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Montastruc F, Muscari F, Tack I, Benevent J, Lafaurie M, de Canecaude C, Bagheri H, Despas F, Damase-Michel C, Durrieu G, Sommet A. Teaching pharmacovigilance to French medical students during the COVID-19 pandemic: Interest of distance learning clinical reasoning sessions. Therapie 2024:S0040-5957(24)00001-5. [PMID: 38267292 DOI: 10.1016/j.therap.2023.12.003] [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: 03/27/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Considering data from the literature in favor of active educational intervention to teach pharmacovigilance, we describe an innovative model of distance learning clinical reasoning sessions (CRS) of pharmacovigilance with 3rd year medical French students. METHODS The three main objectives were to identify the elements necessary for the diagnosis of an adverse drug reaction, report an adverse drug reaction and perform drug causality assessment. The training was organized in 3 stages. First, students practiced clinical reasoning (CRS) by conducting fictive pharmacovigilance telehealth consultations. Second, students wrote a medical letter summarizing the telehealth consultation and analyzing the drug causality assessment. This letter was sent to the teacher for a graded evaluation. In the third stage was a debriefing course with all the students. RESULTS Of the 293 third-year medical students enrolled in this course, 274 participated in the distance learning CRS. The evaluation received feedback from 195 students, with an average score of 8.85 out of 10. The qualitative evaluation had only positive feedback. The students appreciated the different format of the teaching, with the possibility to be active. CONCLUSION Through distance CRS of pharmacovigilance, medical students' competences to identify and report adverse drug reactions were tested. The students experienced the pharmacovigilance skills necessary to detect adverse drug reactions in a manner directly relevant to patient care. The overall evaluation of the students is in favor of this type of method.
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Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France.
| | - Fabrice Muscari
- Department of Health Education, Toulouse University Hospital, Faculty of Medicine, 31000 Toulouse, France; Department of Digestive Surgery, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Ivan Tack
- Department of Health Education, Toulouse University Hospital, Faculty of Medicine, 31000 Toulouse, France; Physiological Functional Investigations, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Justine Benevent
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Margaux Lafaurie
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Haleh Bagheri
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Fabien Despas
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Christine Damase-Michel
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Geneviève Durrieu
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
| | - Agnès Sommet
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France
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Montastruc F, Storck W, de Canecaude C, Victor L, Li J, Cesbron C, Zelmat Y, Barus R. Will artificial intelligence chatbots replace clinical pharmacologists? An exploratory study in clinical practice. Eur J Clin Pharmacol 2023; 79:1375-1384. [PMID: 37566133 DOI: 10.1007/s00228-023-03547-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/13/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Recently, there has been a growing interest in using ChatGPT for various applications in Medicine. We evaluated the interest of OpenAI chatbot (GPT 4.0) for drug information activities at Toulouse Pharmacovigilance Center. METHODS Based on a series of 50 randomly selected questions sent to our pharmacovigilance center by healthcare professionals or patients, we compared the level of responses from the chatbot GPT 4.0 with those provided by specialists in pharmacovigilance. RESULTS Chatbot answers were globally not acceptable. Responses to inquiries regarding the assessment of drug causality were not consistently precise or clinically meaningful. CONCLUSION The interest of chatbot assistance needs to be confirmed or rejected through further studies conducted in other pharmacovigilance centers.
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Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Wilhelm Storck
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Léa Victor
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Julien Li
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Candice Cesbron
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Yoann Zelmat
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France
| | - Romain Barus
- Department of Medical and Clinical Pharmacology, Centre of Pharmacovigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital (CHU), Toulouse, France.
