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Boiffard E, Dimet J, Baron O, Billon O, Boivineau C, Charvet M, Doizon T, Federspiel C, Flori M, Georges JL, Haddad G, Lipp D, Nguyen JO, Mouhoub D, Pernollet P, Philippot M, Pouliquen H, Roy N, Trebouet E, Turlotte G, Zeninari B, Orion L. [An independent observatory in Vendée on ST-elevated acute myocardial infarction (the OVISCA Register). A Departmental evaluation of demographic trends, mortality and delays before treatment]. Ann Cardiol Angeiol (Paris) 2019; 68:300-305. [PMID: 31542204 DOI: 10.1016/j.ancard.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022]
Abstract
AIM Mortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée. PATIENTS AND METHODS From 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2). RESULTS Between the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The "door-to-balloon" time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05). CONCLUSIONS In vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.
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Affiliation(s)
- E Boiffard
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France.
| | - J Dimet
- Clinical Research Centre, Mont-de-Marsan Hospital, 40000, Mont-de-Marsan, France
| | - O Baron
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - O Billon
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - C Boivineau
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Charvet
- Post-emergency medical monitoring, polyclinique de l'Europe, 44600 Saint-Nazaire, France
| | - T Doizon
- General medicine department, CHD Vendée, 85400, Luçon, France
| | - C Federspiel
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Flori
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-L Georges
- Service de cardiologie centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - G Haddad
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Lipp
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-O Nguyen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Mouhoub
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - P Pernollet
- Cardiology department, CH Côte-de-Lumière, 85100, Les Sables d'Olonne, France
| | - M Philippot
- Medical Information Service, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - H Pouliquen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - N Roy
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - E Trebouet
- Emergency Department, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - G Turlotte
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - B Zeninari
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - L Orion
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
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Verbrugghe S, Coulon-Bidet E, Dimet J. Impact du “manger-mains” chez le résident institutionnalisé ne mangeant pas seul, en raison de troubles cognitifs et/ou physiques, à travers l’interdisciplinarité soignants/cuisiniers d’une recherche en EHPAD. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.324] [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: 11/28/2022]
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Dochez V, Dimet J, David-Gruselle A, Le Thuaut A, Ducarme G. French family physician experience concerning the outpatient care for women suffering from nausea and vomiting in pregnancy. J Gynecol Obstet Hum Reprod 2017. [PMID: 28643666 DOI: 10.1016/j.jogoh.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore thoughts and attitudes among French family physicians on the outpatient care for women suffering from nausea and vomiting in pregnancy (NVP). DESIGN AND SETTING A retrospective study was conducted among family physicians who had taken care of pregnant women who gave birth in our hospital in 1 year. PATIENTS AND METHODS Fifty-nine French family physicians responded to a questionnaire assessing their experience about outpatient care for women suffering from NVP. Analysis were done according to the physicians' age, as the annual demographics data analysis from the French Medical Council. RESULTS More than 89% of family physicians asked systematically the question concerning NVP (53/59), which were estimated as a frequent symptom (n=44, 74.6%). The intensity of NVP was assessed as mild in 28.8% (n=17), moderate in 62.7% (n=37), severe in 6.8% (n=4) and unbearable in 1.7% (n=1). Physicians younger than 40 years questionned less frequently about NVP compared to those older than 40 or older than 60 years (66.7% vs. 90.5% vs. 95.5%, respectively; P=0.04). Severe and unbearable NVP were significantly estimated more frequent among younger physicians (33.3% vs. 6.8%; P=0.03). Treatments (sick leave, diet, drugs, homeopathy, acupuncture or psychotherapy) did not differ between groups. DISCUSSION AND CONCLUSION Outpatient care for women suffering from NVP may vary according to the physician. French family physicians played a key role in NVP. Younger family physician considered NVP as a frequent symptom which needed active management in severe forms.
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Affiliation(s)
- V Dochez
- Department of obstetrics and gynecology, centre hospitalier departemental, Les Oudairies, 85000 La-Roche-sur-Yon, France; Department of obstetrics and gynecology, centre hospitalier universitaire, 44000 Nantes, France
| | - J Dimet
- Clinical research center, centre hospitalier departemental, Les Oudairies, La-Roche-sur-Yon, France
| | | | - A Le Thuaut
- Clinical research center, centre hospitalier departemental, Les Oudairies, La-Roche-sur-Yon, France
| | - G Ducarme
- Department of obstetrics and gynecology, centre hospitalier departemental, Les Oudairies, 85000 La-Roche-sur-Yon, France.
