrosioni J. Corrigendum to “Dolutegravir-based antiretroviral therapy in a severely overweight child with a multi-drug resistant human immunodeficiency virus infection. A case report and review” [New Microbes New Infect] 6 (2015) 1–4]. New Microbes New Infect 2015; 8:174. [PMID: 27257500 PMCID: PMC4877397 DOI: 10.1016/j.nmni.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Storelli F, Bruggmann C, Doffey-Lazeyras F, Samer C, Desmeules J, Daali Y. Evaluation of CYP450 and transporters expression and activity in heparg cell line under different conditions. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bouatou Y, Samer C, Fontana P, Daali Y, Desmeules J. Evidence-Based Choice of P2Y12 Inhibitors in End Stage Renal Disease Patients: A Mini-Review. Curr Drug Metab 2015; 16:97-104. [DOI: 10.2174/138920021602150713114437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/23/2015] [Accepted: 03/28/2015] [Indexed: 11/22/2022]
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Besson M, Samer C, Rollason V, Dayer P, Desmeules J. Providing Quality Therapeutics in Switzerland: Role of the Stakeholders and Recent Incentives for Further Improvements. Clin Ther 2015; 37:1588-92. [PMID: 26049714 DOI: 10.1016/j.clinthera.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/18/2015] [Accepted: 05/06/2015] [Indexed: 11/26/2022]
Abstract
Quality therapeutics play an important role in Switzerland's health care and economy. Switzerland holds a key position in the world of research and development, as well as in drug production. Recently, new emphasis has been placed on promoting clinical research and maintaining Switzerland's position as a center of excellence in the field. Recent revisions to the law regarding medical trials in human research allow for better allocation of regulatory resources and simplified procedures for drugs already authorized in Switzerland. The country has its own regulatory agency, the Swiss Agency for Therapeutic Products (Swissmedic), which is a public institution of the Swiss government. Swissmedic is responsible for ensuring safety in medicines, particularly regarding authorizations and market surveillance in the sector of medicinal products and medical devices. Although the centralized authorization procedure of the European Union for medicines does not apply to Switzerland, there are mutual recognition mechanisms between the Swiss medicine regulatory authority and the European Medicines Agency. Swissmedic is also in charge of postmarketing safety and oversees the national pharmacovigilance center, which collaborates closely with the World Health Organization center in Uppsala. In addition, university hospital-based clinical pharmacologists, who are involved in basic science and clinical research, regulatory affairs, ethics committees, and pharmacovigilance, promote quality therapeutics. This article discusses the role of the various stakeholders and the recent efforts made to provide a better allocation of resources aimed at further improving quality therapeutics in Switzerland.
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Affiliation(s)
- Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland.
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Clinical Research Center, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Pierre Dayer
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Medical Direction, University Hospital of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Clinical Research Center, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
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Wagner N, Wyler-Lazarevic CA, Yerly S, Samer C, Peytavin G, Posfay-Barbe KM, Calmy A, Ambrosioni J. Dolutegravir-based antiretroviral therapy in a severely overweight child with a multidrug-resistant human immunodeficiency virus infection. A case report and review. New Microbes New Infect 2015; 6:1-4. [PMID: 26082840 PMCID: PMC4430707 DOI: 10.1016/j.nmni.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/02/2015] [Accepted: 02/18/2015] [Indexed: 12/03/2022] Open
Abstract
The management of multidrug-resistant human immunodeficiency virus (MDR HIV) infections in children is particularly challenging due to the lack of experience with new drugs. Dolutegravir, combined with an optimized antiretroviral background therapy, is promising for the treatment of MDR HIV and has been approved recently for adults and adolescents. Data for children are extremely limited. We describe the efficacy, safety and plasmatic levels of a dolutegravir-based, complex active antiretroviral treatment regimen in a severely overweight 11-year-old child infected with an MDR HIV strain.