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de Canecaude C, Montastruc F, Bergeron S, Sanchez-Pena P, Grandvuillemin A. French pharmacovigilance survey of casirivimab - imdevimab monoclonal antibodies in coronavirus disease (COVID-19). Therapie 2023; 78:517-522. [PMID: 36918316 PMCID: PMC9943551 DOI: 10.1016/j.therap.2023.02.004] [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: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Casirivimab and imdevimab (Ronapreve®) are two recombinant human monoclonal antibodies (mAbs) that bind to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, preventing the virus from entering cells. In March 2021, this drug was granted emergency use authorisation (EUA) in France for early treatment of COVID-19 in patients at increased risk of progression to severe COVID-19. In August/September 2021, the indication was expanded to COVID-19 prevention (pre- or post-exposure prophylaxis) and treatment of hospitalised patients requiring non-invasive oxygen therapy. The aim of the study was to better describe the adverse drug reaction (ADR) profile and detect safety signals of this new drug used in COVID-19 treatment. METHODS We described ADR profile with casirivimab/imdevimab reported as suspect/interacting drug to the French pharmacovigilance network and the pharmaceutical company between 17/03/2021 and 30/06/2022. Data presented correspond to the 2 periods of the pharmacovigilance survey: the first carried out by the pharmaceutical company for curative and prophylactic uses and the second by Toulouse university regional pharmacovigilance center (RPVC). RESULTS A total of 384 reports were analysed and 256 were "serious". ADR profile was comparable between the 2 periods and between curative and prophylactic use, corresponding to expected ADRs such as infusion-related reactions and hypersensitivity, inefficiencies or worsened infections and deaths. Two potential pharmacovigilance signals were also studied: acute pulmonary oedemas and sudden deaths. DISCUSSION No pharmacovigilance signal emerged from this 15 months French pharmacovigilance survey. Moreover data from published studies are also reassuring. This pharmacovigilance survey was the first one for the new version of EUA and with a new ADR reporting process i.e. declaration to the RPVC instead of the pharmaceutical company. Casirivimab/imdevimab is no longer used in France today but we continue to monitor this drug for any future evidence of resurgent activity on a new variant of Sars-CoV-2.
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Affiliation(s)
- Claire de Canecaude
- Service de pharmacologie médicale et clinique, centre régional de pharmacovigilance de pharmacoépidémiologie et d'informations sur le médicament (CRPV), centre hospitalier universitaire - Faculté de médecine, 31000 Toulouse, France.
| | - François Montastruc
- Service de pharmacologie médicale et clinique, centre régional de pharmacovigilance de pharmacoépidémiologie et d'informations sur le médicament (CRPV), centre hospitalier universitaire - Faculté de médecine, 31000 Toulouse, France
| | - Sandrine Bergeron
- Service de pharmacologie, centre régional de pharmacovigilance, centre hospitalier universitaire - Faculté de médecine, 59000 Lille, France
| | - Paola Sanchez-Pena
- Centre régional de pharmacovigilance, service de pharmacologie médicale, centre hospitalier universitaire, 33000 Bordeaux, France
| | - Aurélie Grandvuillemin
- Centre régional de pharmacovigilance, centre hospitalier universitaire, 21000 Dijon, France
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Aghnatios L, Karsenty C, Viard C, de Canecaude C, Durrieu G. Severe hepatitis after sevoflurane anesthesia in an 8-month old child with a Down syndrome: Case report and review of the literature. Therapie 2023; 78:459-462. [PMID: 36404159 DOI: 10.1016/j.therap.2022.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Lucas Aghnatios
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France
| | - Clément Karsenty
- Pediatric Cardiology Unit, Children's Hospital, CHU Toulouse, France; Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Caroline Viard
- Pediatric Pharmacy, Children's Hospital, CHU Toulouse, Université de Toulouse, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Régional de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU, 31000 Toulouse, France.
