1
|
Gaillard-Bigot F, Zendjidjian XY, Kheloufi F, Casse-Perrot C, Guilhaumou R, Micallef J, Fakra E, Azorin JM, Blin O. Quantitative System Pharmacology (QSP): An Integrative Framework for paradigm change in the treatment of the first-episode schizophrenia. Encephale 2019; 44:S34-S38. [PMID: 30935485 DOI: 10.1016/s0013-7006(19)30077-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite the lack of progress in the curative treatment of mental illness, especially schizophrenia, the accumulation of neuroscience data over the past decade suggests the re-conceptualization of schizophrenia. With the advent of new biomarkers and cognitive tools, new neuroscience technologies such as functional dynamic connectivity and the identification of subtle clinical features; it is now possible to detect early stages at risk or prodromes of a first psychotic episode. Current concepts reconceptualizes schizophrenia as a neurodevelopmental disorder at early onset, with polygenic risk and only symptomatic treatment for positive symptoms at this time. The use of such technologies in the future suggests new diagnostic and therapeutic options. Next steps include new pharmacological perspectives and potential contributions of new technologies such as quantitative system pharmacology brain computational modeling approach.
Collapse
Affiliation(s)
- F Gaillard-Bigot
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - X-Y Zendjidjian
- Pôle psychiatrie centre, hôpital de la Conception, assistance publique des hôpitaux de Marseille, Marseille, France
| | - F Kheloufi
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - C Casse-Perrot
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - R Guilhaumou
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - J Micallef
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - E Fakra
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France, Inserm U1059, University of Lyon, Saint-Etienne F-42023, France
| | - J-M Azorin
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France
| | - O Blin
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France.
| |
Collapse
|
2
|
Lacroix C, Kheloufi F, Montastruc F, Bennis Y, Pizzoglio V, Micallef J. Serious central nervous system side effects of cephalosporins: A national analysis of serious reports registered in the French Pharmacovigilance Database. J Neurol Sci 2019; 398:196-201. [PMID: 30683462 DOI: 10.1016/j.jns.2019.01.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Among antibiotics, Central Nervous System (CNS) adverse drug reactions (ADRs) are often under-suspected and overlooked. Cephalosporins are an important cause of drug-induced CNS ADRs but the characteristics of such ADR have not been fully explored. We aimed to characterize the profile of cephalosporins serious CNS ADRs. METHOD We performed an analysis of serious reports recorded in the French Pharmacovigilance database from 1987 to 2017. RESULTS A total of 511 serious ADRs reports was analyzed. Patients had a mean age of 67.1 years and were mainly men (52.5%), with a mean creatinine clearance of 32.9 ml/min. The most involved molecules were cefepime (33.1%), ceftriaxone (29.7%), ceftazidime (19.6%), cefotaxime (9%) and cefazoline (2.9%), mostly administered intravenously (87.3%). A CNS history was observed in 25% of the reports (n = 128). Patients exhibited encephalopathy (30.3%), confusional state (19.4%), convulsion (15.1%), myoclonia (9.4%), status epilepticus (9.2%), coma (6.3%) and hallucination (4.3%). The mean time of onset was 7.7 days and the mean duration was 6 days. Cephalosporin plasma levels were recorded for 153 patients (29.9%) and 107 were above the standards including 62 (57.9%) related to renal impairment. Electroencephalograms were performed in 38.2% (n = 195) of the patients and 81% (n = 158) were abnormal. CONCLUSION This study characterizes an off-target CNS ADRs of several cephalosporins. Ceftriaxone represented a large part of our reports after cefepime and it would be relevant to warn healthcare professionals. Investigations (EEG, though plasma levels and renal function) can be precious tools for clinicians to make a prompt diagnosis and improve patients' outcomes.
Collapse
Affiliation(s)
- C Lacroix
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Kheloufi
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Montastruc
- Centre Midi-Pyrénées de Pharmacovigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Service de Pharmacologie Médicale et Clinique, Toulouse, France; Unité clinique de Pharmacologie psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Y Bennis
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - V Pizzoglio
- Centre Régional de Pharmacovigilance, Hospices Civils de Lyon, Lyon, France
| | - J Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France.
