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Timsit JF, Mootien J, Akrich B, Bourge X, Brassac I, Castan B, Mackosso C, Tavares LM, Ruiz F, Boutoille D, Ruimy R. Ceftolozane/Tazobactam for the Treatment of Complicated Infections in Hospital Settings-A French Real-world Study. Open Forum Infect Dis 2024; 11:ofae037. [PMID: 38390458 PMCID: PMC10883286 DOI: 10.1093/ofid/ofae037] [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: 08/28/2023] [Indexed: 02/24/2024] Open
Abstract
Background This study describes the conditions of use of ceftolozane/tazobactam (C/T) and associated outcomes in French hospital settings. Methods This was a prospective, multicenter, French observational study. Patients who received at least 1 dose of C/T were included and followed up as per routine clinical practice, until stop of C/T. Results A total of 260 patients were enrolled between October 2018 and December 2019 in 30 centers across France. Of these, 177 (68.0%) received C/T as per indication of usage following the results of the antibiogram (documented cases). Among documented patients, the mean age was 61.8 years, 73.4% were males, and 93.8% presented with multidrug-resistant (MDR) bacteria at inclusion. C/T was most frequently prescribed for pneumonia (48.6%), bacteremia (14.7%), complicated intra-abdominal infections (13.0%), or complicated urinary tract infections (9.6%). Pseudomonas aeruginosa was the species most frequently isolated with 212 strains from 155 patients, and 96.2% of these strains were susceptible to C/T. The median duration of C/T treatment was 16.1 days (1-115, n = 176). Complete or partial cure was achieved in 71.7% of patients, C/T was discontinued upon adaptation to microbiology results in 11.3% of patients for the following reasons: treatment failure in 2.8%, death in 4.0%, adverse events in 1.7%, and other in 8.5%. Conclusions This is the first prospective observational study of C/T utilization in a health care setting enrolling many patients in France. C/T demonstrated a high rate of clinical effectiveness in MDR infections, confirming it as an effective treatment option for complicated infections in a high-risk population.
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Affiliation(s)
| | - Joy Mootien
- Unité Fonctionnelle de Conseil en Antibiothérapie, CHU Mulhouse, Mulhouse, France
| | | | | | | | - Bernard Castan
- Service de Médecine Interne et Maladies Infectieuses, CH Périgueux, Périgueux, France
| | | | | | | | - David Boutoille
- Service des Maladies Infectieuses, Nantes Université, CIC 1413, Inserm, Nantes, France
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Klingmann V, Vallet T, Münch J, Wolters L, Stegemann R, Bosse HM, Ruiz F. Dosage Forms Suitability in Pediatrics: Acceptability of Antibiotics in a German Hospital. Antibiotics (Basel) 2023; 12:1709. [PMID: 38136743 PMCID: PMC10740640 DOI: 10.3390/antibiotics12121709] [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: 10/12/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Although drug acceptability can have a significant impact on patient adherence in pediatric therapy, data are limited, even for common therapeutic areas. We present the second part of an acceptability study conducted at the University Children's Hospital Düsseldorf, Germany. The study investigated the acceptability of most commonly used antibiotics in a pediatric hospital setting. The researchers used the acceptability reference framework to score the acceptability of five antibiotics based on 150 real-life observer reports of medicine intake. Four antibiotics assessed in this study were formulated as preparations for injection (ampicillin, ampicillin/sulbactam, ceftriaxone, and gentamicin) and one as a powder for oral liquid suspension (co-amoxiclav). All the antibiotics formulated as preparations for injection were rated negatively due to high rates of negative reactions (80%), the use of restraint (51%), the use of extra devices (99%), and long preparation and administration times (100%). The antibiotic formulated as a powder was significantly more well accepted. The study concluded that there is a lack of appropriate formulations for antibiotics for use in children. These findings are important in improving knowledge on acceptability drivers and might help in formulating and prescribing better medicines for children. The study highlights the need for healthcare professionals to have knowledge about the acceptability of different products to select the best-adapted product for each patient.
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Affiliation(s)
- Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France; (T.V.); (F.R.)
| | - Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Lena Wolters
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Robin Stegemann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France; (T.V.); (F.R.)
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Murdan S, Wei L, van Riet-Nales DA, Gurmu AE, Usifoh SF, Tăerel AE, Yıldız-Peköz A, Krajnović D, Azzopardi LM, Brock T, Fernandes AI, dos Santos ALS, Anto BP, Vallet T, Lee EE, Jeong KH, Akel M, Tam E, Volmer D, Douss T, Shukla S, Yamamura S, Lou X, van Riet BH, Usifoh CO, Duwiejua M, Ruiz F, Furnham A. Association between culture and the preference for, and perceptions of, 11 routes of medicine administration: A survey in 21 countries and regions. Explor Res Clin Soc Pharm 2023; 12:100378. [PMID: 38094713 PMCID: PMC10716026 DOI: 10.1016/j.rcsop.2023.100378] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 03/07/2024] Open
Abstract
Medicines can be taken by various routes of administration. These can impact the effects and perceptions of medicines. The literature about individuals' preferences for and perceptions of the different routes of administration is sparse, but indicates a potential influence of culture. Our aim was to determine: (i) any association between one's culture and one's preferred route of medicine administration and (ii) individual perceptions of pain, efficacy, speed of action and acceptability when medicines are swallowed or placed in the mouth, under the tongue, in the nose, eye, ear, lungs, rectum, vagina, on the skin, or areinjected. A cross-sectional, questionnaire-based survey of adults was conducted in 21 countries and regions of the world, namely, Tunisia, Ghana, Nigeria, Turkey, Ethiopia, Lebanon, Malta, Brazil, Great Britain, United States, India, Serbia, Romania, Portugal, France, Netherlands, Japan, South Korea, Hong Kong, mainland China and Estonia, using the Inglehart-Welzel cultural map to ensure coverage across all cultures. Participants scored the pain/discomfort, efficacy, speed of onset and acceptability of the different routes of medicine administration and stated their preferred route. Demographic information was collected. A total of 4435 participants took part in the survey. Overall, the oral route was the most preferred route, followed by injection, while the rectal route was the least preferred. While the oral route was the most preferred in all cultures, the percentage of participants selecting this route varied, from 98% in Protestant Europe to 50% in the African-Islamic culture. A multinomial logistic regression model revealed a number of predictors for the preferred route. Injections were favoured in the Baltic, South Asia, Latin America and African-Islamic cultures while dermal administration was favoured in Catholic Europe, Baltic and Latin America cultures. A marked association was found between culture and the preference for, and perceptions of the different routes by which medicines are taken. This applied to even the least favoured routes (vaginal and rectal). Only women were asked about the vaginal route, and our data shows that the vaginal route was slightly more popular than the rectal one.
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Affiliation(s)
| | - Li Wei
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | | | - Abyot Endale Gurmu
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Stella Folajole Usifoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Adriana-Elena Tăerel
- Faculty of Pharmacy, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Ayca Yıldız-Peköz
- Dept. of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Turkey
| | - Dušanka Krajnović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Lilian M. Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery University of Malta, Msida, Malta
| | - Tina Brock
- Department of Clinical Pharmacy, UCSF School of Pharmacy, UCSF Box 0622, 521 Parnassus Ave, San Francisco 94143, USA
| | - Ana I. Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Caparica, Almada, Portugal
| | | | - Berko Panyin Anto
- Dept of Clinical & Social Pharmacy, Faculty of Pharmacy & Pharmaceutical sciences, KNUST, Kumasi, Ghana
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | | | | | - Marwan Akel
- School of Pharmacy, Lebanese International University, Lebanon
- Inspect-Lb (Institut National De Santé Publique, D'épidémiologie Clinique Et De Toxicologie-Liban), Beirut, Lebanon
| | - Eliza Tam
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Daisy Volmer
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, 50411 Tartu, Estonia
| | | | - Sharvari Shukla
- Symbiosis Statistical Institute, Symbiosis International (Deemed University), Pune, India
| | - Shigeo Yamamura
- Department of Biostatistics, Faculty of Pharmaceutical Sciences, Josai International University, Togane, Chiba, Japan
| | | | - Bauke H.G. van Riet
- Department of Radiotherapy, Netherlands Cancer Institute (at the time of participant recruitment in the Netherlands: MEB and VU University Medical Center), Amsterdam, the Netherlands
| | - Cyril O. Usifoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Mahama Duwiejua
- Dept of Clinical & Social Pharmacy, Faculty of Pharmacy & Pharmaceutical sciences, KNUST, Kumasi, Ghana
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Adrian Furnham
- Dept Leadership and Orgnaisational Behaviour, Norwegian Business School, Norway
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Clapham D, Belissa E, Inghelbrecht S, Pensé-Lhéritier AM, Ruiz F, Sheehan L, Shine M, Vallet T, Walsh J, Tuleu C. A Guide to Best Practice in Sensory Analysis of Pharmaceutical Formulations. Pharmaceutics 2023; 15:2319. [PMID: 37765288 PMCID: PMC10535428 DOI: 10.3390/pharmaceutics15092319] [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: 08/10/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
It is well established that treatment regime compliance is linked to the acceptability of a pharmaceutical formulation, and hence also to therapeutic outcomes. To that end, acceptability must be assessed during the development of all pharmaceutical products and especially for those intended for paediatric patients. Although acceptability is a multifaceted concept, poor sensory characteristics often contribute to poor patient acceptability. In particular, poor taste is often cited as a major reason for many patients, especially children, to refuse to take their medicine. It is thus important to understand and, as far as possible, optimise the sensory characteristics and, in particular, the taste/flavour/mouthfeel of the formulation throughout the development of the product. Sensory analysis has been widely practiced, providing objective data concerning the sensory aspects of food and cosmetic products. In this paper, we present proposals concerning how the well-established principles of sensory analysis can best be applied to pharmaceutical product development, allowing objective, scientifically valid, sensory data to be obtained safely. We briefly discuss methodologies that may be helpful in reducing the number of samples that may need to be assessed by human volunteers. However, it is only possible to be sure whether or not the sensory characteristics of a pharmaceutical product are non-aversive to potential users by undertaking sensory assessments in human volunteers. Testing is also required during formulation assessment and to ensure that the sensory characteristics remain acceptable throughout the product shelf life. We provide a risk assessment procedure to aid developers to define where studies are low risk, the results of a survey of European regulators on their views concerning such studies, and detailed guidance concerning the types of sensory studies that can be undertaken at each phase of product development, along with guidance about the practicalities of performing such sensory studies. We hope that this guidance will also lead to the development of internationally agreed standards between industry and regulators concerning how these aspects should be measured and assessed throughout the development process and when writing and evaluating regulatory submissions. Finally, we hope that the guidance herein will help formulators as they seek to develop better medicines for all patients and, in particular, paediatric patients.
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Affiliation(s)
- David Clapham
- Independent Researcher, Bishop’s Stortford CM23 4FQ, UK
| | | | | | | | - Fabrice Ruiz
- ClinSearch, 92240 Malakoff, France; (F.R.); (T.V.)
| | - Liz Sheehan
- SRL Pharma, T12 XF62 Cork, Ireland; (L.S.); (M.S.)
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Ruiz F, Nunn A, Gill A, Clapham D, Fotaki N, Salunke S, Cram A, O'Brien F. A review of paediatric injectable drug delivery to inform the study of product acceptability - an introduction. Eur J Pharm Biopharm 2023:S0939-6411(23)00090-5. [PMID: 37100092 DOI: 10.1016/j.ejpb.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/01/2022] [Revised: 02/23/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
AIM The EMA defines acceptability as "the overall ability and willingness of the patient to use, and their caregiver to administer, the medicine as intended" [1]. This paper seeks to outline issues of acceptability in relation to injectable therapy, namely intravenous (IV), intramuscular (IM) and subcutaneous (SC) administration routes, and to lay a foundation to identify a minimum set of data that would satisfy Regulatory Authorities when discussing the acceptability of an injectable product. In addition, it will alert drug product developers to other factors that might contribute to good practice, alternative administration strategies and overall adherence to achieve successful treatment. Whilst the term 'parenteral' means "outside the intestine" [2,3] and so potentially covers a range of administration routes including intranasal and percutaneous administration, this review focuses on IV, IM and SC administration by injection. The use of indwelling canulae or catheters to reduce venepuncture and facilitate prolonged treatment is common and may impact acceptability [4]. This may be influenced by information provided by the manufacturer but is not always in their direct control. Other injectable products suitable for routes such as intradermal, intra-articular, intraosseous and intrathecal, share the requirement to be acceptable but are not specifically covered in this paper [2,5].