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Barus R, Montastruc F, de Canecaude C, Bagheri H, Sommet A, Lapeyre-Mestre M. Sublingual/Buccal buprenorphine and dental problems: a pharmacovigilance study. Expert Opin Drug Saf 2023; 22:1283-1287. [PMID: 37584264 DOI: 10.1080/14740338.2023.2247962] [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: 05/25/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The association between dental problems and sublingual/buccal buprenorphine is unclear. We conducted an analysis of dental adverse drug reactions reported with sublingual/buccal buprenorphine in VigiBase®, the pharmacovigilance database of the World Health Organization. RESEARCH DESIGN AND METHODS We performed disproportionality analyses to compare the reporting rates of dental problems with sublingual/buccal buprenorphine, compared to other buprenorphine formulations and methadone. Significant signals were considered if the lower boundary of the 95% confidence interval of the Reporting Odds Ratio (ROR) was > 1; cases were ≥ 3 and p-value <0.05. We conducted sensitivity analyses by calculating the ROR according to the reporter's qualification and the reporting continent (United States of America and Europe). RESULTS We included 30,769 reports with all buprenorphine forms. We found 20 cases of dental problems with sublingual/buccal buprenorphine. Sublingual/buccal buprenorphine was associated with an overreporting of dental problems compared to other buprenorphine formulations (ROR = 15.10; 95% CI [7.50-30.39]; p < 0.005) and compared to methadone (ROR = 6.02; 95% CI [3.21-11.30]; p < 0.005). Overreporting of dental problems was consistent in sensitivity analyses, except in Europe compared with other buprenorphine formulations and with methadone. CONCLUSIONS Sublingual/buccal buprenorphine might increase the risk of reporting dental problems. However, these results do not modify the benefits of sublingual/buccal buprenorphine in the treatment of opioid use disorders.
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Affiliation(s)
- Romain Barus
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Haleh Bagheri
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Agnès Sommet
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
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Montastruc F, de Canecaude C. Tixagevimab-Cilgavimab Treatment and Cardiovascular Events: Immortal Time Bias. Clin Infect Dis 2023; 76:2044-2045. [PMID: 36799347 DOI: 10.1093/cid/ciad089] [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] [Received: 01/16/2023] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Faculty of Medicine, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Faculty of Medicine, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, 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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Montastruc F, Lafaurie M, Flumian C, de Canecaude C. Increased reporting of venous and arterial thromboembolic events reported with tixagevimab-cilgavimab for coronavirus disease 2019. Clin Microbiol Infect 2022; 29:543.e1-543.e3. [PMID: 36464214 PMCID: PMC9714079 DOI: 10.1016/j.cmi.2022.11.026] [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: 07/18/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES As two phase three clinical trials indicated a disproportion in the number of thromboembolic events in the tixagevimab/cilgavimab group than in the placebo group, there has been a cardiovascular safety concern with the use of anti-SARS-CoV-2 monoclonal antibody (mAb). Whether tixagevimab/cilgavimab use in real life increases the risk of thromboembolic events is unclear. METHODS We used VigiBase, WHO's individual case safety reports database, to assess the risk of reporting arterial or venous thromboembolic events in patients with COVID-19 (aged ≥12 years) exposed to tixagevimab/cilgavimab compared with patients with COVID-19 exposed to other anti-SARS-CoV-2 mAbs, including casirivimab/imdevimab, bamlanivimab/etesevimab and sotrovimab. RESULTS Among the 8952 reports of patients with an anti-SARS-CoV-2 mAb, 31 reports of thromboembolic events were associated with tixagevimab/cilgavimab, mainly deep vein thrombosis (10), pulmonary embolism (8) and myocardial infarction (7). Compared with other anti-SARS-CoV-2 mAbs, the use of tixagevimab/cilgavimab was associated with an increased risk of reporting arterial thromboembolic events (reporting OR 3.25; 95% CI 1.73, 6.10). Concerning venous thromboembolic events, a significant increase in the risk of reporting was observed with the use of tixagevimab/cilgavimab (reporting OR 3.59; 95% CI 2.16, 5.96). DISCUSSION This observational study corroborates in a real-world setting in which the cardiovascular safety signal has already been found for tixagevimab/cilgavimab in two clinical trials. Owing to these thromboembolic safety concerns and considering the lack of clinical trials supporting protection against the omicron variant, there is an urgent need to improve knowledge on the effectiveness of tixagevimab/cilgavimab with new COVID-19 variants.
