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Prioul A, Fournier D, Lefeuvre C, Duranton S, Olivier P, Blanc E, Peyro-Saint-Paul L, Ruault S, Jamet A, Mouchel C. Overview of literature monitoring practice of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group. Therapie 2023; 78:659-666. [PMID: 36906491 DOI: 10.1016/j.therap.2023.02.008] [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: 05/04/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The evaluation of clinical trial (CT) safety is the main task of CT vigilance units. In addition to the management of adverse events, the units must review the literature to identify information that may impact the benefit-risk assessment of studies. In this survey, we investigated the literature monitoring (LM) activity of French Institutional Vigilance Units (IVU) from the working group "REflexion sur la VIgilance et la SEcurite des essais cliniques" (REVISE). MATERIAL AND METHODS We sent a questionnaire of 26 questions, divided into four themes, to the 60 IVU: (1) Presentation of the IVU and the LM activity; (2) Used sources, queries and criteria for selecting articles; (3) Valuation of the LM and (4) Practical organisation. RESULTS Of the 27 IVU that responded to the questionnaire, 85% of them carried out LM. This was mainly provided by medical staff to improve general knowledge (83%), to detect Adverse Reactions (AR) not listed in the reference documents (70%) and to detect new safety information (61%). Due to lack of time, staff, available recommendations and sources, only 21% of IVU conducted LM for all CT. On average, units reported four sources: ANSM information (96%), PubMed database (83%), EMA alerts (57%) and the subscription to APM international (48%). The LM had an impact on the CT of 57% of the IVU such as changing the conditions of a study (39%) or suspending a study (22%). DISCUSSION/CONCLUSION LM is an important but time-consuming activity with heterogeneous practices. According to the results of this survey, we proposed seven ways to improve this practice: (1) Target the highest risk CT; (2) Refine the PubMed queries; (3) Use other tools; (4) Create a decision flowchart for the selection of PubMed articles; (5) Improve training; (6) Value the activity and (7) Outsource the activity.
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Affiliation(s)
- Astrid Prioul
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France.
| | - Dorine Fournier
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Cécile Lefeuvre
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Sophie Duranton
- Direction de la recherche, unité de vigilance des essais cliniques, CHU de Poitiers, 86021 Poitiers cedex, France
| | - Pascale Olivier
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament INSERM UMR 1027, CIC 1436, CHU de Toulouse, 31059 Toulouse, France
| | - Emeline Blanc
- Direction de la recherche en santé, unité de vigilance des essais cliniques, Hospices civils de Lyon, 69229 Lyon, France
| | | | - Sophie Ruault
- Maison de la recherche clinique, CHU de Rouen, 76031 Rouen, France
| | - Aurélie Jamet
- Vigilance des essais cliniques, CHU d'Angers, 49933 Angers, France
| | - Catherine Mouchel
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
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Peyro-Saint-Paul L, Gaillard C, Paris A, Gourio C, Zerger C, Ficheux M, Grandazzi G, Parienti JJ, Morello R. Compensating patients in trials: Perspectives from an ethical committee versus sponsor. Eur J Clin Invest 2023; 53:e14044. [PMID: 37345217 DOI: 10.1111/eci.14044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND According to European clinical research legislation, no undue influence, including financial incentives, should be used to encourage participation in clinical trials. Financial compensation should be based on the inconvenience experienced by patients and is determined by the sponsor. OBJECTIVES The objective of this study was to assess the adequacy of patients' financial compensation by obtaining an external ethical opinion compared to the actual compensation provided. METHODS We randomly selected and reviewed 50 clinical drug trials, including 25 academic and 25 industry-sponsored studies. An external ethics group consisting of three members from French ethics committees, blinded to the actual compensation and the sponsor, retrospectively reviewed the study characteristics and assessed whether financial compensation was appropriate. Cohen's Kappa test measured agreement between actual compensation and the ethics group's opinion, and the McNemar test measured discrepancies. RESULTS There was no agreement between the actual financial compensation and the ethics group's opinion (K = -.07; 95% CI = [-.16-.02]). More discrepancies were found in favour of financial compensation according to the ethics group than provided by sponsors (12 vs. 2, p = .016). The ethics group recommended financial compensation in 12 out of 50 studies (24%), which were studies with a higher number of additional visits (p = .004) and were more frequently sponsored by industry (p = .008). Sponsors only provided financial compensation in 2 out of 50 studies (4%). CONCLUSION Patients are rarely compensated despite the perceived inconvenience. Both sponsors and ethics members struggle to determine the need for financial compensation, indicating a need for more precise recommendations for both parties.