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Boivineau C, Orion L, Dimet J, Boiffard E. Indications for fibrinolysis in patients with ST-segment elevation myocardial infarction: From guidelines to practice. Ann Cardiol Angeiol (Paris) 2016; 65:377. [PMID: 27968766 DOI: 10.1016/j.ancard.2016.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND European guidelines on managing ST segment elevation myocardial infarction (STEMI) during the first 12hours recommend fibrinolysis when the time elapsing between the first medical contact and balloon time (FMCBT) is more than 120minutes. AIM To assess the real-life clinical efficacy of guidelines on fibrinolysis in managing STEMI and identify obstacles to their everyday implementation. METHODS An observational study based on a permanent registry of reperfusion strategies and timing among patients treated in a French general hospital for STEMI with chest pain lasting for less than two hours. Patients were enrolled between January 1st 2008 and December 31st 2014. RESULTS The study included 669 patients: 79 (11.8%) benefited from effective fibrinolysis followed by coronary arteriography (PCI) within 24hours, 445 (66.5%) underwent a primary PCI, 99 (14.8%) received a rescue PCI and 46 (6.9%) did not undergo revascularization. The FMCBT was 120minutes or longer in 209 patients: fibrinolysis was performed in 68 of these patients (32.5%), and primary PCI in 141 (114 (54.6%) without contraindications to fibrinolysis and 27 (12.9%) with contraindications). The patient's age, female gender, co-morbidities and clinical management were factors that appeared to be linked to poor compliance with the guidelines, but none were significant (P>00.5). Nor were there significant differences regarding bleeding complications between patients receiving fibrinolysis or primary PCI (P>0.05). CONCLUSION The guidelines on fibrinolysis were not followed in 54.6% of patients when the FMCBT was more than 120minutes. Some criteria (age, gender, co-morbidities) may have been responsible for this non-compliance, although underestimating the time between first medical contact and arrival in the catheterisation laboratory could not be excluded. Further studies are necessary to improve estimates of this delay.
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Affiliation(s)
- C Boivineau
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France.
| | - L Orion
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France
| | - J Dimet
- Recherche clinique, CHD de Vendée, 85000 La Roche-sur-Yon, France
| | - E Boiffard
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France
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Doizon T, Orion L, Dimet J, Boiffard E. [ST elevation myocardial infarction (STEMI) in patients aged 85 and over. Invasive management versus exclusive medical treatment: Departmental study]. Ann Cardiol Angeiol (Paris) 2015; 64:345-51. [PMID: 26482627 DOI: 10.1016/j.ancard.2015.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) and/or fibrinolysis for management of an ST elevation myocardial infarction (STEMI) are at high risk in the elderly. Is there any place for an invasive management in this particular population? METHODS It is a single-center retrospective study (CHD Vendée, La Roche-sur-Yon) including patients aged 85 and over who had STEMI between January 2008 and December 2013, divided into two groups: coronary angiogram/fibrinolysis ("invasive") versus exclusive medical treatment ("non-invasive"), comparing mortality, morbidity, complications and loss of independence. RESULTS Among the 1373 patients hospitalized for STEMI, 118 (8.6%) were included: 71 (60.2%) underwent an invasive procedure for reperfusion whereas 47 had "non-invasive" management. All cause mortality rate was higher in the "non-invasive" group (28% versus 45%; P=0.077 NS). The identified pejorative criteria are age, female gender, past history of severe valvular disease, and delay for primary care. No difference was found in intrahospital complication rate (23 vs 21; P=0.21) nor in loss of independence. CONCLUSION The invasive management of STEMI in the elderly may reduce the one-year mortality rate without increasing morbidity.
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Affiliation(s)
- T Doizon
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France.
| | - L Orion
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
| | - J Dimet
- Service de recherche clinique, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
| | - E Boiffard
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
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Abstract
INTRODUCTION Compliance with continuous positive pressure treatment (CPAP) is a determining factor in the management of the obstructive sleep apnea syndrome (OSAS). Long-term compliance has been poorly studied. METHODS The probability of long-term continuation of CPAP was evaluated retrospectively by an analysis of survival in 252 patients treated by CPAP after a screening of 472 patients during the years 2002 and 2003. RESULTS Twenty-eight patients fulfilling the criteria for CPAP immediately refused the treatment. The mean follow-up for the 252 treated patients was 76.9±46.4 months, with 38 patients having died and 75 having discontinued treatment during the period. The 136 patients who continued treatment used CPAP for a mean of 7.4±1.6hours daily. The probability of continuing treatment was 71% at 5 years and 68% at 10 years. The severity of OSAS was a predictive factor for long-term CPAP compliance, with a 10-year compliance of 82% in patients having an apnoea/hypopnoea index >60, versus 68% with an index between 30-60 and 44% with an index <30. CONCLUSION Long-term CPAP treatment is globally well accepted, with a 68% probability of continuing treatment for 10 years, particularly in the most severely affected patients. Long-term daily compliance is very satisfactory.