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Affiliation(s)
- Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Anthony Nunn
- University of Liverpool, Department of Women's and Children's Health, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS UK
| | - Andrea Gill
- Paediatric Medicines Research Unit, Alder Hey Children's NHSFT, Liverpool, L12 2AP UK
| | | | - Nikoletta Fotaki
- Department of Life Sciences, Centre for Therapeutic Innovation (CTI), University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Smita Salunke
- European Paediatric Formulation Initiative (EUPFI) School of Pharmacy, University College London, London WC1N 1AX, UK
| | - Anne Cram
- Pfizer R&D UK Ltd, Ramsgate Road, Sandwich CT13 9ND, UK
| | - Fiona O'Brien
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin 2, Ireland
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Granet J, Peyrusqué E, Ruiz F, Buckinx F, Abdelkader LB, Dang-Vu TT, Sirois MJ, Gouin JP, Pageaux B, Aubertin-Leheudre M. Online physical exercise intervention in older adults during lockdown: Can we improve the recipe? Aging Clin Exp Res 2023; 35:551-560. [PMID: 36635450 PMCID: PMC9838396 DOI: 10.1007/s40520-022-02329-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/16/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recorded and live online physical exercise (PE) interventions are known to provide health benefits. However, the effects of prioritizing the number of live or recorded sessions remain unclear. AIMS To explore which recorded-live sessions ratio leads to the best implementation and benefits in older adults. METHODS Forty-six community-dwelling adults (> 60y.o.) were randomized into two groups completing a 12-week online PE intervention. Each group had a different ratio of live-recorded online sessions as follows: Live-Recorded-Live sessions (LRL; n = 22) vs. Recorded-Live-Recorded sessions (RLR; n = 24). RESULTS Drop-out rates did not reach significance (LRL:14% vs. RLR: 29%, p = 0.20), and adherence was similar (> 85%) between groups. Both groups reported similar levels of satisfaction (> 70%), enjoyment (> 75%), and perceived exertion (> 60%). Both groups increased physical health and functional capacities, with greater improvements in muscle power (LRL: LRL: + 35 ± 16.1% vs. RLR: + 7 ± 13.9%; p = 0.010) and endurance (LRL: + 34.7 ± 15.4 vs. RLR: + 27.0 ± 26.5, p < 0.001) in the LRL group. DISCUSSION Both online PE intervention modalities were adapted to the participants' capacities and led to a high level of enjoyment and retention. The greater physical improvements observed in the LRL group are likely due to the higher presence of the instructor compared to the RLR group. Indeed, participants received likely more feedback to appropriately adjust postures and movements, increasing the quality of the exercises. CONCLUSION When creating online PE interventions containing both recorded and live sessions, priority should be given to maximizing the number of live sessions and not the number of recorded sessions.
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Affiliation(s)
- J Granet
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - E Peyrusqué
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - F Ruiz
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - F Buckinx
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - L Ben Abdelkader
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - T T Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Department of Health, Kinesiology and Applied Physiology, PERFFORM Centre and Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, Québec, Canada
| | - M J Sirois
- Department of Physiotherapy, Laval University, Québec city, Québec, Canada
| | - J P Gouin
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Department of Psychology, Concordia University, Montréal, Québec, Canada
| | - B Pageaux
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Faculté de médecine, École de kinésiologie et des sciences de l'activité physique (EKSAP), Université de Montréal, Montréal, Québec, Canada
| | - M Aubertin-Leheudre
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada.
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Melado L, Lawrenz B, Vitorino RL, Patel R, Ruiz F, Marques LM, Bayram A, Elkhatib I, Fatemi H. Clinical and laboratory parameters associated with pregnancy outcomes in patients undergoing frozen euploid blastocyst transfer. Reprod Biomed Online 2023:S1472-6483(23)00153-0. [PMID: 37062636 DOI: 10.1016/j.rbmo.2023.02.014] [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] [Received: 09/25/2022] [Revised: 01/03/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
RESEARCH QUESTION Which factors impact on clinical pregnancy rate (CPR) and live birth rates (LBR) in euploid frozen embryo transfer (eFET) cycles? DESIGN Retrospective observational study including 1660 eFET cycles with 2439 euploid blastocysts, from November 2016 to December 2020. The impact of clinical and laboratory parameters on CPR, biochemical miscarriage rate (BMR), clinical miscarriage rate (CMR) and LBR was evaluated. RESULTS CPR per transfer was 63.4%, LBR per transfer 51.6%. CPR and LBR were significantly higher when double embryo transfer (DET) was performed (71.6% versus 57.7%, P < 0.001; 55.2% versus 49.1%, P = 0.016, respectively). However, pregnancy loss was significantly higher in the DET group (28.8% versus 22.8%, P = 0.02). When patients were classified by body mass index (BMI), no differences were observed for CPR, but CMR was lower (P < 0.001) and LBR higher (p = 0.031) for the normal BMI group. The natural cycle protocol revealed lower CMR (P < 0.001) and lower pregnancy loss (P < 0.001); subsequently, higher LBR (57.6%, 48.8%, 45.0%, P = 0.001) compared with hormonal replacement protocol and stimulated cycle. Day of trophectoderm biopsy affected CPR (P < 0.001) and LBR (P < 0.001), yet no differences were observed for BMR, CMR or pregnancy loss. The multivariate analysis showed that day 6/7 embryos had lower probabilities for pregnancy; overweight and obesity had a negative impact on LBR, and natural cycle improved LBR (adjusted odds ratio 1.445, 95% confidence interval 0.519-0.806). CONCLUSIONS Day of biopsy affected CPR, while BMI and endometrial preparation protocol were associated with LBR in eFET. DET should be discouraged as it will increase the risk of pregnancy loss. Women with higher BMI should be aware of the higher risk of pregnancy loss and lower LBR even though a euploid blastocyst is transferred.
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Moretti F, Ruiz F, Bonifazi F, Pizzo E, Kindblom JM. Health technology assessment of paediatric medicines: European landscape, challenges and opportunities inside the conect4children project. Br J Clin Pharmacol 2022; 88:5052-5059. [PMID: 34931373 PMCID: PMC9786554 DOI: 10.1111/bcp.15190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/25/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022] Open
Abstract
The medicine development process is complex and requires time and effort to ensure safety, efficacy and quality. In paediatrics, this process is even more challenging, as it involves a subgroup of the population that already faces a considerable gap in the clinical evaluation of medicines and devices compared to the adult population. Moreover, access to therapies is heavily influenced by national health technology assessment (HTA) recommendations, which often form the basis for pricing and reimbursement decisions that affect the availability of effective treatments within the national health systems. Yet performing an HTA to assess the relative effectiveness and cost-effectiveness of a new children's treatment has several non-trivial implications, creating a critical issue for the paediatric population. In addition, the advent of innovative health technologies for children emphasises the need to empower the role of HTAs in paediatrics. This article aims at describing the most relevant elements of the drug development process in the paediatric field by focusing on the HTA. Particular attention will be paid to the factors that influence market access for new paediatric medicines and patients' access to treatment. The article will also highlight some central methodological challenges in conducting HTA in the paediatric field. Finally, the article will provide insight into how initiatives, such as conect4children, may subsequently reinforce HTA awareness in the paediatric community and strengthen collaborations through network mechanisms.
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Affiliation(s)
- Francesco Moretti
- Arsenàl.IT—Centro Veneto Ricerca e Innovazione per la Sanità digitalePadovaItaly
| | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi OnlusBariItaly
| | - Elena Pizzo
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Jenny M. Kindblom
- Pediatric Clinical Research Center at the Queen Silvia Children's Hospital at Sahlgrenska University HospitalGöteborgSweden
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Ruiz F, Arrue BC, Ollero A. SOPHIE: Soft and Flexible Aerial Vehicle for Physical Interaction With the Environment. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3196768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F. Ruiz
- GRVC Robotics Lab of Seville, Seville, Spain
| | - B. C. Arrue
- GRVC Robotics Lab of Seville, Seville, Spain
| | - A. Ollero
- GRVC Robotics Lab of Seville, Seville, Spain
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Russell E, Dickinson K, Ruiz F, Mann M. 85 Quality improvement project: Human milk feeding and lactation support in a large pediatric cystic fibrosis clinic. J Cyst Fibros 2022. [PMCID: PMC9527893 DOI: 10.1016/s1569-1993(22)00776-7] [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: 12/04/2022]
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Pokharkar V, Sajith M, Vallet T, Akshantal S, Shah R, Ruiz F, Salunke S. Acceptability of different oral dosage forms in paediatric patients in hospital setting. Arch Dis Child 2022; 107:796-801. [PMID: 34799375 DOI: 10.1136/archdischild-2021-322604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/11/2021] [Accepted: 10/31/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The understanding of acceptability of existing dosage forms is limited in most of the world and hinders the development of acceptable, age-appropriate medicines. The attributes of paediatric medicine acceptability may differ from country to country based on culture, healthcare infrastructure and health policies. This study was designed to map the acceptability of oral medicines in paediatric patients treated in hospital in India. METHODS An observational, cross-sectional study was conducted in patients aged below 18 years and taking any form of oral medication. Acceptability scores were obtained using CAST-ClinSearch Acceptability Score Test tool. FINDINGS 490 patients were recruited and 193 evaluations of different pharmaceutical products available in 20 dosage forms and 7 routes of administration were studied. Oral liquids (50%) and tablets (35%) were the most commonly prescribed and administered forms. Regardless of the therapeutic class and age, the oral liquids were 'positively accepted' in infants and toddlers. Acceptability of tablets improved with age and appeared to be generally good from the age of 6. CONCLUSION This study indicates the limited progress towards adoption of age-appropriate dosage forms in India and thus impact on the acceptability of existing oral dosage forms. The key challenges posed by the adoption of age-appropriate formulations in India are (1) awareness of importance of appropriate administration and acceptability of medicines to children in India, (2) availability of age-appropriate dosage forms and (3) lack of child-appropriate medicine policies.
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Affiliation(s)
- Varsha Pokharkar
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | - Manjusha Sajith
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Shruti Akshantal
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | - Rathin Shah
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Smita Salunke
- School of Pharmacy, University College London, London, UK
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12
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Ruiz F, Liñán A, Elkhatib I, Bayram A, Abdala A, El-Damen A, Shanker U, Melado L, Lawrenz B, Fatemi H. P-589 Natural endometrial preparation for single euploid frozen embryo transfer increases the likelihood of live birth in obese patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.543] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does a natural endometrial preparation for single euploid frozen embryo transfer increase the odds of live birth (LB) in obese patients?
Summary answer
Compared to an artificial approach, a natural endometrial preparation for single euploid frozen embryo transfer improves the odds of LB in obese patients.
What is known already
Several protocols to prepare the endometrium for frozen embryo transfer have been described with comparable clinical outcomes, and no individual protocol has been demonstrated to be superior. Likewise, no specific patient group has been defined that can substantially benefit from a natural endometrial preparation. Despite obesity being linked to adverse clinical outcomes, observational studies and clinical trials have traditionally included participants with normal weight when comparing protocols, resulting in obese patients being underrepresented in clinical research. Therefore, studies focusing on endometrial preparation protocols for frozen embryo transfer that include obese patients are required.
Study design, size, duration
This study involved the analysis of a retrospective dataset including 975 single euploid frozen embryo transfer cycles performed at two tertiary referral centers between March 2017 and November 2019. The primary outcome was LB after natural and artificial endometrial preparation. Participants were stratified according to the World Health Organization Body mass index (BMI) classification into three groups (G): G1: Normal-weight ≤24.9 (n = 390), G2: Overweight 25 to 29.9 (n = 332), and G3: Obese ≥30 (n = 253).
Participants/materials, setting, methods
Cycles included infertility patients attempting a single euploid frozen blastocyst transfer under natural (n = 324) or artificial (n = 651) endometrial preparation. PGT-A was performed after trophectoderm biopsy using Next-Generation Sequencing. Spontaneous LH rise confirmed ovulation for natural endometrial preparation, and embryo transfer occurred five days after initial progesterone elevation. Hormones were measured from blood samples. For artificial preparation, embryo transfer was performed after oral estradiol and 120-hour vaginal progesterone exposure. All participants received luteal phase support.