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Affiliation(s)
- Laure Peyro-Saint-Paul
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | - Cathy Gaillard
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | | | - Charlotte Gourio
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | - Céleste Zerger
- Université Paris Descartes Faculté de Médecine, Paris, France
| | - Maxence Ficheux
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
| | | | | | - Rémy Morello
- Pharmacovigilant, Responsable de lunite de vigilance des essais cliniques (UVEC), Direction de la Recherche et de l'innovation, CHU Caen Normandie, Caen, France
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Peyro-Saint-Paul L, Bechade C, Cesbron A, Debruyne D, Brionne M, Brucato S, Hanoy M, Dumont A, Briant AR, Parienti JJ, Lobbedez T, Ficheux M. Effect of Peritoneal Dialysis in End Stage Renal Disease on Apixaban Pharmacokinetics. Nephrol Dial Transplant 2023:7160463. [PMID: 37169987 PMCID: PMC10387390 DOI: 10.1093/ndt/gfad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
| | - Clémence Bechade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France; ANTICIPE, U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | | | | | - Marie Brionne
- CHU de Caen Normandie, Hématologie Biologique, CAEN, France
| | - Sylvie Brucato
- CHU de Caen Normandie, Centre de Recherche Clinique, CAEN, France
| | - Mélanie Hanoy
- CHU Rouen, Nephrology, Dialysis and Kidney Transplantation, Rouen, France
| | - Audrey Dumont
- Univ Rouen Normandie, INSERM EnVI U1096, "Endothelium, Valvulopathy and Heart Failure"; CHU Rouen, CIC-CRB 1404, Department of Pharmacology, Rouen, France
| | - Anais R Briant
- Department of Clinical Research and Biostatistics, CHU de Caen Normandie and Caen Normandy University, CAEN, France
| | - Jean-Jacques Parienti
- Department of Clinical Research and Biostatistics, CHU de Caen Normandie and Caen Normandy University, Caen, France; INSERM U1311 DYNAMICURE, Caen Normandy University, CAEN, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France; ANTICIPE, U1086 INSERM-UCN, Centre François Baclesse, Caen, France
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Hocqueloux L, Lefeuvre S, Bois J, Brucato S, Alix A, Valentin C, Peyro-Saint-Paul L, Got L, Fournel F, Dargere S, Prazuck T, Fournier A, Gregoire N, McNicholl I, Parienti JJ. Bioavailability of dissolved and crushed single tablets of bictegravir, emtricitabine, tenofovir alafenamide in healthy adults: the SOLUBIC randomized crossover study. J Antimicrob Chemother 2022; 78:161-168. [PMID: 36322475 PMCID: PMC9780524 DOI: 10.1093/jac/dkac369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Crushing or dissolving bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) tablets is not recommended because there are no data supporting this practice. METHODS A crossover, randomized trial in healthy adults (NCT04244448) investigated the bioavailability of two off-label uses of BIC/TAF/FTC (50/200/25 mg), dissolved in water or crushed in apple compote, compared with the solid tablet. Pharmacokinetic (PK) parameters were estimated from sequential intensive plasma antiretroviral concentrations over a 72 h period post dose. Bioequivalence was met if the 90% CIs of the geometric least-squares means ratios comparing BIC/TAF/FTC exposures (AUC and Cmax) from the experimental phases were within 80%-125% of the reference. RESULTS Eighteen subjects participated in each of the three phases. Dissolved tablet Cmax geometric mean ratio (90% CI) for BIC/TAF/FTC was 105% (93-119)/97% (87-108)/96% (74-124), respectively. Dissolved tablet AUC geometric mean ratio (90% CI) for BIC/TAF/FTC was 111% (100-122)/100% (94 to 105)/99% (81 to 120), respectively. Crushed tablet Cmax geometric mean ratio (90%) CI for BIC/TAF/FTC was 110% (97 to 124)/70% (63-78)/66% (51-85), respectively. Crushed tablet AUC geometric mean ratio (90%) CI for BIC/TAF/FTC was 107% (96-118)/86% (82-91)/84% (69-103), respectively. CONCLUSIONS Crushing BIC/TAF/FTC tablets may lead to suboptimal emtricitabine and tenofovir alafenamide drug exposures. Dissolving BIC/TAF/FTC in water may be acceptable if the tablet cannot be swallowed whole.