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Affiliation(s)
- K Berkani
- Service de pneumologie, centre hospitalier départemental Les Oudairies, 85925 La Roche-sur-Yon cedex 9, France.
| | - J Dimet
- Unité de recherche clinique, centre hospitalier départemental Les Oudairies, 85925 La Roche-sur-Yon cedex 9, France
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Loirat M, Orion L, Fradin P, Dimet J, Boiffard E. [Reperfusion delays in acute coronary syndromes with ST segment elevation (STEMI) depending on prehospital care]. Ann Cardiol Angeiol (Paris) 2013; 62:287-292. [PMID: 24075208 DOI: 10.1016/j.ancard.2013.08.008] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization. METHODS To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain=diRect chain (Call the emergency number-specialist mobile emergency unit-Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain=Long chain. RESULTS On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26hours (±3.12), 6.17hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9hours (P<0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit. CONCLUSION These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.
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Affiliation(s)
- M Loirat
- Centre hospitalier départementale Vendée, Les Oudairies, 85925 La Roche-sur-Yon cedex 9, France
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Berkani K, Dimet J, Breton P, Bizieux-Thaminy A, Berruchon J. Prise en charge du syndrome d’apnées du sommeil dans un hôpital général. Étude rétrospective de 1718patients appareillés du 1er janvier 1994 au 1er janvier 2010. Rev Mal Respir 2012; 29:871-7. [DOI: 10.1016/j.rmr.2012.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 01/27/2012] [Indexed: 11/24/2022]
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Trebouet E, Lipp D, Dimet J, Orion L, Fradin P. [Cardiologic emergencies and natural disaster. Prospective study with Xynthia tempest]. Ann Cardiol Angeiol (Paris) 2011; 60:39-41. [PMID: 21272856 DOI: 10.1016/j.ancard.2010.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/22/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Stress-induced cardiomyopathy and ischemic cardiopathy have been described after natural disasters such as earthquakes. OBJECTIVES OF THE STUDY Count stress-induced cardiomyopathies and ischemic cardiopathies just after Xynthia tempest which damaged the Vendean coast on February2010, in order to study epidemiology. PATIENTS AND METHOD Included patients were living in a tempest damaged village, and admitted in Vendee hospital just after or in the week following the tempest, and presenting a suspected acute coronary syndrome or stress-induced cardiomyopathy. RESULTS Among 3350 inhabitants of the two damaged Vendean towns, we count three acute coronary syndromes, two Tako-Tsubo cardiomyopathies, and one coronary spasm. We count five women and one man, average age is 76. CONCLUSION The diagnosis of ischemic cardiopathy and stress-induced cardiomyopathy is over-represented in this tempest damaged population, that have been little described.
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Affiliation(s)
- E Trebouet
- SAMU-SMUR-Urgences, CHD Vendée, La Roche-Sur-Yon, France.
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Trebouet E, Fradin P, Orion L, Dimet J. [Care of ST elevated myocardial infarction patients in Vendée in 2008: observational and descriptive study]. Ann Cardiol Angeiol (Paris) 2010; 59:209-13. [PMID: 20674885 DOI: 10.1016/j.ancard.2010.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE STUDY Estimating the quality of care of the patients presenting an ST-elevation myocardial infarction in Vendee. PATIENTS AND METHOD Prospective observational study carried out over the year 2008. Included patients presenting a myocardial infarction for less than 24 hours, they were alive when emergency team arrived, and were taken care of by the SMUR, the emergencies or the cardiology of the hospital of La Roche-sur-Yon. RESULTS Two hundred and seventeen patients were included, 163 men and 54 women, average age: 65 years. Fifty-six percent of the patients called initially the emergency medical service, half of those within an hour after pain began. Seventy-two percent of them were looked after by a SMUR. Twenty-six percent consulted initially a general practitioner, and one third of those were redirected towards the emergency medical service. Thirty percent of all patients followed the ideal procedure defined by succession of chest pain, emergency medical service call, SMUR, angioplasty or fibrinolysis. The average time between the ECG and the fibrinolysis is 36 minutes, or of the arrival in coronarography room is 105 minutes. The balloon is inflated 42 minutes later. Eighty-six percent of the patients taken care of in the acute phase benefited from a strategy of reperfusion, primary angioplasty (63%) or fibrinolysis (21%). Ninety percent of revascularisations were successful. CONCLUSION In the case of the chest pain, the emergency medical service is under-used. The number of revascularised patients is satisfactory, but the whole procedure takes too much time, especially when the treatment is the angioplasty.