Main results and the role of chance
Within each BMI group, no statistically significant differences in age were observed in patients between a natural and artificial endometrial preparation: G1 (33.5±5.1 vs. 32.7±5.2 years; p = 0.13), G2 (34.5±4.9 vs. 33.9±5.8 years; p = 0.39), and G3 (35.6±4.9 vs. 34.3±5.6 years; p = 0.1). Similarly, no statistically significant differences were observed regarding implantation rates: G1 (60% vs 57.1%; p = 0.57), G2 (54.8% vs 55.7%; p = 0.88), and G3 (64.3% vs 51.4%; p = 0.07). LB rates remained constant across all BMI groups when a natural preparation was conducted: G1 [56.66% (n = 85/150)], G2 [49.03% (n = 51/104)], and G3 [58.57% (n = 41/70)]. We observed a decrease in LB rates in G3 when an artificial endometrial preparation was performed: G1 [47.5% (n = 114/240)], G2 [44.73% (n = 102/228)], and G3 [34.42% (n = 63/183)]. The positive impact of a natural preparation on LB rates was more significant in G3, showing a 24% difference of effect between the natural and artificial endometrial preparations. Univariate logistic regression analysis showed a statistically significant difference in the primary outcome (LB) when a natural endometrial preparation was conducted in G3 (OR 2.69, 95% CI 1.53-4.74; p = 0.001), with no differences found in G1 (OR 1.45, 95% CI 0.96-2.18; p = 0.08) and G2 (OR 1.19, 95% CI 0.75-1.89; p = 0.73).
Limitations, reasons for caution
This study could be subject to bias due to its retrospective nature. Sperm quality was not considered for the present study.
Wider implications of the findings
Obese women appear to be the patient group that can obtain benefit from a natural endometrial preparation for frozen embryo transfer by increasing the odds of LB. Future prospective studies should confirm this hypothesis. A natural approach might be unfeasible in a subgroup of obese patients due to anovulatory cycles.
Trial registration number
not applicable
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Affiliation(s)
- F Ruiz
- ART Fertility Clinics, Medical Department , Abu Dhabi, United Arab Emirates
| | - A Liñán
- ART Fertility Clinics, Embryology Department , Muscat, Oman
| | - I Elkhatib
- ART Fertility Clinics, Embryology Department , Abu Dhabi, United Arab Emirates
| | - A Bayram
- ART Fertility Clinics, Embryology Department , Abu Dhabi, United Arab Emirates
| | - A Abdala
- ART Fertility Clinics, Embryology Department , Abu Dhabi, United Arab Emirates
| | - A El-Damen
- ART Fertility Clinics, Embryology Department , Abu Dhabi, United Arab Emirates
| | - U Shanker
- ART Fertility Clinics, Medical Department , Muscat, Oman
| | - L Melado
- ART Fertility Clinics, Medical Department , Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinics, Medical Department , Abu Dhabi, United Arab Emirates
| | - H Fatemi
- ART Fertility Clinics, Medical Department , Abu Dhabi, United Arab Emirates
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13
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Mattar S, Liñán A, Shanker U, Ruiz F, Elkhatib I, Lawrenz B, Fatemi H. P-358 Effect of endometrial thickness on biochemical pregnancy rate: an analysis of 1534 frozen euploid embryo transfers. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Can a thick endometrial lining measured prior to embryo transfer be considered a protective factor against Biochemical Pregnancy (BP)?
Summary answer
The risk of BP is independent of Endometrial Thickness (EMT), but rather dependent of the type of endometrial preparation and parity.
What is known already
Higher EMT prior to embryo transfer is associated with better clinical outcomes in general, like higher implantation and livebirth, and lower miscarriage rates. But up to our knowledge, no studies evaluated the effect of EMT on BP per say.
Study design, size, duration
This is a two-center retrospective observational study including a total of 1534 euploid Frozen Embryo Transfer (FET) cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE. BP is defined as blood beta-hCG >15 mIU/ml on day 12 post FET, that is progressively decreasing, with no evidence of gestational sac on ultrasound.
Participants/materials, setting, methods
The study group consisted of 112 cases of BP, while the control group consisted of the remaining 1422 FET’s that led to different clinical outcomes. EMT was measured by transvaginal ultrasound on the day of progesterone rise (±1 day); that rise was either spontaneous in Natural Cycles (NC), or iatrogenic in Hormone Replacement Therapy (HRT) cycles. Euploidy status of the embryos was assessed by NGS analysis of trophectoderm biopsies. Bivariate and multivariate analyses were conducted.
Main results and the role of chance
There was no difference in mean EMT between the study and the control groups (7.55 vs. 7.68 mm, p = 0.154).
Looking at the association of different variables with the rate of BP, there was no effect of age, BMI, AMH, number of embryos transferred, degree of blastocyst expansion, inner cell mass or trophectoderm grade, day of biopsy, nor presence of blood or mucus on the transfer catheter. However, patients on HRT cycles had significantly higher rates of BP compared to NC (8.42% vs. 4.99%, p = 0.015). Also, those with a previous livebirth had higher rates of BP compared to nulliparous women (8.7% vs. 5.39%, p = 0.014).
The distribution of BP showed that 54.5% occurred with EMT <7.5 mm, 34.8% with EMT 7.5-9 mm, and 10.7% with EMT >9 mm. These represents respectively 8.16%, 6.68%, and 5.94% of the total sample. This decreasing trend of BP with increasing EMT didn’t reach statistical significance (p = 0.429). Univariate analysis comparing the risk of BP in FET’s done with lower and higher EMT to those performed at 7.5-9 mm yielded similar conclusion: OR = 1.24 [0.82-1.88] for <7.5 mm, and OR = 0.88 [0.45-1.72] for >9 mm.
Controlling for different confounders, HRT cycles and multiparity remained as independent risk factors for BP.
Limitations, reasons for caution
Inter-observer variability in EMT measurement and the transfer technique, the retrospective nature of the study, and the lack of data on the mode of delivery of parous women could all have interfered with the conclusion.
Wider implications of the findings
The reduced adverse clinical outcomes with NC shed light on the role of the corpus luteum in the early phases of implantation, and some potential secreted mediators other than progesterone. Besides, the effect of previous deliveries on the endometrium and its receptivity needs further investigation.
Trial registration number
not applicable
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Affiliation(s)
- S Mattar
- ART Fertility Clinics, Clinical Infertility , Muscat, Oman
| | - A Liñán
- ART Fertility Clinics, IVF Laboratory , Muscat, Oman
| | - U Shanker
- ART Fertility Clinics, Clinical Infertility , Muscat, Oman
| | - F Ruiz
- ART Fertility Clinics, Clinical Infertility , Abu Dhabi, United Arab Emirates
| | - I Elkhatib
- ART Fertility Clinics, IVF Laboratory , Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinics, Clinical Infertility , Abu Dhabi, United Arab Emirates
- Women’s University Hospital of Tuebingen , Obstetrics, Tuebingen, Germany
| | - H.M Fatemi
- ART Fertility Clinics, Clinical Infertility , Abu Dhabi, United Arab Emirates
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14
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Marqueta L, Lawrenz B, Patel R, Loja Vitorino R, Ruiz F, Bayram A, Elkhatib I, Fatemi H, Melado L. P-628 Do ovarian reserve markers and female age predict the rate of euploid blastocysts in IVF/ICSI cycles? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.577] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Are female age and ovarian reserve markers (anti-Mullerian hormone (AMH) and Antral Follicle Count (AFC)), able to predict euploid blastocyst rate in IVF/ICSI cycles?
Summary answer
Female age, serum AMH, AFC and the number of mature oocytes collected during IVF/ICSI cycles significantly affect the rate of euploid blastocysts
What is known already
The age-associated decline in female reproduction has been clearly demonstrated, due to the reduction of the ovarian reserve and the increased risk of chromosomal abnormality occurring in the oocyte. Lately, it has been debated whether a reduced ovarian reserve, independently of age, could be associated with higher aneuploidy rate in embryos. Ovarian reserve can now be accurately measured by serum AMH levels and AFC, both markers with similar high reliability.
Study design, size, duration
This analysis includes data from 10556 blastocysts after preimplantation genetic testing for aneuploidy (PGT-A) with Next Generation Sequencing (NGS). Embryos were obtained from 2564 IVF/ICSI cycles of infertile couples, at ART Fertility Clinics UAE, from November 2016 to December 2020.
Participants/materials, setting, methods
10556 blastocysts with chromosomal information for ploidy were included, mosaic and non-informative embryos were excluded. Trophectoderm biopsy was performed on day 5, 6 or 7 blastocysts. Serum AMH concentrations were measured by Elecsys® AMH automated assay (Cobas 601 platform, Roche®) for all patients in a single laboratory. AFC (sum of small antral follicles in both ovaries) was evaluated with transvaginal 2D-sonography (Voluson E8, GE Healthcare). Ethical approval was obtained from the Research Ethics Committee (REFA023b).
Main results and the role of chance
Patients’ characteristics are described as mean ± SD (min-max): age: 34.72±6.13(18-50), years of infertility: 3.43±3.43(0-25), AMH: 2.52±2.70ng/mL(0.01-23.00), AFC: 11.57±7.86(0-61), body mass index (BMI): 28.57±4.83Kg/m2(14.34-44.96), Metaphase II (MII) inseminated oocytes: 10.11±6.53(1-50), 2PN embryos 7.32±5.12(1-42), blastocysts 4.12±3.21(1-26). Fertilization rate was 73.31%(±19.30), blastulation rate 61.05%(±25.69) and euploidy rate 39.42%(±35.24).
A significant negative Pearson correlation coefficient was found between age and euploidy rate (ρ=-0.5398, p < 0.001). AMH, AFC and total of MII inseminated oocytes showed a significant positive Pearson correlation coefficient with euploid rate (AMH:ρ=0.2076, p < 0.001; AFC: ρ = 0.2578, p < 0.001; MII:ρ=0.2036, p < 0.001). Linear regression analysis was conducted to evaluate the predictability of the variables on euploid rate. As expected, age clearly had a negative impact (Coef=-3.10, Std. Err=0.10, p < 0.0001). A positive effect was observed for AMH (Coef=2.75, Std. Err=0.31, p < 0.0001), AFC (Coef=1.16, Std. Err=0.09, p < 0.0001), number of MII inseminated oocytes (Coef=1.10, Std. Err=0.10, p < 0.0001) and 2PN embryos (Coef=1.43, Std. Err=0.13, p < 0.0001). For patients >35 years old and AMH lower than 1.3 ng/mL, euploid rate was significantly lower compared with the patients >35 years old and AMH equal or higher than 1.3 ng/mL (21.2% vs 25.5%, p = 0.0192).
Limitations, reasons for caution
Despite the large number of cycles and embryos included, the retrospective study design is a limitation.
Wider implications of the findings
Ovarian reserve is not only a quantitative, but also a qualitative biomarker of oocyte-embryo competence. Cumulative success rates for IVF/ICSI cycles are dependent on the availability of euploid blastocysts. Age and ovarian reserve markers should be combined for adequate counselling.
Trial registration number
Not applicable
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Affiliation(s)
- L Marqueta
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - R Patel
- ART Fertility Clinics, Research - Bio Statistics , Abu Dhabi, United Arab Emirates
| | - R Loja Vitorino
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - F Ruiz
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - A Bayram
- ART Fertility Clinics Abu Dhabi, Embryology , Abu Dhabi, United Arab Emirates
| | - I Elkhatib
- ART Fertility Clinics Abu Dhabi, Embryology , Abu Dhabi, United Arab Emirates
| | - H Fatemi
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - L Melado
- ART Fertility Clinics Abu Dhabi, Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
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15
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Vitorino R, Lawrenz B, Patel R, Marqueta L, Ruiz F, Bayram A, Elkhatib I, Fatemi H, Melado L. O-255 Clinical and laboratory factors associated with pregnancy outcomes in patients undergoing frozen euploid blastocyst transfer. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Which variables do have an impact on the pregnancy and live birth rates (LBR) when euploid frozen embryo transfers (FET) are performed?