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Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France,Centre d’Investigation Clinique 1436, Team PEPSS, Pharmacologie En Population Cohortes et Biobanques, Toulouse University Hospital, France,Corresponding author. François Montastruc, Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Margaux Lafaurie
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France,Centre d’Investigation Clinique 1436, Team PEPSS, Pharmacologie En Population Cohortes et Biobanques, Toulouse University Hospital, France
| | - Clara Flumian
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
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Montastruc JL, Lafaurie M, de Canecaude C, Montastruc F, Bagheri H, Durrieu G, Sommet A. COVID-19 vaccines: A perspective from social pharmacology. Therapie 2021; 76:311-315. [PMID: 34119317 PMCID: PMC8161798 DOI: 10.1016/j.therap.2021.05.010] [Citation(s) in RCA: 3] [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: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022]
Abstract
Social pharmacology is a branch of clinical pharmacology, which depicts relationships between society and drugs and in particular factors, reasons, social consequences of drug use as well as representations of drugs in the society. Recent development and marketing of coronavirus disease 2019 (COVID-19) vaccines raises a number of questions of social pharmacology: are vaccines drugs like any other? What is their perception at the individual, population and societal levels? How do individuals perceive the risks and benefits of these vaccines? What is the perception at the societal level? What is the individual and societal acceptability of these vaccines during a pandemic? All these questions are discussed in the light of recent data. A number of proposals, both at the individual and at the collective or population level, are formulated to help solve these problems of social pharmacology.
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Affiliation(s)
- Jean-Louis Montastruc
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France.
| | - Margaux Lafaurie
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
| | - Claire de Canecaude
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
| | - François Montastruc
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
| | - Haleh Bagheri
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
| | - Geneviève Durrieu
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
| | - Agnès Sommet
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France
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Montastruc JL, Lafaurie M, de Canecaude C, Durrieu G, Sommet A, Montastruc F, Bagheri H. Fatal adverse drug reactions: A worldwide perspective in the World Health Organization pharmacovigilance database. Br J Clin Pharmacol 2021; 87:4334-4340. [PMID: 33837554 DOI: 10.1111/bcp.14851] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 01/15/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Adverse drug reactions (ADRs) are important causes of death. However, the main involved drugs are relatively unknown. The present study was performed to characterise death-related drugs recorded in a large pharmacovigilance database during the last 10 years. METHODS A retrospective analysis of VigiBase, the World Health Organization pharmacovigilance database, was performed investigating fatal ADRs registered between 1 January 2010 and 31 December 2019 in male and female patients aged ≥18 years and reported by physicians. Analyses were descriptive investigating age, sex and suspected drugs. Differences in reporting according to sex, age and continents were investigated using disproportionality analysis with calculation of reporting odds ratio and its 95% confidence interval. RESULTS Among the 23 millions ADRs recorded in VigiBase, 3 250 967 were included with 43 685 fatal. They were reported mainly in patients older than 75 years. The 3 most frequently involved drug classes were antineoplastic/immunomodulating drugs followed by nervous system and cardiac drugs. The top 3 individual drugs were denosumab, lenalidomide and thalidomide with marked differences according to age, sex, continents and countries. The risk of reporting fatal ADRs was higher in males, in the Americas and in patients ≥65 years. CONCLUSION Fatal ADRs registered in a large pharmacovigilance database during the last 10 years correspond to just over 1% of the total number of ADRs. They occurred more in males, after 65 years and with antineoplastic/immunomodulating drugs in general. Our study also highlighted, for the first time, important differences in fatal ADRs between continents and countries.