| |
Collapse
|
3
|
Kheloufi F, Default A, Rouby F, Laugier-Castellan D, Boyer M, Rodrigues B, Ponte-Astoul J, Jean-Pastor MJ, Blin O, Micallef J. Informativeness of patient initial reports of adverse drug reactions. Can it be improved by a pharmacovigilance centre? Eur J Clin Pharmacol 2017; 73:1009-1018. [PMID: 28391408 DOI: 10.1007/s00228-017-2254-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/29/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Little is known about the informativeness of initial patient reports before they are reviewed by a pharmacovigilance centre (PVC). We aim to describe the patterns of patient adverse drug reaction (ADR) reporting in France and estimate the contribution of a review by a PVC assessor on the informativeness of these reports. METHODS A retrospective study was conducted on patient reports between July 2011 and July 2015. Informativeness of 16 key elements of information (including drug start and end date, duration of treatment, time to onset and duration of the ADR, outcome, medical history and concomitant medication) was assessed in initial reports before and after review by a pharmacovigilance assessor. RESULTS Overall, 240 reports concerning 522 ADR and involving 278 drugs were reported over this 4-year period. Mean number of available key elements of information in initial reports was increased from 11/16 to 15/16 after review of reports by the PVC. Time to onset and duration of the ADR were respectively available in only 51 and 58% of the reports before review compared to 83 and 90% after review. Medical history and concomitant medication were missing in 75% of the initial reports compared to less than 30% of the reports after review. Contacting the reporter enabled an increase of informativeness of most elements of information for more than 90% of the reports. CONCLUSION Patient reports often need to be completed on key elements of information that are required to assess reports. Both upstream education of patients and downstream intervention of a pharmacovigilance assessor to complete missing information could help to enhance the informativeness of such reports.
Collapse
Affiliation(s)
- F Kheloufi
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS, 7289, Marseille, France
| | - A Default
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS, 7289, Marseille, France
| | - F Rouby
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS, 7289, Marseille, France
| | - D Laugier-Castellan
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - M Boyer
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - B Rodrigues
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - J Ponte-Astoul
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - M J Jean-Pastor
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - O Blin
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS, 7289, Marseille, France
| | - J Micallef
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique - Hôpitaux de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France.
- Aix Marseille Université, Institut de Neurosciences Timone, CNRS, 7289, Marseille, France.
| |
Collapse
|
4
|
Marsot A, Boucherie Q, Kheloufi F, Riff C, Braunstein D, Dupouey J, Guilhaumou R, Zendjidjian X, Bonin-Guillaume S, Fakra E, Guye M, Jirsa V, Azorin JM, Belzeaux R, Adida M, Micallef J, Blin O. [What can we expect from clinical trials in psychiatry?]. Encephale 2017; 42:S2-S6. [PMID: 28236988 DOI: 10.1016/s0013-7006(17)30046-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clinical trials in psychiatry allow to build the regulatory dossiers for market authorization but also to document the mechanism of action of new drugs, to build pharmacodynamics models, evaluate the treatment effects, propose prognosis, efficacy or tolerability biomarkers and altogether to assess the impact of drugs for patient, caregiver and society. However, clinical trials have shown some limitations. Number of recent dossiers failed to convince the regulators. The clinical and biological heterogeneity of psychiatric disorders, the pharmacokinetic and pharmacodynamics properties of the compounds, the lack of translatable biomarkers possibly explain these difficulties. Several breakthrough options are now available: quantitative system pharmacology analysis of drug effects variability, pharmacometry and pharmacoepidemiology, Big Data analysis, brain modelling. In addition to more classical approaches, these opportunities lead to a paradigm change for clinical trials in psychiatry.
Collapse
Affiliation(s)
- A Marsot
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - Q Boucherie
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - F Kheloufi
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - C Riff
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - D Braunstein
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - J Dupouey
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - R Guilhaumou
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - X Zendjidjian
- Service de Psychiatrie, Hôpital de la Conception, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - S Bonin-Guillaume
- Département de Gériatrie, Hôpital Sainte-Marguerite, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - E Fakra
- Service de Psychiatrie Adultes, CHU Saint-Étienne, 5 Chemin de la Marendière, 42055 Saint-Étienne cedex 2, France
| | - M Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, 13385 Marseille, France ; APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, CEMEREM, 13005 Marseille, France
| | - V Jirsa
- Aix-Marseille Université, Institut de Neurosciences des Systèmes, 13385 Marseille, France ; INSERM, UMR_S 1106, 13385 Marseille, France
| | - J-M Azorin
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - R Belzeaux
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - M Adida
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - J Micallef
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - O Blin
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France.
| |
Collapse
|
5
|
Guillaume-Jugnot P, Horreau C, Kheloufi F, Jean Pastor M, Brajon D, Berbis P. DRESS syndrome à la daltéparine sodique : première observation. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.590] [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: 10/24/2022]
|
6
|
Guillaume-Jugnot P, Bioul C, Horreau C, Kheloufi F, Secq V, Ebbo M, Jean-Pastor M, Brajon D, Harle J, Berbis P. Étonnant cas de DRESS syndrome induit à la daltéparine sodique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.269] [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: 10/25/2022]
|