Summary answer
Day of trophectoderm biopsy, Body Mass Index (BMI) and endometrial preparation protocol have an impact on pregnancy rate (PR) and LBR in FET cycles.
What is known already
Preimplantation genetic testing for aneuploidy (PGT-A) and morphological grading of embryos are the two main criteria to select a blastocyst from a pool of embryos, having the highest implantation potential. However, other clinical and laboratory variables might play a crucial role for a successful outcome when top quality euploid embryos are transferred in a FET cycle. It has been described that higher BMI increases the odds for miscarriage when compared with non-obese women.
Study design, size, duration
This analysis includes 1660 FET cycles with data from of pregnancy rates, miscarriage rate and LBR. Embryos were obtained from 2564 IVF/ICSI cycles of couples with primary or secondary infertility at ART Fertility Clinics UAE, from November 2016 to December 2020.
Participants/materials, setting, methods
A total of 1660 FET cycles with 2439 euploid blastocysts were included. FET cycles with mosaic or segmental aneuploid embryos were excluded. PGT-A was performed on trophectoderm cells, using Next Generation Sequencing (NGS). Biopsy was performed on day 5, 6 or 7 blastocysts. Endometrial preparation included ovulatory natural cycles (NC) and hormone replacement therapy (HRT) cycles, chosen according to physician’s discretion. Ethical approval was obtained from the Research Ethics Committee (REFA023b).
Main results and the role of chance
Patients’ characteristics are described as mean±SD (min-max): age: 33.5±5.43(19-47), AMH: 3.30±3.05ng/mL(0.01-23.00), BMI: 27.1±4.87Kg/m2(13.1-43.90), mean number of blastocysts transferred: 1.4±0.49(1-3). Patients were categorized according to age (years) in 4 categories (<30,n=404; 30-34,n=487; 35-40,n=595; >40,n=174) and no association with pregnancy rate (PR, p = 0.856), biochemical miscarriage rate (BMR, p = 0.940), clinical miscarriage rate (CMR, p = 0.06) nor LBR (p = 0.154) was found. BMI (kg/m2) was divided into four groups according to World Health Organization: underweight (<18.5;n=32), normal weight (18.5–24.9;n=555), overweight (25–29.9;n=622), and obese (≥30;n=426). Although no differences were seen for PR or BMR between groups (p = 0.507 and p = 0.343, respectively), CMR was significantly lower for normal BMI group (p < 0.001) and LBR significantly higher when compared to the overweight and obese group (<18.5kg/m2=68.42%; 18.5–24.9kg/m2=68.35%; 25–29.9kg/m2=60.14%; ≥30kg/m2=53.29%; p < 0.001). No differences were observed on the outcomes when AMH was sub-divided as per Bologna Criteria (<1.3ng/mL,n=327; ≥1.3ng/mL,n=1090). Regarding endometrial preparation, NC protocol showed significantly lower BMR and CMR (7.93% vs 12.27%,p=0.026; 8.44% vs 17.97%,p<0.001), and higher LBR (70.33% vs 55.06%,p<0.001) compared to HRT. Day of trophectoderm biopsy had a significant higher PR for day 5 (day 5=75.58% vs day 6=61.1% and day 7=23.81%, p < 0.0001), yet no differences were observed for BMR, CMR nor LBR.
Limitations, reasons for caution
Although the large number of FET included, performed in the same centre with same methodology, the retrospective study design is a limitation. We could not discard other hypothetical variables contributing to miscarriage such as KIR-HLA discrepancies, or other obstetric factors affecting late miscarriage and live birth.
Wider implications of the findings
Evaluating the factors associated with pregnancy outcomes should be considered prior to euploid frozen embryo transfer for personalized treatment approach and adequate blastocyst selection. Women with higher BMI should be aware of higher risk of miscarriage and lower LBR although an euploid blastocyst is transferred.
Trial registration number
not applicable
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Affiliation(s)
- R Vitorino
- ART Fertility Clinic - Abu Dhabi, Reproductive Medicine , Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinic - Abu Dhabi, Reproductive Medicine , Abu Dhabi, United Arab Emirates
| | - R Patel
- ART Fertility Clinic , Biostatistician, Abu Dhabi, United Arab Emirates
| | - L Marqueta
- ART Fertility Clinic - Abu Dhabi, Reproductive Medicine , Abu Dhabi, United Arab Emirates
| | - F Ruiz
- ART Fertility Clinic - Abu Dhabi, Reproductive Medicine , Abu Dhabi, United Arab Emirates
| | - A Bayram
- ART Fertility Clinic - Abu Dhabi , Embryologist, Abu Dhabi, United Arab Emirates
| | - I Elkhatib
- ART Fertility Clinic - Abu Dhabi , Embryologist, Abu Dhabi, United Arab Emirates
| | - H Fatemi
- ART Fertility Clinic - Abu Dhabi, Medical Director , Abu Dhabi, United Arab Emirates
| | - L Melado
- ART Fertility Clinic - Abu Dhabi, Clinical Director , Abu Dhabi, United Arab Emirates
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Liñán Tegedor A, Elkhatib I, Arnanz A, Bayram A, Abdala A, Ruiz F, Shanker U, Akram A, Melado L, Patel R, Lawrenz B, Fatemi H. P-137 ICM and TE quality significantly impact the live birth in euploid frozen blastocyst transfer cycles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.132] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is the live birth rate (LBR) in euploid frozen blastocyst transfer (FET) affected by the quality of ICM (Inner cell mass) and TE (Trophectoderm)?
Summary answer
ICM and TE significantly impacts the LBR with a decline of LB from 57.3% (ICM-A) to 48.5% (ICM-B) to 22.1% (ICM-C) (p < 0.001)
What is known already
The morphological blastocyst grading system proposed by Gardner-Schoolcraft remains the most accepted system to identify blastocysts with higher implantation potential. It relies on morphological features within the blastocyst, including ICM and TE. Several studies tried to identify the individual contribution of each. However, the conclusions remain contradictory and no clear consensus has yet been achieved. Due to heterogeneity of parameters evaluated between different publications, where embryos with unknown ploidy status were transferred in conjunction with a variability of stimulation protocols and in the number of transferred embryos, the real effect of the ICM and TE is difficult to infer.
Study design, size, duration
This two-center retrospective observational study includes a total of 977 euploid single FET cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE.
Participants/materials, setting, methods
Trophectoderm biopsies were analyzed with Next Generation Sequencing (NGS). All blastocysts available on D5 or D6 with a quality ≥ BL3CC were subjected to TE biopsy for PGT-A analysis and LBR was recorded. Vitrification/warming of blastocysts was performed using Cryotop method (Kitazato). Bivariate and multivariate analysis were performed between LB outcomes and ICM and TE grade while controlling for confounding factors.
Main results and the role of chance
A total of 977 single FET cycles were analyzed: 651 in hormone replacement therapy (HRT) and 326 in natural cycle regimen (NC) resulting in a 46.88% LBR. The mean patients’ age was 33.80 years with a mean Body Mass Index (BMI) of 26.80 kg/m2. Though all qualities of ICM and TE were associated with LB, blastocyst ICM-A LBR was statistically significantly higher (57.3%) than ICM-B (48.4%) and ICM-C (22.1%) (p < 0.001). Similarly, blastocyst TE-A LBR was statistically significantly higher (59.2%) than TE- B (48.6%) and TE- C (30.3%) (p < 0.001). Miscarriage rate was similar in all groups.
The grade of ICM and TE were significantly associated with Anti-Mullerian-Hormone (AMH) and day of blastocyst biopsy. Mean AMH (ng/ml) was higher in ICM groups (A: 3.78, B: 3.24, p < 0.001) and TE group (A: 3.63, B: 3.38, p < 0.05) compared to lower grade (ICM-C: 2.86, TE-C: 2.82).
In multivariate analysis, endometrial preparation for FET, BMI and AMH were the parameters influencing LBR: OR:1.45, [CI:1.07-1.96], p < 0.015) for NC; OR 0.96 [CI:0.93-0.99], p = 0.004 for BMI; OR 0.95 [CI:0.90-1.00], p = 0.033 for AMH; Both, ICM-C and TE-C, resulted in a significantly lower chance of LB [ICM: OR 0.32, CI:0.17-0.61, p < 0.001; TE: OR 0.44, CI:0.27-0.73, p = 0.002), compared to grade A.
Limitations, reasons for caution
The retrospective nature of the study and inter-observer variability in blastocyst scoring is a limitation. The physician/embryologist performing the embryo transfer could not been standardized due to the multicenter design. Randomized controlled studies are needed to determine whether ICM or TE should be prioritized in the selection of the blastocyst.
Wider implications of the findings
The ICM and TE scoring in FET may influence the LBR and should be considered as an important factor for the success of embryo transfer cycles. Whether these results can be extrapolated to fresh embryo transfer and to blastocysts with unknown ploidy status, needs further investigation.
Trial registration number
not applicable
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Affiliation(s)
- A Liñán Tegedor
- ART Fertility Clinics- Muscat- Sultanate of Oman, IVF Laboratory , Muscat, Oman
| | - I Elkhatib
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF Laboratory , Abu Dhabi, United Arab Emirates
| | - A Arnanz
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF Laboratory , Abu Dhabi, United Arab Emirates
| | - A Bayram
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF Laboratory , Abu Dhabi, United Arab Emirates
| | - A Abdala
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF Laboratory , Abu Dhabi, United Arab Emirates
| | - F Ruiz
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Specialist Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - U Shanker
- ART Fertility Clinics- Muscat- Sultanate of Oman, Specialist Reproductive Medicine and Infertility , Muscat, Oman
| | - A Akram
- ART Fertility Clinics- Muscat- Sultanate of Oman, Medical Operations , Muscat, Oman
| | - L Melado
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Specialist Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - R Patel
- ART Fertility Clinics, Department of Biostatistics , Gurugram- Haryana., India
| | - B Lawrenz
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Specialist Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
| | - H.M Fatemi
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Specialist Reproductive Medicine and Infertility , Abu Dhabi, United Arab Emirates
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17
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Stegemann S, Sheehan L, Rossi A, Barrett A, Paudel A, Crean A, Ruiz F, Bresciani M, Liu F, Shariff Z, Shine M, Schmelzer C, Pense-Lheritier AM. Rational and practical considerations to guide a Target Product Profile for patient-centric drug product development with measurable patient outcomes - A proposed roadmap. Eur J Pharm Biopharm 2022; 177:81-88. [PMID: 35718077 DOI: 10.1016/j.ejpb.2022.06.006] [Citation(s) in RCA: 3] [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: 05/20/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
The increasing awareness of acceptability and usability of pharmaceutical drug products by the patient as a key quality requirement continues to drive need for integrating patient centric drug product design into the pharmaceutical development process. The complex matrix of multiple drug product related decisions during the early drug development process often limits patient-centric drug product (PCDP) design options in the final commercial drug product development phase. To integrate the specific needs and perspectives of patients into drug development and product design process, a rational approach integrated into the complex development matrix is required from the start and weighs product development decision options accordingly. The aim of this work was to develop a roadmap for PCDP design in a multidisciplinary approach that leads to better usability, adherence and acceptance of the drug by patients via early integration into the development matrix. The proposed rational approach is based upon regulatory requirements and lessons learned from pediatric and geriatric drug development.
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Affiliation(s)
- Sven Stegemann
- Institute for Process and Particle Engineering, Graz University of Technology, Inffeldgasse 13, 8010 Graz, Austria.
| | - Liz Sheehan
- SRL, Office of Technology 2-44, Western Gateway Building, University College Cork, Ireland.
| | - Alessandra Rossi
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy.
| | - Andrew Barrett
- Drug Product Design, Pharmaceutical Sciences, Pfizer, Discovery Park House, Ramsgate Road, Sandwich, Kent CT13 9NJ, UK.
| | - Amrit Paudel
- Institute for Process and Particle Engineering, Graz University of Technology, Inffeldgasse 13, 8010 Graz, Austria; Research Center Pharmaceutical Engineering GmbH, Inffeldgasse 13, 8010 Graz, Austria.
| | - Abina Crean
- SSPC Pharmaceutical Research Centre, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue, Pierre Brossolette, 92240 Malakoff, France.
| | - Massimo Bresciani
- CMAC Technology and Innovation Centre, University of Strathclyde, 99 George Street, Glasgow G1 1RD, UK.
| | - Fang Liu
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK.
| | - Zakia Shariff
- School of Pharmacy, Aston University, Birmingham, B4 7ET, UK.
| | - Margarete Shine
- SRL, Office of Technology 2-44, Western Gateway Building, University College Cork, Ireland.