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Affiliation(s)
- Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Margaux Lafaurie
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Agnès Sommet
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
| | - Haleh Bagheri
- Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC INSERM, Centre Hospitalier Universitaire-Faculté de Médecine de Toulouse, 1436, France
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Peyro-Saint-Paul L, Besnier P, Demessine L, Biour M, Hillaire-Buys D, de Canecaude C, Fedrizzi S, Parienti JJ. Cushing's syndrome due to interaction between ritonavir or cobicistat and corticosteroids: a case-control study in the French Pharmacovigilance Database. J Antimicrob Chemother 2020; 74:3291-3294. [PMID: 31369085 DOI: 10.1093/jac/dkz324] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 07/02/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To explore the frequent interaction between antiretroviral-boosting agents and corticosteroids causing Cushing's syndrome (CS) in the French Pharmacovigilance Database (FPVD). METHODS We conducted a retrospective case-control study describing CS recorded in the FPVD between 1996 and 2018. Case was defined as CS occurring in people living with HIV (PLWH) and control was defined as CS in uninfected individuals. Drug-drug interaction (DDI) was defined as an interaction between corticosteroids and CYP3A4 inhibitors. Data concerning the DDI, corticosteroids involved, route of administration and seriousness of the CS were described. RESULTS Among the 139 instances of CS identified, 34/35 cases (97%) had DDIs (31 with ritonavir and 3 with cobicistat) and 7/104 controls (7%) had DDIs (6 with itraconazole and 1 with verapamil). The main corticosteroid involved was inhaled fluticasone (28/35, 80%) among the cases and oral prednisone (38/104, 37%) among the controls. More CS cases (30/35, 86%) than CS controls (62/104, 60%) were serious (OR = 4.0, 95% CI = 1.4-14.4; P = 0.007). CONCLUSIONS Antiretroviral-boosting agents were responsible for one out of four iatrogenic CS cases in a French national database. Prescribers should be aware of the risk of potentially serious DDIs between antiretroviral-boosting agents and corticosteroids, including single-tablet regimens containing cobicistat.
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Affiliation(s)
- Laure Peyro-Saint-Paul
- Department of Biostatistics and Clinical Research, University Hospital of Caen Normandy, Caen, France
| | - Paul Besnier
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Ludivine Demessine
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Michel Biour
- Centre Régional de Pharmacovigilance, University Hospital of Paris Saint-Antoine, Paris, France
| | - Dominique Hillaire-Buys
- Centre Régional de Pharmacovigilance, University Hospital of Montpellier, Montpellier, France
| | - Claire de Canecaude
- Centre Régional de Pharmacovigilance, University Hospital of Toulouse, Toulouse, France
| | - Sophie Fedrizzi
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, University Hospital of Caen Normandy, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), University of Caen Normandy, Caen, France
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de Canecaude C, Rousseau V, Chebane L, Lafaurie M, Durrieu G, Montastruc JL. Can tramadol really induce hyponatraemia? A pharmacovigilance study. Br J Clin Pharmacol 2020; 87:683-686. [PMID: 32470196 DOI: 10.1111/bcp.14401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/28/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022] Open
Abstract
Several papers have described hyponatraemia with tramadol. However, in most reports, several confounding factors can be found. We used the WHO pharmacovigilance database (VigiBase®) to investigate if tramadol alone could be associated with hyponatraemia. All 1992-2019 ICSRs (individual case safety reports) with the preferred term (PT) "hyponatraemia" and tramadol were included. Two disproportionality analyses were performed: (1) after inclusion of all reports, and (2) after exclusion of concomitant hyponatraemic drugs. Results are expressed as reporting odds ratios (ROR; 95% CI) and information component (IC). Of 19 747 604 ICSRs, 225 575 were included. A significant association was found between tramadol use and reports of hyponatraemia (ROR = 1.49 [1.39-1.60], IC = 0.57 [IC025 = 0.47]). After exclusion of hyponatraemic drugs, the previously found association disappeared. The study failed to find any pharmacovigilance signal of hyponatraemia with tramadol alone. We suggest that reports of hyponatraemia with tramadol can be explained principally by other underlying causes of hyponatraemia, especially other concomitant hyponatraemic drugs.