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Affiliation(s)
- N Wagner
- Department of Paediatrics, Switzerland
| | | | - S Yerly
- Laboratory of Virology, Department of Genetics and Laboratory Medicine, Switzerland
| | - C Samer
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Switzerland
| | - G Peytavin
- Department of Clinical Pharmaco-Toxicology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - A Calmy
- Division of Infectious Diseases, Department of Medical Specialties, Geneva University, Geneva, Switzerland
| | - J Ambrosioni
- Division of Infectious Diseases, Department of Medical Specialties, Geneva University, Geneva, Switzerland ; Infectious Diseases Department, Hospital-Clinic-IDIBAPS, Barcelona, Spain
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Abstract
Direct oral anticoagulants have recently emerged as an attractive choice for patients requiring anticoagulation treatment. They have a rapid onset of action and can be administered at fixed doses without the need for routine anticoagulation monitoring. They may present fewer interactions than warfarin but further experience is needed to assess the clinical significance of the interactions with cytochrome CYP3A and P-gp inhibitors/inducers. A higher rate of bleeding has been observed in association with antiplatelet agents or non-steroidal anti-inflammatory drugs. Their safety profile has not been sufficiently studied in the elderly, and in patients with liver disease or severe renal impairment. Dose adjustment is necessary in patients with moderate renal impairment and a higher bleeding rate has been observed in this subgroup, although not higher than with warfarin. The clinical settings that require monitoring of coagulation assays have not yet been specified. Reversal of their anticoagulant effect may be problematic in case of severe bleeding. Therefore, despite the obvious advantages of the direct oral anticoagulants, experience is still lacking for many patient subgroups in which they should be withheld awaiting more data.
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Affiliation(s)
- Thomas A Mavrakanas
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals, Switzerland
| | - Arnaud Perrier
- Division of General Internal Medicine, Geneva University Hospitals, Switzerland
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Bouatou Y, Samer C, Ing Lorenzini K, Daali Y, Daou S, Fathi M, Rebsamen M, Desmeules J, Calmy A, Escher M. Therapeutic drug monitoring of voriconazole: a case report of multiple drug interactions in a patient with an increased CYP2C19 activity. AIDS Res Ther 2014; 11:25. [PMID: 25120580 PMCID: PMC4130425 DOI: 10.1186/1742-6405-11-25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Voriconazole is metabolized by cytochrome P450 (CYP) 2C19 and CYP 3A4. Drug-drug interactions and genetic polymorphisms modulate their activities. Case presentation A 35-year old African female patient with resistant HIV and a cerebral mass of unknown origin was treated with voriconazole for a suspicion of disseminated Aspergillosis infection. Voriconazole trough concentrations (C0) were within target range while the patient was under esomeprazole, a CYP2C19 inhibitor. Phenotyping showed decreased CYP2C19 activity, whereas genotyping showed a variant allele associated with increased enzyme activity. The patient was switched to ranitidine because of the introduction of atazanavir. CYP3A4 inhibition by atazanavir combined with uninhibited CYP2C19 activity resulted in subtherapeutic voriconazole C0. The reintroduction of esomeprazole allowed restoring voriconazole C0 back to target range. Conclusion The integration of drug-drug interactions and pharmacogenetics data is crucial to interpret drug concentrations correctly, thus preventing suboptimal exposure to voriconazole.
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Rollason V, Samer C, Daali Y, Desmeules J. Prediction by Pharmacogenetics of Safety and Efficacy of Non-Steroidal Anti- Inflammatory Drugs: A Review. Curr Drug Metab 2014; 15:326-43. [DOI: 10.2174/1389200215666140202214454] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
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Marsousi N, Daali Y, Humphries H, Almond L, Dayer P, Desmeules J, Samer C. PP189—A Physiologically-Based Mechanistic Pharmacokinetic Model to Assess the Metabolism of Oxycodone in Healthy Volunteers: Interplay Between CYP3A and 2D6 Inhibition. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ing Lorenzini K, Samer C, Pugin J, Harbarth S, Bonnabry P, Fathi M, Dayer P, Desmeules J. PP197—Therapeutic Drug Monitoring of Vancomycin and Aminoglycosides in an Intensive Care Unit, a Retrospective Study. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guignard B, Samer C, Perrier A, Bonnabry P, Dayer P, Desmeules J. PP008—Drug-related problems in a general internal medicine service. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Samer C, Doffey-Lazeyras F, Sorg O, Saurat JH, Dayer P, Daali Y, Desmeules J. PP233—CYP1A activity after chronic exposure to dioxins from a waste incinerator. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bosilkovska M, Deglon J, Samer C, Walder B, Dayer P, Desmeules J, Staub C, Daali Y. PP193—Simultaneous LC-MS/MS Quantification of P-Glycoprotein and Cytochrome P450 Probe Substrates and Their Metabolites In Dried Blood Spots. Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mavrakanas TA, Bouatou Y, Samer C, de Seigneux S, Meyer P. Carbimazole-Induced, ANCA-Associated, Crescentic Glomerulonephritis: Case Report and Literature Review. Ren Fail 2013; 35:414-7. [DOI: 10.3109/0886022x.2012.760356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ancrenaz V, Déglon J, Samer C, Staub C, Dayer P, Daali Y, Desmeules J. Pharmacokinetic interaction between prasugrel and ritonavir in healthy volunteers. Basic Clin Pharmacol Toxicol 2012; 112:132-7. [PMID: 22900583 PMCID: PMC3561686 DOI: 10.1111/j.1742-7843.2012.00932.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/09/2012] [Indexed: 12/22/2022]
Abstract
The new anti-aggregating agent prasugrel is bioactivated by cytochromes P450 (CYP) 3A and 2B6. Ritonavir is a potent CYP3A inhibitor and was shown in vitro as a CYP2B6 inhibitor. The aim of this open-label cross-over study was to assess the effect of ritonavir on prasugrel active metabolite (prasugrel AM) pharmacokinetics in healthy volunteers. Ten healthy male volunteers received 10 mg prasugrel. After at least a week washout, they received 100 mg ritonavir, followed by 10 mg prasugrel 2 hr later. We used dried blood spot sampling method to monitor prasugrel AM pharmacokinetics (Cmax, t1/2, tmax, AUC0–6 hr) at 0, 0.25, 0.5, 1, 1.5, 2, 4 and 6 hr after prasugrel administration. A ‘cocktail’ approach was used to measure CYP2B6, 2C9, 2C19 and 3A activities. In the presence of ritonavir, prasugrel AM Cmax and AUC were decreased by 45% (mean ratio: 0.55, CI 90%: 0.40–0.7, p = 0.007) and 38% (mean ratio: 0.62, CI 90%: 0.54–0.7, p = 0.005), respectively, while t1/2 and tmax were not affected. Midazolam metabolic ratio (MR) dramatically decreased in presence of ritonavir (6.7 ± 2.6 versus 0.13 ± 0.07) reflecting an almost complete inhibition of CYP3A4, whereas omeprazole, flurbiprofen and bupropion MR were not affected. These data demonstrate that ritonavir is able to block prasugrel CYP3A4 bioactivation. This CYP-mediated drug–drug interaction might lead to a significant reduction of prasugrel efficacy in HIV-infected patients with acute coronary syndrome.
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Affiliation(s)
- Virginie Ancrenaz
- Clinical Pharmacology and Toxicology Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Baudet H, McLin V, Parvex P, Chehade H, Combescure C, Samer C, Bonnabry P, Fonzo-Christe C, Posfay-Barbe K. TDM and stabilisation of paediatric patients in liver and kidney transplantation. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Daali Y, Samer C, Déglon J, Thomas A, Chabert J, Rebsamen M, Staub C, Dayer P, Desmeules J. Oral flurbiprofen metabolic ratio assessment using a single-point dried blood spot. Clin Pharmacol Ther 2012; 91:489-96. [PMID: 22237256 DOI: 10.1038/clpt.2011.247] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated whether a single blood measurement using the minimally invasive technique of a finger prick to draw a blood sample of 5 µl (to yield a dried blood spot (DBS)) is suitable for the assessment of flurbiprofen (FLB) metabolic ratio (MR). Ten healthy volunteers who had been genotyped for CYP2C9 were recruited as subjects. They received FLB alone in session 1 and FLB with fluconazole in session 2. In session 3, the subjects were pretreated for 4 days with rifampicin and received FLB with the last dose of rifampicin on day 5. Plasma and DBS samples were obtained between 0 and 8 h after FLB administration, and urine was collected during the 8 h after administration. The pharmacokinetic profiles of the drugs were comparable in DBS and plasma. FLB's apparent clearance values decreased by 35% in plasma and DBS during session 2 and increased by 75% in plasma and by 30% in DBS during session 3. Good correlations were observed between MRs calculated from urine, plasma, and DBS samples.
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Affiliation(s)
- Y Daali
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Ancrenaz V, Daali Y, Fontana P, Besson M, Samer C, Dayer P, Desmeules J. Impact of Genetic Polymorphisms and Drug – Drug Interactions on Clopidogrel and Prasugrel Response Variability. Curr Drug Metab 2010; 11:667-77. [DOI: 10.2174/138920010794233521] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/30/2010] [Indexed: 11/22/2022]
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