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18
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Klingmann V, Vallet T, Münch J, Stegemann R, Wolters L, Bosse HM, Ruiz F. Dosage Forms Suitability in Pediatrics: Acceptability of Analgesics and Antipyretics in a German Hospital. Pharmaceutics 2022; 14:pharmaceutics14020337. [PMID: 35214070 PMCID: PMC8879646 DOI: 10.3390/pharmaceutics14020337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/29/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Abstract
Although medicine acceptability is likely to have a significant impact on the patient’s adherence in pediatrics and therefore on therapy success, there is still little data even for common therapeutic areas. For analgesics/antipyretics, healthcare professionals face a wide variety of products and need knowledge to select the best adapted product for each patient. We investigated acceptability of those products most used at the University Children’s Hospital Düsseldorf, Germany. Based on 180 real-life observer reports of medicine intake, we used the acceptability reference framework to score acceptability of six distinct medicines. Both ibuprofen and paracetamol tablets, mainly used in adolescents, were positively accepted. This was not the case for the solution for injection of metamizole sodium. Regarding syrups, mainly used in children under 6 years of age, ibuprofen flavored with strawberry and provided with an oral syringe was positively accepted, while paracetamol flavored with orange and provided with a measuring cup was not. Suppository appeared to be an alternative to oral liquids in infants and toddlers with palatability and administration issues. Differences appeared to be driven by dosage forms and formulations. These findings improve knowledge on acceptability drivers and might help formulating and prescribing better medicines for children.
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Affiliation(s)
- Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
- Correspondence: (V.K.); (F.R.); Tel.: +49-211-81-17687 (V.K.); +33-1-4735-1717 (F.R.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Robin Stegemann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Lena Wolters
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Hans-Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
- Correspondence: (V.K.); (F.R.); Tel.: +49-211-81-17687 (V.K.); +33-1-4735-1717 (F.R.)
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19
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Ricciolini E, Rocchi L, Cardinali M, Paolotti L, Ruiz F, Cabello JM, Boggia A. Assessing Progress Towards SDGs Implementation Using Multiple Reference Point Based Multicriteria Methods: The Case Study of the European Countries. Soc Indic Res 2022; 162:1233-1260. [PMID: 35125614 PMCID: PMC8802750 DOI: 10.1007/s11205-022-02886-w] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
To achieve the UN 2030 Agenda Goals, and considering their complexity and multidisciplinary, Multi-criteria analysis appears to be a suitable approach to give a true support to public decision makers in defining policy lines. This study focuses on the application of the Multiple Reference Point Weak-Strong Composite Indicators (MRP-WSCI) and its partially compensatory version (MRP-PCI), to assess, in the framework of the UN 2030 Agenda, the sustainability of the 28 members of the European Union (pre-Brexit). Countries were analyzed and compared according to their conditions and progress against the 17 Sustainable Development Goals, considering three reference years: 2007, 2012 and 2017. The analysis shows that Nordic countries reach a good level of global sustainability, with values of the indicators, W-W-W and S-W-W, between 2 and 3; while the States of east Europe, in particular Romania, Bulgaria and Greece, stay at the worst levels, having overall indicators values less than 1.5. Furthermore, the results highlight how countries in the lower group have difficulties especially in social and economic sustainability. On the other hand, states with a good overall condition record the worst results in the environmental dimension, such as the Netherlands, which shows, for the year 2017, a value for this sphere less than 2, while in the other two show a good value (over 2.5).
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Affiliation(s)
- E. Ricciolini
- University of Perugia, Perugia, Italy
- Programa de Doctorado en Economía y Empresa, Universidad de Málaga, Málaga, Spain
| | - L. Rocchi
- University of Perugia, Perugia, Italy
| | | | | | - F. Ruiz
- University of Málaga, Málaga, Spain
| | | | - A. Boggia
- University of Perugia, Perugia, Italy
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20
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Perez F, Vallet T, Bravo Z, Callahan K, Ruiz F. Acceptability of Mebendazole Chewable Tablet in Children Aged 2 to 4 Years in Peru. Pharmaceutics 2021; 14:pharmaceutics14010027. [PMID: 35056923 PMCID: PMC8780656 DOI: 10.3390/pharmaceutics14010027] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023] Open
Abstract
Soil-transmitted helminthiasis (STH) is among the most common of parasitic infections, affecting vulnerable populations in tropical/subtropical areas globally. In endemic countries, children, a high-risk population, require treatment and preventive interventions. Mebendazole, a WHO-recommended medicine, originally formulated as a tablet that was often crushed for administration to young children unable to swallow it, was reformulated as a chewable tablet. Acceptability is a key aspect for treatment effectiveness in pediatrics. Herein, we used a validated data-driven approach to investigate the acceptability of the 500-mg mebendazole chewable tablet in children aged 2 to 4 years in Peru. Observer-reported outcomes were collected for 182 medicine intakes. Acceptability was scored using the acceptability reference framework: a three-dimensional map juxtaposing “positively accepted” and “negatively accepted” profiles. Results found that the 500-mg mebendazole chewable tablet was classified as “positively accepted” in children aged 2 to 4 years. Acceptability increased with age and some acceptability issue remain for the younger children. Nevertheless, this formulation was considerably better accepted than the conventional tablets regardless of treatment in young children. This chewable formulation appears to be an appropriate alternative to the hard tablet of mebendazole for treatment of STH and preventive interventions in children aged 2 to 4 years.
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Affiliation(s)
- Fernando Perez
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Zarela Bravo
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Kristin Callahan
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
- Correspondence: ; Tel.: +33-1-4735-1717
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21
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Jani YH, Liu F, Orlu M, Desai N, du Chayla F, Ruiz F, Vallet T. Medicine acceptability for older people in hospital and care home: the influence of setting. Int J Pharm Pract 2021; 30:67-74. [PMID: 34908100 DOI: 10.1093/ijpp/riab077] [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: 11/13/2020] [Accepted: 11/23/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Medicines acceptability is likely to have a significant impact on older people's adherence and, consequently, treatment effectiveness. The objective was to explore the influence of setting on medicines acceptability in older people. METHODS A multi-centre, prospective, cross-sectional, observational study was conducted in one care home and one elderly care hospital ward in London, UK, involving individuals on ≥1 medicine(s) and aged ≥65 years. Data-driven approach was applied using multiple observer-reported outcomes analysis tool to distinguish between positively and negatively accepted medicines. KEY FINDINGS 263 observer reports from the care home (n = 97) and hospital ward (n = 166) involving 155 distinct medicinal products were assessed. Collectively, medicines appeared better accepted by patients at the hospital. Differences appeared to be driven by variations in solid oral dosage form (SODF) acceptability. Patients with dysphagia poorly accepted medicines in both settings, as expected. SODFs were unexpectedly better accepted in the hospital than in the care home in patients without dysphagia. CONCLUSIONS Medicines acceptability was affected by patient's characteristics, dosage form type and setting. Changes in care practices between care home and hospital may affect medicine administration and lead to variations in the ability and willingness of patients and carers to use the product as intended.
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Affiliation(s)
- Yogini H Jani
- Centre for Medicines Optimisation Research and Education, UCLH NHS Foundation Trust and UCL School of Pharmacy, London, UK
| | - Fang Liu
- Department of Clinical Pharmaceutical and Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Mine Orlu
- UCL School of Pharmacy, University College London, London, UK
| | - Neel Desai
- UCL School of Pharmacy, University College London, London, UK
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22
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Vallet T, Bensouda Y, Saito J, Mathiesen L, Pokharkar V, Klingmann V, Peak M, Elhamdaoui O, Yamatani A, Ivanovic I, Sajith M, Münch J, Bracken L, Duncan JC, Salunke S, Wang S, Ruiz F. Exploring Acceptability Drivers of Oral Antibiotics in Children: Findings from an International Observational Study. Pharmaceutics 2021; 13:1721. [PMID: 34684014 PMCID: PMC8537532 DOI: 10.3390/pharmaceutics13101721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Antibiotics are among the most commonly prescribed drugs in children. Adherence to the treatment with these drugs is of the utmost importance to prevent the emergence of resistant bacteria, a global health threat. In children, medicine acceptability is likely to have a significant impact on compliance. Herein we used a multivariate approach, considering simultaneously the many aspects of acceptability to explore the drivers of oral antibiotic acceptability in children under twelve, especially in toddlers and in preschoolers. Based on 628 real-life observer reports of the intake of 133 distinct medicines, the acceptability reference framework highlighted the influence of many factors such as age and sex of patients, previous exposure to treatment, place of administration, administration device, flavor agent in excipients and active pharmaceutical ingredient. These findings from an international observational study emphasize the multidimensional nature of acceptability. Therefore, it is crucial to consider all these different aspects for assessing this multi-faceted concept and designing or prescribing a medicine in order to reach adequate acceptability in the target population.
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Affiliation(s)
| | - Yahya Bensouda
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Jumpei Saito
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Liv Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Varsha Pokharkar
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Viviane Klingmann
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Omar Elhamdaoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Akimasa Yamatani
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Ivana Ivanovic
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Manjusha Sajith
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Juliane Münch
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Louise Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Jennifer Claire Duncan
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Smita Salunke
- Department of Pharmaceutics, University College London School of Pharmacy, London WC1N 1AX, UK;
| | - Siri Wang
- Norwegian Medicines Agency, 0213 Oslo, Norway;
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23
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Clapham D, Bennett J, Cram A, Discihnger A, Inghelbrecht S, Pense-Lheriter AM, Ruiz F, Salunke S, Schiele J, Soto J, Walsh J, Tuleu C. Proposed Tool to Compare and Assess the Applicability of Taste Assessment Techniques for Pharmaceuticals. J Pharm Sci 2021; 111:1219-1223. [PMID: 34499899 DOI: 10.1016/j.xphs.2021.09.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Palatability is amongst the most important determinants of whether or not a child will take a medicine. In order to increase concordance with treatment regimens it is often necessary to utilise a range of formulation techniques to improve the palatability of medicines. These can include selecting a different molecule or version of a molecule (such as a different polymorph or salt form), various taste masking techniques and/or the inclusion of flavours and sweeteners. In order to be able to understand the taste of the Active Pharmaceutical Ingredient (API) and to validate the formulation approach used, it is necessary to be able to use the most reliable taste evaluation method possible. Multiple in vivo and in vitro methods exist nowadays or are proposed in the literature but are often little understood by the pharmaceutical product development community. In particular, different methods may be more relevant at different stages of product development. The aim of this article is to propose a tool to guide the selection of the most appropriate method for the desired evaluation. A spreadsheet-based tool is proposed that is designed to allow the systematic assessment of the applicability of any taste assessment technique existing or new to the users proposed application. A series of criteria are defined that will allow the user to assess the analytical, usability and availability factors for the technique that is being considered. Such a systematic review will help the user to understand the benefits and risks of using each methodology for that application. The use of the tool is illustrated based on currently available data and literature. As new/existing methods are developed/improved, the outcomes of the tool may change.
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Affiliation(s)
- David Clapham
- Independent pharmaceutical consultant, Bishops Stortford, UK.
| | | | | | - Angela Discihnger
- Pharmaceutical Research and Development, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
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24
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Cameron LH, Peloquin CA, Hiatt P, Mann M, Starke JR, Faircloth J, McNeil JC, Patel A, Ruiz F. Administration and monitoring of clofazimine for NTM infections in children with and without cystic fibrosis. J Cyst Fibros 2021; 21:348-352. [PMID: 34479810 DOI: 10.1016/j.jcf.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/10/2021] [Revised: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
Few studies have evaluated clofazimine (CLOF) drug monitoring and safety in children. We treated 10 children, 8 with CF, for NTM infection with multiple antimicrobials, including CLOF. All had serial blood CLOF concentrations measured and were followed for adverse events. Despite CLOF dose escalation, most children with CF did not reach a target CLOF concentration. Our data suggest that children with CF may require earlier initiation of CLOF at higher doses than is currently recommended.
