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Bourneau-Martin D, Grandvuillemin A, Babin M, Mullet C, Said H, Cellier M, Geniaux H, Gautier S, Beurrier M, Veyrac G, Lagarce L, Laroche ML, Briet M. Adverse drug effect in the context of drug shortage: the CIRUPT prospective study from the French pharmacovigilance network. Eur J Hosp Pharm 2024:ejhpharm-2023-004047. [PMID: 38621957 DOI: 10.1136/ejhpharm-2023-004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Drug shortages are of increasing concern to worldwide public health. The consequences of drug shortages for patient safety have been little studied, especially from a pharmacovigilance point of view. In this context, the network of French pharmacovigilance centres conducted the CIRUPT study (Conséquences Iatrogènes des RUPTures de stock/iatrogenic consequences of drug shortages) based on a prospective campaign of adverse effects occurring in the context of drug shortage notifications. METHODS All notifications involving a shortage drug submitted to the French pharmacovigilance centres between 1 January 2020 and 30 June 2021 were collected and registered in the French national pharmacovigilance database with the standardised high level term 'product supply and availability issues' and with predefined keywords in the narrative section. RESULTS 224 cases were included, involving mainly adverse drug reactions (ADRs) (n=131/224, 59%) and medication errors (n=51/224, 23%); 29% of the cases were serious. The most represented classes of shortage drugs were: vaccines (n=78/224, 35%); drugs for acid-related disorders (H2-receptor antagonists) (n=27/224, 12%); antineoplastic agents (n=17/224, 8%); and antiepileptics (n=15/224, 7%). In 82% of cases, the involved shortage drug was the subject of information delivered to health professionals by the National Agency for the Safety of Medicines and Health Products. Drug shortages were associated with an ADR related to replacement drugs in 59% (n=131/224) of the cases, drug inefficacy in 18% (n=41/224), and/or an aggravation of the underlying disease in 11% (n=25/224). CONCLUSIONS From a pharmacovigilance point of view, a large diversity of anatomical therapeutic classes is involved and the risk related to drug shortages is not limited to drugs registered on 'major therapeutic interest or essential drug' lists. Information from health agencies is not sufficient to avoid the risks, and further strategies should be developed.
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Affiliation(s)
- Delphine Bourneau-Martin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Aurelie Grandvuillemin
- Centre Regional de Pharmacovigilance, University Hospital Centre Dijon Bourgogne, Dijon, Bourgogne-Franche-Comté, France
| | - Marina Babin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Charlotte Mullet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Hillary Said
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Morgane Cellier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Helene Geniaux
- Centre Regional de Pharmacovigilance, University Hospital Centre of Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Sophie Gautier
- Centre Régional de Pharmacovigilance, Lille University Hospital, Lille, Hauts-de-France, France
| | - Mathilde Beurrier
- Centre Régional de Pharmacovigilance, Nancy University Hospital Center, Nancy, Grand Est, France
| | - Gwenaelle Veyrac
- Centre Regional de Pharmacovigilance, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Marie-Laure Laroche
- Centre Régional de Pharmacovigilance, University Hospital Centre of Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Marie Briet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
- UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, SFR ICAT, University of Angers, Angers, Pays de la Loire, France
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Bourneau-Martin D, Babin M, Grandvuillemin A, Mullet C, Salvo F, Singier A, Cellier M, Fresse A, de Canecaude C, Pietri T, Drablier G, Geniaux H, Lagarce L, Laroche ML, Briet M. Adverse drug reaction related to drug shortage: A retrospective study on the French National Pharmacovigilance Database. Br J Clin Pharmacol 2023; 89:1080-1088. [PMID: 36177609 DOI: 10.1111/bcp.15550] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
AIM Drug shortages are a growing global health issue. The aim of the study was to evaluate the consequences of drug shortages on patient safety based on data recorded in the French National Pharmacovigilance Database. METHODS All cases involving drug shortages reported from 1985 to the end of 2019 were extracted from the database. RESULTS Following the selection process, 462 cases were included. The number of cases increased significantly from 2004 to 2019. Cases mainly involved drugs from the nervous system (22.1%, 95% confidence interval [CI] 17.5-27.0%), the cardiovascular system (16.4%, 95% CI 11.9-21.4%) and anti-infectives for systemic use (14.3%, 95% CI 9.7-19.2%) ATC classes. Most of the cases reported an adverse drug reaction (ADR) belonging to the SOC nervous system (21%, 95% CI 18-24%), skin and subcutaneous (14%, 95% CI 11-17%), general (13%, 95% CI 10-17%) and gastrointestinal (8%, 95% CI 5-11%) disorders. Disease worsening was observed in 15.9% of the cases, mostly related to a lack of efficacy of the replacement drug. Half of the cases were considered as serious. Evolution was favourable in 79.4% of the cases. Death and/or life-threatening situations were reported in 5.8% of the cases. Medication errors (MEs) were identified in 51 cases (11%), mostly occurring at the administration step and involving a human factor. CONCLUSION This study emphasizes the clinical impact of drug shortage in terms of ADRs, ME and inefficiency. These observations underline the importance of a global health policy programme to limit the occurrence of drug shortages and to reinforce the information provided to patients and health care professionals in this context to limit risk.