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Affiliation(s)
- Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
| | - Leila Chebane
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
| | - Margaux Lafaurie
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM UMR 1027, CIC 1426, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, France
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Jacquot J, Rousseau V, de Canecaude C, Montastruc JL, Durrieu G. Interest of a general practitioner pharmacovigilance network to provide drug information: A comparative study in France. Therapie 2020; 75:617-622. [PMID: 32354462 DOI: 10.1016/j.therap.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/09/2019] [Revised: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Since 2015, Toulouse University PharmacoVigilance Center (TUPVC) set up a pharmacovigilance (PV) general practitioner (GP) network, called PharmacoMIP-MG. A clinical research assistant (CRA) moves to the office of GPs included in the PharmacoMIP-MG network (PMIP-GPs). There, he collects the adverse drug reaction (ADR) reports and drug-related questions. This additional support is not available to GPs not included in the PV network (NoPMIP-GPs) who have to ask drug questions spontaneously to the TUPVC. OBJECTIVE The objective of this study was to compare the number and characteristics of drug questions between PMIP-GPs and NoPMIP-GPs. METHODS All questions asked by GPs to the TUPVC from 01 Jan 2015 to 31 Dec 2017 were reviewed. Questions were classified into two groups: "general" and "related to a patient". The "related to a patient" category was divided in three subgroups: "ADRs", Drug-Drug Interactions and "Drug Management". Drugs were classified according to anatomical therapeutic chemical (ATC) classification. For comparisons, Wilcoxon test, Chi2 test or Fisher test were used. RESULTS During the study period, the CRA collected 293 questions from the 165 PMIP-GPs. TUPVC received 333 questions asked spontaneously by the 3400 NoPMIP-GPs. PMIP-GPs asked significantly 3 times more questions than NoPMIP-GPs. Most of the GP questions were classified in the "related to a patient" category (74.9%). When we compared the proportion of "related to a patient" to "general" questions, there was no statistically significant difference between PMIP-GPs and NoPMIP-GPs. PMIP-GPs asked more questions about "ADRs", but less on "Drug Management" and or "Drug-Drug Interactions". The drugs most frequently involved were amiodarone, rivaroxaban and levothyroxine. CONCLUSION This is the first study about GPs' drug-related questions asked to a PV center. We found that an organization, such as a CRA-GP "face to face" visit, increased the number of drug questions. This kind of organization should be developed in order to improve independent drug information outreach.
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Affiliation(s)
- Julien Jacquot
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, laboratoire de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Pharmacopôle, faculté de médecine de Toulouse, centre hospitalier universitaire, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Vanessa Rousseau
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, laboratoire de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Pharmacopôle, faculté de médecine de Toulouse, centre hospitalier universitaire, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Claire de Canecaude
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, laboratoire de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Pharmacopôle, faculté de médecine de Toulouse, centre hospitalier universitaire, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, laboratoire de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Pharmacopôle, faculté de médecine de Toulouse, centre hospitalier universitaire, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Geneviève Durrieu
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, laboratoire de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, Pharmacopôle, faculté de médecine de Toulouse, centre hospitalier universitaire, 37, allées Jules-Guesde, 31000 Toulouse, France.
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de Canecaude C, Gazagne C, Paraire M, Durrieu G. Tobramycine eye drops and ocular myasthenia gravis reactivation: A case report. Therapie 2020; 76:252-253. [PMID: 32171441 DOI: 10.1016/j.therap.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/05/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Claire de Canecaude
- Service de pharmacologie médicale, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, faculté de médecine, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France.
| | - Christophe Gazagne
- Centre narbonnais d'ophtalmologie, service d'ophtalmologie, 11100 Narbonne, France
| | - Magali Paraire
- Centre narbonnais d'ophtalmologie, service d'ophtalmologie, 11100 Narbonne, France
| | - Geneviève Durrieu
- Service de pharmacologie médicale, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, faculté de médecine, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
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Fouque C, Martin R, Seguro F, Montastruc JL, de Canecaude C. Splenic Infarction in a Narcoleptic Patient Treated With Methylphenidate, Venlafaxine, and Pitolisant. Ann Pharmacother 2020; 54:189-190. [DOI: 10.1177/1060028019872795] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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