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Affiliation(s)
- L H Cameron
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States.
| | - C A Peloquin
- University of Florida, Department of Pharmacy, United States
| | - P Hiatt
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - M Mann
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - J R Starke
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States
| | - J Faircloth
- Section of Pediatric Pulmonology, United States; Texas Children's Hospital, Department of Pharmacy, United States
| | - J C McNeil
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Infectious Diseases, United States
| | - A Patel
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
| | - F Ruiz
- Baylor College of Medicine, Department of Pediatrics, United States; Section of Pediatric Pulmonology, United States
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25
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Liñá. Tegedor A, Elkhatib I, Abdala A, Bayram A, Ab. Ali K, Arnanz A, Ruiz F, Melado L, Lawrenz B, Munck ND, Fatemi HM. P–677 Endometrial thickness, endometrial preparation protocol and number of euploid embryos transferred, significantly impact the live birth in frozen embryo transfer cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.676] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the live birth rate (LBR) in euploid frozen embryo transfer (FET) cycles affected by the endometrial thickness (EMT)?
Summary answer
A significantly higher LBR was observed in patients with an endometrial thickness of at least 7.5mm (46.24% vs. 54.63%)
What is known already
Parameters assessing the endometrium prior planning a FET include endometrial thickness, pattern and blood flow. The impact of the endometrial thickness on ART outcomes is controversial, with conflicting results published. A recent meta-analysis evaluated whether EMT could predict pregnancy outcomes and suggested that lower EMT was associated with lower incidence of clinical pregnancy rate (CPR), implantation rate (IR) and LBR. Due to heterogeneity of parameters evaluated between different publications, where embryos with unknown ploidy status were transferred, in conjunction with variability of stimulation protocols and the number of embryos transferred, the real effect of the EMT was difficult to infer.
Study design, size, duration
This was a two-center retrospective observational study including a total of 1522 euploid FET cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE.
Participants/materials, setting, methods
Trophectoderm biopsies were analyzed with Next Generation Sequencing (NGS). Vitrification/warming of blastocysts was performed using Cryotop method (Kitazato). EMT was measured by vaginal ultrasound prior initiating the progesterone administration (± 1 day) and LBR was recorded. Multivariate analysis was performed between LB outcomes and median EMT while controlling for confounding factors.
Main results and the role of chance
A total of 1522 FET cycles were analyzed: 975 single embryo transfer (SET) and 547 double embryo transfer (DET). The mean age of the patients was 33.38 years with a mean BMI of 27.1 kg/m2. FET were performed in EMT ranging from 3 to 15 mm and 50.52% resulted in a live birth. Though potentially all ranges of EMT were associated with LB, the median EMT in patients with LB was significantly higher than the median EMT of patients without LB (7.6mm vs. 7.4mm; p < 0.001).
The dataset was stratified into two groups based on the median EMT (7.5mm): < 7.5mm (n = 744 cycles) and ≥ 7.5mm (n = 778 cycles). A significantly higher live birth rate was observed in ≥ 7.5mm group (46.24% vs. 54.63%. p = 0.0012).
In multivariate analysis, EMT, FET endometrial preparation protocol, and number of embryos transferred were the main parameters influencing the chance to achieve LB: OR 1.10 [1.01–1.19], p < 0.015 for the EMT; OR 1.84 [1.47–2.30], p < 0.0001 for Natural Cycle protocol and OR 1.55 [1.25–1.93], p < 0.0001 for DET. Intercept 0.18 [0.07–0.44] p < 0.0002. Female age did not reach significance: OR 1.02 [1.00–1.04], p = 0.056.
Limitations, reasons for caution
Besides the retrospective nature of the study, the inter-observer variability in EMT assessment between different physicians is a limitation. The physician and embryologist performing the embryo transfer could not been standardized due to the multicenter design of the study.
Wider implications of the findings: The EMT in FET may influence the LBR and should be considered as an important factor for the success of embryo transfer cycles. Whether these results can be extrapolated to fresh embryo transfer and to blastocysts with unknown ploidy status, needs further investigation.
Trial registration number
Not applicable
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Affiliation(s)
- A Liñá. Tegedor
- ART Fertility Clinics- Muscat- Sultanate of Oman, IVF lab, Muscat, Oman
| | - I Elkhatib
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF lab, Abu Dhabi, United Arab Emirates
| | - A Abdala
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF lab, Abu Dhabi, United Arab Emirates
| | - A Bayram
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF lab, Abu Dhabi, United Arab Emirates
| | - K Ab. Ali
- ART Fertility Clinics- Muscat- Sultanate of Oman, IVF lab, Muscat, Oman
| | - A Arnanz
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF lab, Abu Dhabi, United Arab Emirates
| | - F Ruiz
- ART Fertility Clinics- Muscat- Sultanate of Oman, Medical Department, Muscat, Oman
| | - L Melado
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Medical Department, Abu Dhabi, United Arab Emirates
| | - B Lawrenz
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, Medical Department, Abu Dhabi, United Arab Emirates
| | - N D Munck
- ART Fertility Clinics- Abu Dhabi- United Arab Emirates, IVF lab, Abu Dhabi, United Arab Emirates
| | - H M Fatemi
- ART Fertility Clinics, Medical Director, Abu Dhabi, United Arab Emirates
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Ruiz F, Jehng T, Spindler T, Munson D, Karlen J, Thota V, Wang A, Chuan J, Yedwabnick M, Dubovsky J, Aftab BT. COMPREHENSIVE ACTIVATION PROFILING OF TABELECLEUCEL, AN OFF‐THE‐SHELF, ALLOGENEIC EBV‐SPECIFIC T‐CELL IMMUNOTHERAPY. Hematol Oncol 2021. [DOI: 10.1002/hon.90_2881] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F. Ruiz
- Atara Biotherapeutics Thousand Oaks California USA
| | - T. Jehng
- Atara Biotherapeutics Thousand Oaks California USA
| | - T. Spindler
- Atara Biotherapeutics Thousand Oaks California USA
| | - D. Munson
- Atara Biotherapeutics Thousand Oaks California USA
| | - J. Karlen
- Atara Biotherapeutics Thousand Oaks California USA
| | - V. Thota
- Atara Biotherapeutics Thousand Oaks California USA
| | - A. Wang
- Atara Biotherapeutics Thousand Oaks California USA
| | - J. Chuan
- Atara Biotherapeutics Thousand Oaks California USA
| | | | - J. Dubovsky
- Atara Biotherapeutics Thousand Oaks California USA
| | - B. T. Aftab
- Atara Biotherapeutics Thousand Oaks California USA
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Selfa A, Ros B, Iglesias S, Ruiz F, Pérez A, Arráez MA. External cranial expansion as treatment of intracranial hypertension. Technical note. Neurosurg Rev 2021; 45:897-901. [PMID: 34075508 DOI: 10.1007/s10143-021-01571-9] [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: 01/18/2021] [Revised: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
Intracranial hypertension may be idiopathic or due to multiple etiologies. Some bone dysplasias and chronic shunt overdrainage syndrome may sometimes lead to intracranial hypertension associated with craniocerebral disproportion due to thickening of cranial diploe. The internal cranial expansion procedure has been used for patients with intracranial hypertension, whether or not associated with craniocerebral disproportion. Its purpose is to increase the intracranial volume by drilling down the inner table. This technique enables the craniocerebral disproportion to be improved and intracranial hypertension reduced. In other etiologies of intracranial hypertension with non-thickened diploe, internal cranial expansion may not be enough to resolve the hypertension. For these cases we propose a modification of the technique by expanding the cranial vault outwards; external cranial expansion. We describe this technique as used in a pediatric patient who presented with chronic headache, tonsillar ectopia, and sleep apnea syndrome. This patient also had a multisuture craniosynostosis, a non-thickened diploe, and intracranial hypertension.
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Affiliation(s)
- A Selfa
- Department of Neurological Surgery, Regional University Hospital, Malaga, Spain.
| | - B Ros
- Pediatric Neurological Surgery Section, Department of Neurological Surgery, Regional University Hospital, Malaga, Spain
| | - S Iglesias
- Pediatric Neurological Surgery Section, Department of Neurological Surgery, Regional University Hospital, Malaga, Spain
| | - F Ruiz
- Pediatric Section, Department of Oral and Maxillofacial Surgery, Regional University Hospital, Malaga, Spain
| | - A Pérez
- Neuroradiology Section, Department of Radiology, Regional University Hospital, Malaga, Spain
| | - M A Arráez
- Department of Neurological Surgery, Regional University Hospital, Malaga, Spain
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Moreno M, Srihari S, Ruiz F, Ambalathingal Thomas G, Le Texier L, Panikkar A, Raju J, Rehan S, Beagley L, Solomon M, Smith C, Dubovsky J, Khanna R, Aftab B. Comprehensive profiling of ATA188, an off-the-shelf, allogeneic epstein-barr virus-specific T-cell immunotherapy for progressive multiple sclerosis. Cytotherapy 2021. [DOI: 10.1016/s1465324921004291] [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: 10/21/2022]
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Ruiz F, Jehng T, Spindler T, Munson D, Karlen J, Thota V, Wang A, Chuan J, Yedwabnick M, Dubovksy J, Aftab B. Comprehensive activation profiling of tabelecleucel, an off-the-shelf, allogeneic EBV-specific T-cell immunotherapy. Cytotherapy 2021. [DOI: 10.1016/s146532492100548x] [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: 11/24/2022]
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Henny J, Nadif R, Got SL, Lemonnier S, Ozguler A, Ruiz F, Beaumont K, Brault D, Sandt E, Goldberg M, Zins M. The CONSTANCES Cohort Biobank: An Open Tool for Research in Epidemiology and Prevention of Diseases. Front Public Health 2020; 8:605133. [PMID: 33363097 PMCID: PMC7758208 DOI: 10.3389/fpubh.2020.605133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/11/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
“General-purpose cohorts” in epidemiology and public health are designed to cover a broad scope of determinants and outcomes, in order to answer several research questions, including those not defined at study inception. In this context, the general objective of the CONSTANCES project is to set up a large population-based cohort that will contribute to the development of epidemiological research by hosting ancillary projects on a wide range of scientific domains, and to provide public health information. CONSTANCES was designed as a randomly selected sample of French adults aged 18–69 years at study inception; 202,045 subjects were included over an 8-year period. At inclusion, the selected participants are invited to attend one of the 24 participating Health Prevention Centers (HPCs) for a comprehensive health examination. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HPC. Procedures have been developed to use the national healthcare databases to allow identification and validation of diseases over the follow-up. The biological collection (serum, lithium heparinized plasma, EDTA plasma, urine and buffy coat) began gradually in June 2018. At the end of the inclusions, specimens from 83,000 donors will have been collected. Specimens are collected according to a standardized protocol, identical in all recruitment centers. All operations relating to bio-banking have been entrusted by Inserm to the Integrated Biobank of Luxembourg (IBBL). A quality management system has been put in place. Particular attention has been paid to the traceability of all operations. The nature of the biological samples stored has been deliberately limited due to the economic and organizational constraints of the inclusion centers. Some research works may require specific collection conditions, and can be developed on request for a limited number of subjects and in specially trained centers. The biological specimens that are collected will allow for a large spectrum of biomarkers studies and genetic and epigenetic markers through candidate or agnostic approaches. By linking the extensive data on personal, lifestyle, environmental, occupational and social factors with the biomarker data, the CONSTANCES cohort offers the opportunity to study the interplays between these factors using an integrative approach and state-of-the-art methods.
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Affiliation(s)
- J Henny
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - R Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - S Le Got
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - S Lemonnier
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - A Ozguler
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - F Ruiz
- ClinSearch, Malakoff, France
| | - K Beaumont
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - D Brault
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - E Sandt
- Integrated Biobank of Luxembourg (IBBL), Dudelange, Luxembourg
| | - M Goldberg
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France.,Faculty of Medicine, University of Paris, Paris, France
| | - M Zins
- Inserm UMS 011, Population-based Epidemiological Cohorts, Villejuif, France.,Faculty of Medicine, University of Paris, Paris, France
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Tuleu C, Hughes DA, Clapham D, Vallet T, Ruiz F. Acceptability of generic versus innovator oral medicines: not only a matter of taste. Drug Discov Today 2020; 26:329-343. [PMID: 33217597 DOI: 10.1016/j.drudis.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/22/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022]
Abstract
Optimum use of generic products would require equivalence, not only in terms of quality, safety, and efficacy in clinical studies, but also patient acceptability to not jeopardize treatment success because of non-adherence which would de facto limit the potential cost saving anticipated by their use. Although acceptability is a requirement for the authorization of pediatric innovator products, a survey of European Union (EU) regulatory authorities showed that few have a formal process for assessing patient acceptability of generic products during the registration processes. The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) focus on unifying guidance for the development and scrutiny of generics but should include acceptability alongside the other factors being considered for harmonization.