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Affiliation(s)
- Delphine Bourneau-Martin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Marina Babin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | | | - Charlotte Mullet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Francesco Salvo
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,Service de Pharmacologie, CHU de Bordeaux, Bordeaux, France
| | | | - Morgane Cellier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Audrey Fresse
- CHRU de Nancy - Hôpitaux de Brabois, Centre Régional de Pharmacovigilance, Vandœuvre-lès-Nancy, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur Le Médicament, Faculté de Médecine, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Tessa Pietri
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre régional de pharmacovigilance, Marseille, France
| | - Guillaume Drablier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Hélène Geniaux
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Marie-Laure Laroche
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France.,UR 24134 (Vie Santé: Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
| | - Marie Briet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France.,Université d'Angers, Angers, France.,MitoVasc Research Institute, UMR CNRS 6214 INSERM 1083, Angers, France
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Carnoy C, Müller-Alouf H, Desreumaux P, Mullet C, Grangette C, Simonet M. The superantigenic toxin of Yersinia pseudotuberculosis: a novel virulence factor? Int J Med Microbiol 2000; 290:477-82. [PMID: 11111929 DOI: 10.1016/s1438-4221(00)80069-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/18/2022] Open
Abstract
Recently, a superantigenic toxin designated YPM (Yersinia pseudotuberculosis-derived mitogen) was characterized in the supernatant of Y. pseudotuberculosis, a Gram-negative bacterium involved in human enteric infection. To assess the role of YPM in pathophysiology of Y. pseudotuberculosis, a superantigen-deficient mutant was constructed and its virulence was tested in a murine model of infection and compared with the virulence of the wild-type strain (wt). Determination of the survival rate after intravenous inoculation of mice clearly demonstrated a higher survival rate when animals were infected with the superantigen-deficient strain. This decreased virulence of the mutant strain could not be explained by a lower bacterial growth rate in spleen, liver or lung of infected animals. Therefore, production of IFNgamma, TNFalpha, IL-2, IL-6 and IL-10 was followed during the course of infection by cytokine assay in the blood and mRNA detection in the spleen. IL-6 and IFNgamma were the two major cytokines detected whereas TNFalpha production was never observed.
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Affiliation(s)
- C Carnoy
- Equipe Mixte INSERM E 9919, Université JE 2225, Institut de Biologie de Lille, France.
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Abstract
Yersinia pseudotuberculosis, a gram-negative bacterium responsible for enteric and systemic infection in humans, produces a superantigenic toxin designated YPMa (Y. pseudotuberculosis-derived mitogen). To assess the role of YPMa in the pathogenesis of Y. pseudotuberculosis, we constructed a superantigen-deficient mutant and compared its virulence in a mouse model of infection to the virulence of the wild-type strain. Determination of the survival rate after intravenous (i.v.) bacterial inoculation of OF1 mice clearly showed that inactivation of ypmA, encoding YPMa, reduced the virulence of Y. pseudotuberculosis. Mice infected i.v. with 10(4) and 10(5) wild-type bacteria died within 9 days, whereas mice infected with the ypmA mutant survived 12 and 3 days longer, respectively. This decreased virulence of the ypmA mutant strain was not due to an impaired colonization of the spleen, liver, or lungs. In contrast to i.v. challenge, bacterial inoculation by the intragastric (i.g.) route did not reveal any difference in virulence between wild-type Y. pseudotuberculosis and the ypmA mutant since the 50% lethal doses were identical for both strains. Moreover, inactivation of ypmA gene did not affect the bacterial growth of Y. pseudotuberculosis in Peyer's patches, mesenteric lymph nodes (MLNs), and spleen after oral infection. Histological studies of spleen, liver, lungs, heart, Peyer's patches, and MLNs after i.v. or i.g. challenge with the wild type or the ypmA mutant did not reveal any feature that can be specifically related to YPMa. Our data show that the superantigenic toxin YPMa contributes to the virulence of Y. pseudotuberculosis in systemic infection in mice.
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Affiliation(s)
- C Carnoy
- Equipe Mixte INSERM (E9919)-Université (JE 2225), Institut de Biologie de Lille, Lille, France.
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Aliouat EM, Escamilla R, Cariven C, Vieu C, Mullet C, Dei-Cas E, Prévost MC. Surfactant changes during experimental pneumocystosis are related to Pneumocystis development. Eur Respir J 1998; 11:542-7. [PMID: 9596099] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pneumocystosis-related surfactant changes have been reported in both humans and corticosteroid-treated experimental hosts. As corticosteroids induce an increase in pulmonary surfactant, some findings could be considered as controversial. The aim of this study was to investigate whether the surfactant composition changes during experimental pneumocystosis were related to the Pneumocystis development. In this work two corticosteroid-untreated animal models were used: rabbits, which develop spontaneous pneumocystosis at weaning; and severe combined immunodeficiency mice, which were intranasally inoculated with Pneumocystis carinii. Surfactant phospholipid and protein content was explored by bronchoalveolar lavage. The in vitro effect of surfactant on P. carinii growth was also explored. In the two models, the surfactant phospholipid/protein ratio was significantly increased, whereas parasite rates were low. This ratio decreases with the slope increase of the parasite growth curve. These early surfactant changes suggested that Pneumocystis proliferation requires alveolar lining fluid changes, and that normal surfactant is not suitable for parasite development. In this way, in vitro experiments presented here have revealed an inhibitory effect of synthetic or seminatural surfactants on the P. carinii growth. Further studies are needed to determine how Pneumocystis induces the reported early modifications of the surfactant, and why the parasite development is inhibited by pulmonary surfactant.