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Affiliation(s)
- E Trebouet
- Samu, SMUR, urgences, CHD Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-Sur-Yon cedex 09, France.
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Jullien V, Raïs A, Urien S, Dimet J, Delaugerre C, Bouillon-Pichault M, Rey E, Pons G, Blanche S, Tréluyer JM. Age-related differences in the pharmacokinetics of stavudine in 272 children from birth to 16 years: a population analysis. Br J Clin Pharmacol 2007; 64:105-9. [PMID: 17324223 PMCID: PMC2000613 DOI: 10.1111/j.1365-2125.2007.02854.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS To develop a population pharmacokinetic model for stavudine in children and to investigate the consistency of the currently recommended dose based on adult target concentrations. METHODS The pharmacokinetics of stavudine were investigated using a population approach. Individual estimates of CL/F were used to calculate the stavudine dose required to achieve the area under the concentration-time curve reported in adults given recommended doses. RESULTS Stavudine pharmacokinetics were well described by a one-compartment model with zero-order absorption. Typical population estimates (% interindividual variability) of the apparent distribution volume (V/F) and plasma clearance (CL/F) were 40.9 l (32%) and 16.5 l h(-1) (38%), respectively. Stavudine V/F and CL/F were similarly related to age. Mean calculated doses (0.61 mg kg(-1) for children less than 2 weeks, 1.23 mg kg(-1) for children more than 2 weeks with bodyweight less than 30 kg, and 31.5 mg for children with a bodyweight between 30 and 60 kg) were in agreement with the current paediatric doses (0.5 mg kg(-1), 1 mg kg(-1), and 30 mg, respectively). CONCLUSIONS Our findings support the current recommended paediatric dosage regimens for stavudine, as they result in the same exposure to the drug as in adults.
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Affiliation(s)
- V Jullien
- Université Paris Descartes-Faculté de Médecine, France.
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Jullien V, Tréluyer JM, Chappuy H, Dimet J, Rey E, Dupin N, Salmon D, Pons G, Urien S. Weight related differences in the pharmacokinetics of abacavir in HIV-infected patients. Br J Clin Pharmacol 2005; 59:183-8. [PMID: 15676040 PMCID: PMC1884744 DOI: 10.1111/j.1365-2125.2004.02259.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM To study the possible influence of patient characteristics on abacavir pharmacokinetics. METHODS A population pharmacokinetic model for abacavir was developed using data from 188 adult patients by the use of a nonlinear mixed effects modelling method performed with NONMEM. RESULTS Abacavir pharmacokinetics was well described by a two-compartment open model with linear absorption and elimination. Typical population estimates for the absorption rate constant (Ka), the apparent central distribution volume (Vc/F), the apparent peripheral distribution volume (Vp/F), the apparent intercompartmental clearance (Q/F) and the apparent plasma clearance (CL/F) were 1.8 h(-1), 75 l, 23.6 l, 10 l h(-1) and 47.5 l h(-1), respectively. Apparent plasma clearance was positively related to bodyweight. Individual Bayesian estimates of CL/F were used to calculate abacavir AUC. The latter decreased from 10.7 +/- 5.0 to 5.7 +/- 1.6 mgh l(-1) when bodyweight increased from 36 to 102 kg. This drop in abacavir exposure could lead to suboptimal treatment for the heaviest patients, as antiviral efficacy of abacavir is known to be related to its AUC. A 400 mg abacavir dose would be necessary to achieve adequate exposure to abacavir in patients weighing more than 60 kg. CONCLUSIONS The apparent plasma clearance of abacavir was positively related to bodyweight. The efficacy of the current recommended abacavir dosage for patients with high bodyweight should be evaluated in further studies.
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Affiliation(s)
- V Jullien
- Pharmacologie Clinique, Université René Descartes, Groupe Hospitalier Cochin-Saint-Vincent-de-Paul, Assitance Publique-Hôpitaux de Paris, Paris, France.
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Chappuy H, Treluyer J, Dimet J, Rey E, Foucher M, Firtion G, Pons G, Mandelbrot L. Maternal-fetal transfer and amniotic fluid accumulation of antiretroviral drugs in HIV infected pregnant women. Clin Pharmacol Ther 2003. [DOI: 10.1016/s0009-9236(03)90624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Treluyer J, Morini J, Dimet J, Gorin I, Rey E, Pons G, Dupin N. High concentrations of nelfinavir as an independent risk factor for lipodystrophy in HIV-infected patients. Clin Pharmacol Ther 2003. [DOI: 10.1016/s0009-9236(03)90615-1] [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: 11/27/2022]
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