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Affiliation(s)
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - David Clapham
- Independent Pharmaceutical Consultant, Bishops Stortford, UK.
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Vallet T, Elhamdaoui O, Berraho A, Cherkaoui LO, Kriouile Y, Mahraoui C, Mouane N, Pense-Lheritier AM, Ruiz F, Bensouda Y. Medicines Acceptability in Hospitalized Children: An Ongoing Need for Age-Appropriate Formulations. Pharmaceutics 2020; 12:pharmaceutics12080766. [PMID: 32823568 PMCID: PMC7463451 DOI: 10.3390/pharmaceutics12080766] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/30/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
Although knowledge on medicine acceptability remains fragmented, this multi-faceted concept has emerged as a key factor for compliance in pediatrics. In order to investigate the acceptability of medicines used in the University Medical Centre Ibn Sina (CHIS) of Rabat, Morocco, an observational study was conducted. Using a multivariate approach integrating the many aspects of acceptability, standardized observer reports were collected for 570 medicine intakes in patients up to the age of 16, then analyzed on a reference framework. Tablets appeared to be well accepted in children greater than 6 years old, but were crushed/dissolved for 90% of the 40 children aged from 3 to 5, and 100% of the 38 patients younger than 3. Moreover, the prescribed dose was fully taken for only 52% and 16% of these younger children, respectively. Despite this, tablets represented 24% of evaluations in children from 3 to 5 and 20% in infants and toddlers. Oral liquid preparations appeared to be better accepted than tablets in preschoolers, but not for those under 3. Overall, these findings highlight the lack of suitable alternatives for the younger children, especially for formulations of antiepileptics, antithrombotic, and psycholeptic agents in the local context.
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Affiliation(s)
- Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
- Correspondence: ; Tel.: +33-(0)-1-47-35-17-17
| | - Omar Elhamdaoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Quartier Souissi, 10170 Rabat, Morocco
| | - Amina Berraho
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Quartier Souissi, 10170 Rabat, Morocco
| | - Lalla Ouafae Cherkaoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Quartier Souissi, 10170 Rabat, Morocco
| | - Yamna Kriouile
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Pediatrics Hospital, University Medical Centre Ibn Sina (CHIS), Avenue Ibn Rochd, 10100 Rabat, Morocco
| | - Chafiq Mahraoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Pediatrics Hospital, University Medical Centre Ibn Sina (CHIS), Avenue Ibn Rochd, 10100 Rabat, Morocco
| | - Nezha Mouane
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Pediatrics Hospital, University Medical Centre Ibn Sina (CHIS), Avenue Ibn Rochd, 10100 Rabat, Morocco
| | | | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Yahya Bensouda
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Impasse Souissi, 10170 Rabat, Morocco; (O.E.); (A.B.); (L.O.C.); (Y.K.); (C.M.); (N.M.); (Y.B.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Quartier Souissi, 10170 Rabat, Morocco
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Ruiz F, Brault N, Ouar N, Atlan M, Qassemyar Q. Anterolateral thigh free flap with extended pedicle for the secondary reconstruction of a large thoracolumbar wall defect. ANN CHIR PLAST ESTH 2020; 65:163-166. [PMID: 32278492 DOI: 10.1016/j.anplas.2019.05.001] [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: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
Affiliation(s)
- F Ruiz
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
| | - N Brault
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - N Ouar
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - M Atlan
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - Q Qassemyar
- Faculty of Medecine, Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Division of Plastic & Reconstructive Surgery, Faculty of Medecine, Sorbonne Université, Tenon Hospital, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
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Granados F, Santos-Ruiz L, Contreras M, Mellado J, Martin G, Bermudo L, Ruiz F, Aguilar Y, Yáñez I. Squamous cell carcinoma related with dental implants. A clinical cases report. J Clin Exp Dent 2020; 12:e98-e102. [DOI: 10.4317/medoral.55964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/07/2019] [Indexed: 11/05/2022] Open
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Granados F, Santos-Ruiz L, Contreras M, Mellado J, Martin G, Bermudo L, Ruiz F, Aguilar Y, Yáñez I. Squamous cell carcinoma related with dental implants. A clinical cases report. J Clin Exp Dent 2020. [PMID: 31976051 PMCID: PMC6969962 DOI: 10.4317/jced.55964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
One third of all cases of head and neck carcinoma (CA) concern the oral mucosa. The use of dental implants (DI) for dental rehabilitation is widely extended. However, a few studies have reported some cases with neoplasic alterations, among the tissue surrounding implants. Our aim was to analyze possible alterations at the bone-implant interface in patients with oral squamous cell carcinoma (SCC), providing new evidence that could relate or discard a possible link between these factors. We used, for the first time, different techniques, including electron microscopy and histology, to analyze the implant ´s surface and the surrounding tissue from four clinical cases with neoplasic alterations surrounding DI. Histologically, ample inflammatory tissue was found in direct contact with the implant surface. Surface analysis of this tissue, revealed titanium percentages. According to our study, no oncological relation with deterioration of the implant surface was found, although DI were constantly related with peri-implantitis, a chronic trauma of the oral mucosa that could involve a neoplastic factor. Key words:Dental implants, carcinoma, peri-implantitis.
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Belissa E, Vallet T, Laribe-Caget S, Chevallier A, Chedhomme FX, Abdallah F, Bachalat N, Belbachir SA, Boulaich I, Bloch V, Delahaye A, Depoisson M, Wojcicki AD, Gibaud S, Grancher AS, Guinot C, Lachuer C, Lechowski L, Leglise P, Mahiou A, Meaume S, Michel C, Michelon H, Orven Y, Perquy I, Piccoli M, Rabus M, Ribemont AC, Rwabihama JP, Trouvin JH, Ruiz F, Boudy V. Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues. BMC Geriatr 2019; 19:344. [PMID: 31810442 PMCID: PMC6898963 DOI: 10.1186/s12877-019-1337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/03/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. Methods An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. Results Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men. Conclusion This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.
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Affiliation(s)
- Emilie Belissa
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Thibault Vallet
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Sandra Laribe-Caget
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Alain Chevallier
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - François-Xavier Chedhomme
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Sid-Ahmed Belbachir
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Vanessa Bloch
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Anne Delahaye
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Mathieu Depoisson
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Amélie Dufaÿ Wojcicki
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Stéphane Gibaud
- Centre Hospitalier de l'Ouest Vosgien, 1280 avenue division Leclerc, 88300, Neufchâteau, France
| | - Anne-Sophie Grancher
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Caroline Guinot
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Celia Lachuer
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Laurent Lechowski
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Patrick Leglise
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Abdel Mahiou
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Sylvie Meaume
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Corinne Michel
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Hugues Michelon
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Yann Orven
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Ines Perquy
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Matthieu Piccoli
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Maïté Rabus
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Hugues Trouvin
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Fabrice Ruiz
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Vincent Boudy
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France.
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Díez de los Ríos J, Serra Batlles J, Ruiz F. Corneal involvement due to Erdheim-Chester disease. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.11.004] [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: 10/27/2022]
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Abstract
Multiple sclerosis (MS) is a frequent autoimmune demyelinating disease of the central nervous system (CNS). There are three clinical forms described: relapsing-remitting multiple sclerosis (RRMS), the most common initial presentation (85%) among which, if not treated, about half will transform, into the secondary progressive multiple sclerosis (SPMS) and the primary progressive MS (PPMS) (15%) that is directly progressive without superimposed clinical relapses. Inflammation is present in all subsets of MS. The relapsing/remitting form could represent itself a particular interest for the study of inflammation resolution even though it remains incomplete in MS. Successful resolution of acute inflammation is a highly regulated process and dependent on mechanisms engaged early in the inflammatory response that are scarcely studied in MS. Moreover, recent classes of disease-modifying treatment (DMTs) that are effective against RRMS act by re-establishing the inflammatory imbalance, taking advantage of the pre-existing endogenous suppressor. In this review, we will discuss the active role of regulatory immune cells in inflammation resolution as well as the role of tissue and non-hematopoietic cells as contributors to inflammation resolution. Finally, we will explore how DMTs, more specifically induction therapies, impact the resolution of inflammation during MS.
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Affiliation(s)
- F Ruiz
- Laboratories of Neuroimmunology, Neuroscience Research Center and Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Chemin des Boveresses 155, 1066, Epalinges, Switzerland
| | - S Vigne
- Laboratories of Neuroimmunology, Neuroscience Research Center and Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Chemin des Boveresses 155, 1066, Epalinges, Switzerland
| | - C Pot
- Laboratories of Neuroimmunology, Neuroscience Research Center and Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Chemin des Boveresses 155, 1066, Epalinges, Switzerland.
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Nuciforo P, Jimenez J, Fasani R, Ruiz F, Sevillano C, Sanchez G, Martinez P, Serres X, Saura C, Elez E, Felip E, Oaknin A, Brana I, Muñoz-Couselo E, Macarulla Mercade T, Alsina Maqueda M, Carles J, Dienstmann R, Tabernero J, Garralda E. Prospective pathological experience with research biopsies in the context of clinical trials at Vall d’Hebron Institute of Oncology. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.013] [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: 11/12/2022] Open
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Alsina Maqueda M, Ruiz F, Landolfi S, Viaplana C, Miquel J, Jimenez J, Diez M, Gullo I, Mirallas O, Tabernero J, Carneiro F, Nuciforo P, Vivancos A, Dienstmann R. Molecular subtypes of metastatic (met) gastric cancer (GC) (MoTriGastric): New biomarkers closer to the clinics. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.149] [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: 11/14/2022] Open
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Ruiz F, Vallet T, Dufaÿ Wojcicki A, Belissa É, Fontan JE, de Pontual L, Nathanson S, Chevallier A, Laribe-Caget S, Boudy V. Dosage form suitability in vulnerable populations: A focus on paracetamol acceptability from infants to centenarians. PLoS One 2019; 14:e0221261. [PMID: 31430323 PMCID: PMC6701828 DOI: 10.1371/journal.pone.0221261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 08/04/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Medicine acceptability is a multi-faceted concept driven by both product and user characteristics. Although a key factor for treatment effectiveness, especially in vulnerable populations, knowledge of those medicine features that best promote individual user acceptability remains fragmented. Focusing on paracetamol, this study has explored the appropriateness of pharmaceutical products in different dosage forms to achieve adequate patient acceptability from infants to centenarians. METHODS This observational, multicentre, prospective study was carried out in 10 hospitals, 8 nursing homes and over 150 community dispensaries. Observers reported several behaviours/events evaluating acceptability for 1016 different pharmaceutical product uses in paediatrics (<18y.) and 1288 in the elderly (≥65y.). Using mapping and clustering, a multivariate approach offered an intelligible reference framework for each population, providing comprehensive scores: positively or negatively accepted. RESULTS Among all the evaluations supporting the acceptability reference frameworks, there were 502 reports on paracetamol products intake. Herein we focused on the 5 products with ≥30 evaluations. Although oral suspension and powder for oral solution were positively-accepted in the paediatric group, the powder had a higher rate of negative patient reaction (p<0.001). Of those that received this formulation, 72% were ≤8y., and therefore suitable to receive the better accepted oral suspension. In the elderly, patients with swallowing disorders were preferentially treated with such powders (p<0.001), which were less often fully taken than orally disintegrating tablets (p<0.001). Even in those patients ≥90y., capsule formulations appeared to be the best accepted product in patients without swallowing alterations, and thus could be a suitable alternative to the powder in this population. CONCLUSIONS By better integrating patient characteristics when choosing dosage forms, clinicians and caregivers may improve treatment acceptability and adherence. Moreover, hospitals and healthcare institutions could optimise purchasing to best suit their local population, disseminating information to help staff align specific dosage forms to targeted patients.