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Aliouat EM, Escamilla R, Cariven C, Vieu C, Mullet C, Dei-Cas E, Prevost MC. Surfactant changes during experimental pneumocystosis are related to Pneumocystis development. Eur Respir J 1998. [DOI: 10.1183/09031936.98.11030542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pneumocystosis-related surfactant changes have been reported in both humans and corticosteroid-treated experimental hosts. As corticosteroids induce an increase in pulmonary surfactant, some findings could be considered as controversial. The aim of this study was to investigate whether the surfactant composition changes during experimental pneumocystosis were related to the Pneumocystis development. In this work two corticosteroid-untreated animal models were used: rabbits, which develop spontaneous pneumocystosis at weaning; and severe combined immunodeficiency mice, which were intranasally inoculated with Pneumocystis carinii. Surfactant phospholipid and protein content was explored by bronchoalveolar lavage. The in vitro effect of surfactant on P. carinii growth was also explored. In the two models, the surfactant phospholipid/protein ratio was significantly increased, whereas parasite rates were low. This ratio decreases with the slope increase of the parasite growth curve. These early surfactant changes suggested that Pneumocystis proliferation requires alveolar lining fluid changes, and that normal surfactant is not suitable for parasite development. In this way, in vitro experiments presented here have revealed an inhibitory effect of synthetic or seminatural surfactants on the P. carinii growth. Further studies are needed to determine how Pneumocystis induces the reported early modifications of the surfactant, and why the parasite development is inhibited by pulmonary surfactant.
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Aliouat EM, Martinez A, Jimenez E, Dei-Cas E, Mullet C, Delcourt P, Gargallo-Viola D. Development of pneumocystosis animal models: corticosteroid-treated Wistar rat; SCID mouse and nude rat. J Eukaryot Microbiol 1997; 44:41S-42S. [PMID: 9508429 DOI: 10.1111/j.1550-7408.1997.tb05765.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Creusy C, Bahon-le Capon J, Fleurisse L, Mullet C, Dridba M, Cailliez JC, Antoine M, Camus D, Dei-Cas E. Pneumocystis carinii pneumonia in four mammal species: histopathology and ultrastructure. J Eukaryot Microbiol 1996; 43:47S-48S. [PMID: 8822850 DOI: 10.1111/j.1550-7408.1996.tb04983.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C Creusy
- Faculté Libre Médecine, Univ. Catholique, Lille, France
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Cortambert F, Marti-Flich J, Dasset MP, Mullet C. [The pharmacokinetics of propofol used in cesarean section; a preliminary study in the newborn infant]. Cah Anesthesiol 1989; 37:33-7. [PMID: 2784338] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A prospective study was carried out: 1) To compare the pharmacokinetics of propofol in two groups of patients: group 1 (eight pregnant women undergoing a prophylactic caesarean section at term), group 2 (control group: eight non pregnant women anaesthetized for short gynaecological procedures). 2) To study the kinetics of this agent in five newborns. Both groups were similar for weight, age, ASA I, oral premedication, anaesthetic method and duration. Dosages were performed using HPLC and results were statistically compared by Student's t-test. The haemodynamic parameters did not show large variations during induction. Propofol plasma levels were high (4,600 +/- 2,200 ng/ml-1) at intubation time; however, at extraction time (group 1) or 25 minutes after induction (group 2), plasma levels were close to anaesthetic threshold. The decreasing slopes were similar in the two groups. The quality of recovery in both groups was satisfactory. The first measured level in umbilical cord blood after birth was low, close to half of the maternal level, without any constant correlation. During the first hour of life, the drug catabolism is lesser in the newborn than in its mother, then plasmatic concentrations decrease similarly. Apgar scores were excellent in four of the five studied newborns; one child had a mean score notwithstanding a low propofol level (171 ng/ml-1), but recovery was perfect after a short oxygenation. There was no significant difference between pregnant women and control group with the propofol dose of 4 mg/kg-1 used for anaesthesia. Thus propofol appears to be convenient for prophylactic caesarean section without damage for the newborn.
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Affiliation(s)
- F Cortambert
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon
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Berland M, Miellet C, Broussalian G, Broussard P, Marsaud H, Monnet F, Mullet C. [The truth about noninvasive methods of obstetrical analgesia. Round table at the Lyons Seminars, 26 September 1986]. Rev Fr Gynecol Obstet 1988; 83:75-84. [PMID: 3283913] [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: 01/05/2023]
Affiliation(s)
- M Berland
- Faculté de Médecine Lyon Nord, Service de Gynécologie-Obstétrique
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