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Affiliation(s)
| | | | - Amélie Dufaÿ Wojcicki
- Département innovation pharmaceutique, Agence Générale des Équipements et Produits de Santé (AGEPS), Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Émilie Belissa
- Département innovation pharmaceutique, Agence Générale des Équipements et Produits de Santé (AGEPS), Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Eudes Fontan
- Hôpital Jean Verdier, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris (AP-HP), Bondy, France
| | - Loïc de Pontual
- Hôpital Jean Verdier, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris (AP-HP), Bondy, France
| | - Sylvie Nathanson
- Centre Hospitalier de Versailles - André Mignot, Le Chesnay, France
| | - Alain Chevallier
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Sandra Laribe-Caget
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Vincent Boudy
- Département innovation pharmaceutique, Agence Générale des Équipements et Produits de Santé (AGEPS), Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Université Paris Descartes, Paris, France
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Ruiz F, Keeley A, Léglise P, Tuleu C, Lachuer C, Rwabihama JP, Bachalat N, Boulaich I, Abdallah F, Rabus M, Ribemont AC, Michelon H, Wojcicki AD, Orlu M, Vallet T, Boudy V. Sex Differences in Medicine Acceptability: A New Factor to Be Considered in Medicine Formulation. Pharmaceutics 2019; 11:pharmaceutics11080368. [PMID: 31374869 PMCID: PMC6723034 DOI: 10.3390/pharmaceutics11080368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/27/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022] Open
Abstract
Palatability is a recognized driver of medicine acceptability in pediatrics but deemed less relevant in older populations due to sensory decline. Preliminary findings from an observational study implicated palatability problems with one Alzheimer's medicine. Among 1517 observer reports combining multiple measures on medicines uses in patients aged over 64, we focused on two original formulations of memantine (Ebixa®, tablets (n = 25) and oral solution (n = 60)). Evaluations were scored with an acceptability reference framework (CAST), the rodent Brief Access Taste Aversion (BATA) model tested aversiveness. Focusing on women treated with Ebixa® (n = 54), the oral formulation sub-group was classified as "negatively accepted", while the coated tablet was associated with the "positively accepted" cluster. In men, both formulations belonged to the "positively accepted" profile. Using BATA, the original oral solution was categorized as highly aversive/untolerated while solutions of excipients only were well tolerated. Furthermore, the number of licks was significantly lower in female than in male rats. These results revealed that medicine palatability remains important for acceptability in older populations. Moreover, converging results from humans and animal models highlighted that palatability profiles can significantly vary between the sexes. These drivers should be closely considered during drug development to enhance acceptability in this population.
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Affiliation(s)
- Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France.
| | - Alexander Keeley
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Patrick Léglise
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Catherine Tuleu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Célia Lachuer
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Maité Rabus
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Hugues Michelon
- Hôpital Sainte-Périne, Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), 11 rue Chardon-Lagache, 75016 Paris, France
| | - Amélie Dufaÿ Wojcicki
- Unité de R&D Galénique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer À Moulin, 75005 Paris, France
| | - Mine Orlu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Vincent Boudy
- Unité de R&D Galénique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer À Moulin, 75005 Paris, France
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Asensio V, Flórido FG, Ruiz F, Perlatti F, Otero XL, Oliveira DP, Ferreira TO. The potential of a Technosol and tropical native trees for reclamation of copper-polluted soils. Chemosphere 2019; 220:892-899. [PMID: 33395810 DOI: 10.1016/j.chemosphere.2018.12.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/12/2018] [Accepted: 12/27/2018] [Indexed: 06/12/2023]
Abstract
Technosols created to reclaim degraded soils is a promising solution that needs further research. The objectives of the study were: i) to create a Technosol with a very high capacity to immobilize copper from mining, ii) to assess the capacity of the Technosol to immobilize copper after planting two tropical native tree species, and iii) to analyse the capacity of the native trees for extracting copper from polluted soils. Myracrodruon urundeuva (aroeira) and Cedrela fissilis (pink cedar) were planted in pots with Technosol spiked with copper at concentrations of 125, 1525 and 3050 mg Cu kg-1. Height and stem diameter were measured over 90 days. Biomass and Cu concentration in leaves, stem and roots were determined. Copper was analysed in soils by sequential extraction, as well as in leached water. The Technosol showed a very high capacity to immobilize copper, since 60-80% of the added copper was strongly retained in the soil, mainly by bentonite and carbonates. The Technosol with trees showed the same capacity to immobilize copper as the control, since concentration in shoots was higher than 300 mg Cu kg-1 and concentration in roots was even higher. These results show that Technosol and both species are useful tools to immobilize copper in polluted soils. Further studies are necessary to determine the total capacity of these trees to immobilize and/or extract copper in the long term and under field conditions.
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Affiliation(s)
- V Asensio
- Department of Soil Science, University of São Paulo (USP/ESALQ), Av. Pádua Dias 11, 13418-900, Piracicaba, SP, Brazil.
| | - F G Flórido
- Department of Soil Science, University of São Paulo (USP/ESALQ), Av. Pádua Dias 11, 13418-900, Piracicaba, SP, Brazil
| | - F Ruiz
- Department of Soil Science, University of São Paulo (USP/ESALQ), Av. Pádua Dias 11, 13418-900, Piracicaba, SP, Brazil
| | - F Perlatti
- Department of Soil Science, University of São Paulo (USP/ESALQ), Av. Pádua Dias 11, 13418-900, Piracicaba, SP, Brazil; National Mining Agency - ANM, Rua Loefgren, 2225, 04040-033, São Paulo, SP, Brazil
| | - X L Otero
- Departamento de Edafoloxía e Química Agrícola, Facultade de Bioloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - D P Oliveira
- Centro de Ciências, Universidade Federal do Ceará (UFC), Av. Mister Hull, 2977, 60021-970, Fortaleza, Ceará, Brazil
| | - T O Ferreira
- Department of Soil Science, University of São Paulo (USP/ESALQ), Av. Pádua Dias 11, 13418-900, Piracicaba, SP, Brazil
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Demotes-Mainard J, Cornu C, Guérin A, Bertoye PH, Boidin R, Bureau S, Chrétien JM, Delval C, Deplanque D, Dubray C, Duchossoy L, Edel V, Fouret C, Galaup A, Lesaulnier F, Matei M, Naudet F, Plattner V, Rubio M, Ruiz F, Sénéchal-Cohen S, Simon T, Vidal A, Viola A, Violleau M. Quel impact du nouveau règlement européen sur la protection des données sur la recherche clinique et recommandations. Therapie 2019; 74:17-29. [DOI: 10.1016/j.therap.2018.11.008] [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] [Received: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
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Demotes-Mainard J, Cornu C, Guérin A, Bertoye PH, Boidin R, Bureau S, Chrétien JM, Delval C, Deplanque D, Dubray C, Duchossoy L, Edel V, Fouret C, Galaup A, Lesaulnier F, Matei M, Naudet F, Plattner V, Rubio M, Ruiz F, Sénéchal-Cohen S, Simon T, Vidal A, Viola A, Violleau M. How the new European data protection regulation affects clinical research and recommendations? Therapie 2019; 74:31-42. [DOI: 10.1016/j.therap.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
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Asensio V, G Flórido F, Ruiz F, Perlatti F, Otero XL, Ferreira TO. Screening of native tropical trees for phytoremediation in copper-polluted soils. Int J Phytoremediation 2019; 20:1456-1463. [PMID: 30652533 DOI: 10.1080/15226514.2018.1501341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Due to the limited number of studies on phytoremediation using native tree species in tropical soils, the aim was to identify new phytoremediator species from tropical climate with the purpose of promoting an increase in the diversity of tropical native trees used in phytoremediation projects. Seven native tree species from Brazil were selected: Cedrela fissilis, Handroanthus serratifolius, Copaifera langsdorffii, Hymenaea courbaril, Mimosa caesalpiniifolia, Cecropia sp. and Myracrodruon urundeuva. Seedlings of these species were planted in pots with an unpolluted Arenosol, and then spiked with 60, 100 and 500 mg kg-1 Cu. Height and stem diameters were measured over 60 days. Biomass and total Cu concentration were determined in leaves, stem and roots. Copper in bulk soils and rhizospheres was analyzed by a sequential extraction method. All species accumulated high concentration of Cu in roots (>300 mg kg-1), so they could be used as phytostabilizators for this metal. Copper mobilization increased in the rhizospheres, but it was mostly absorbed by roots. Cecropia sp., M. urundeuva and C. langsdorffii are hyperaccumulators of Cu (>300 mg kg-1 in shoots), so they are potential phytoextractor species. This study evidence the potential of seven tree species native from tropical regions for phytostabilizing copper-polluted soils.
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Affiliation(s)
- V Asensio
- a Department of Soil Science , University of São Paulo (USP/ESALQ) , Piracicaba , Brazil
| | - F G Flórido
- a Department of Soil Science , University of São Paulo (USP/ESALQ) , Piracicaba , Brazil
| | - F Ruiz
- a Department of Soil Science , University of São Paulo (USP/ESALQ) , Piracicaba , Brazil
| | - F Perlatti
- a Department of Soil Science , University of São Paulo (USP/ESALQ) , Piracicaba , Brazil
- b National Mining Agency - ANM , São Paulo , Brazil
| | - X L Otero
- c Departmento de Edafoloxía e Química Agrícola, Facultade de Bioloxía , Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - T O Ferreira
- a Department of Soil Science , University of São Paulo (USP/ESALQ) , Piracicaba , Brazil
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Ziad A, Olekhnovitch R, Ruiz F, Berr C, Bégaud B, Goldberg M, Zins M, Mura T. Anticholinergic drug use and cognitive performances in middle age: findings from the CONSTANCES cohort. J Neurol Neurosurg Psychiatry 2018; 89:1107-1115. [PMID: 30196250 PMCID: PMC6166611 DOI: 10.1136/jnnp-2018-318190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previous studies have shown associations between the use of anticholinergics (AC) and cognitive performance in the elderly, considering AC as a homogeneous set of drugs. The present study aims to assess the relationship between exposure to AC drugs and cognitive performance in middle-aged adults according to AC potency and drug class. METHODS Our cross-sectional study used baseline data of 34 267 participants aged 45-70 from the Consultants des centres d'examen de santé de la sécurité sociale (CONSTANCES) cohort. The cumulative exposure to AC was measured using national reimbursement databases over the 3-year period preceding assessment of cognitive performance. Eight classes of AC drugs were differentiated. Episodic verbal memory, language abilities and executive functions were evaluated by validated neuropsychological tests. Analyses were controlled on lifestyle and health status variables. RESULTS This study showed a negative association between overall cumulative AC exposure and cognitive performances after adjustment. The use of drugs with possible AC effect according to the Anticholinergic Cognitive Burden scale (ACB-1 score) was only associated with executive functions. Analyses of AC exposure across drug classes showed a negative association between the use of AC antipsychotics and all cognitive functions assessed. Heterogeneous associations were found for the use of AC anxiolytics, AC opioids and AC drugs targeting the gastrointestinal tract or metabolism. We did not find significant associations between the use of antihistamines, antidepressants, cardiovascular system or other AC medications and cognitive function. CONCLUSION Association between AC drugs and cognitive performance was highly heterogeneous across drug classes; this heterogeneity will have to be considered by future studies.
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Affiliation(s)
- Abdelkrim Ziad
- ClinSearch -110, Malakoff, France.,Population-Based Epidemiological Cohorts Unit, UMS 011 Inserm-UVSQ, Paris, France.,Versailles Saint Quentin en-Yvelines University, Versailles, France.,Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U 1168, Paris, France
| | - Romain Olekhnovitch
- Population-Based Epidemiological Cohorts Unit, UMS 011 Inserm-UVSQ, Paris, France
| | | | - Claudine Berr
- INSERM, U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Bernard Bégaud
- INSERM, U1219-Pharmacoepidemiology, Université de Bordeaux, Bordeaux, France
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, UMS 011 Inserm-UVSQ, Paris, France.,Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U 1168, Paris, France.,Paris Descartes University, Paris, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, UMS 011 Inserm-UVSQ, Paris, France.,Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U 1168, Paris, France.,Paris Descartes University, Paris, France
| | - Thibault Mura
- INSERM, U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France .,Montpellier University Hospital, Montpellier University, Montpellier, France
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