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Affiliation(s)
| | - Sandrine Lefeuvre
- Laboratoire de Biologie, CHR d’Orléans, Orléans, France,Laboratoire de Biologie, CHU—La Milétrie, Poitiers, France
| | - Julie Bois
- Laboratoire de Biologie, CHR d’Orléans, Orléans, France
| | | | | | | | - Laure Peyro-Saint-Paul
- Unité de Biostatistique et de Recherche Clinique, CHU de Caen; INSERM UMR 1311 DYNAMICURE, Université Caen Normandie, Caen, France
| | - Laurence Got
- Laboratoire de Biologie, CHR d’Orléans, Orléans, France
| | - François Fournel
- Unité de Biostatistique et de Recherche Clinique, CHU de Caen; INSERM UMR 1311 DYNAMICURE, Université Caen Normandie, Caen, France
| | - Sylvie Dargere
- Department of Infectious Diseases, Service des Maladies Infectieuses, CHU de Caen, CaenFrance
| | - Thierry Prazuck
- Service des Maladies Infectieuses, CHR d’Orléans, Orléans, France
| | - Anna Fournier
- Department of Infectious Diseases, Service des Maladies Infectieuses, CHU de Caen, CaenFrance
| | | | - Ian McNicholl
- Global HIV Medical Affairs, Gilead Sciences, Foster City, CA, USA
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Parienti JJ, Prazuck T, Peyro-Saint-Paul L, Fournier A, Valentin C, Brucato S, Verdon R, Sève A, Colin M, Lesne F, Guinard J, Ar Gouilh M, Dina J, Vabret A, Hocqueloux L. Effect of Tenofovir Disoproxil Fumarate and Emtricitabine on nasopharyngeal SARS-CoV-2 viral load burden amongst outpatients with COVID-19: A pilot, randomized, open-label phase 2 trial. EClinicalMedicine 2021; 38:100993. [PMID: 34222849 PMCID: PMC8235994 DOI: 10.1016/j.eclinm.2021.100993] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tenofovir and emtricitabine interfere with the SARS CoV-2 ribonucleic acid (RNA)-dependent RNA polymerase (RdRp). Several cohorts reported that people treated by tenofovir disoproxil fumarate and emtricitabine are less likely to develop SARS CoV-2 infection and related severe COVID-19. METHODS We conducted a pilot randomized, open-label, controlled, phase 2 trial at two hospitals in France. Eligible patients were consecutive outpatients (aged ≥18 years) with RT-PCR-confirmed SARS-CoV-2 infection and an interval from symptom onset to enrolment of 7 days or less. Patients were randomly assigned in a 1:1 ratio to receive oral tenofovir disoproxil fumarate and emtricitabine (2 pills on day 1 followed by 1 pill per day on days 2-7) or the standard of care. The primary and secondary endpoints were SARS-CoV-2 viral clearance from baseline assessed by cycle threshold (Ct) RT-PCR on nasopharyngeal swab collected at day 4 and day 7, respectively. A higher Ct corresponds to a lower SARS CoV-2 viral burden. Other endpoints were the time to recovery and the number of adverse events. This trial is registered with ClinicalTrials.gov, NCT04685512. FINDINGS From November, 20th 2020 to March, 19th 2021, 60 patients were enrolled and randomly assigned to a treatment group (30 to tenofovir disoproxil fumarate and emtricitabine and 30 to standard of care). The median number of days from symptom onset to inclusion was 4 days (IQR 3-5) in both groups. Amongst patients who received tenofovir disoproxil fumarate, the difference from standard of care in the increase in Ct RT-PCR from baseline was 2.3 (95% confidence interval [-0.6 to 5.2], p = 0.13) at day 4 and 2.9 (95% CI [0.1 to 5.2], p = 0.044) at day 7. At day 7, 6/30 in the tenofovir disoproxil fumarate and emtricitabine group and 3/30 in the standard of care group reported no COVID-related symptoms. Adverse events included 11 cases of gastrointestinal side effects (grade ≤ 2), three of which leaded to drug discontinuation. Three patients had COVID-19 related hospitalisation, no participant died. INTERPRETATION In this pilot study of outpatients adult with recent non-severe COVID-19, tenofovir disoproxil fumarate plus emtricitabine appeared to accelerate the natural clearance of nasopharyngeal SARS-CoV-2 viral burden. These findings support the conduct of larger trials of tenofovir-based therapies for the prevention and early treatment of COVID-19. FUNDING No external funding.
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Affiliation(s)
- Jean-Jacques Parienti
- Department of Clinical Research and Innovation, Caen University Hospital, Caen, France
- Department of Infectious Diseases, Caen University Hospital, Caen, France
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
- Corresponding author.
| | - Thierry Prazuck
- Department of Infectious Diseases, Orléans Regional Hospital, Orléans, France
| | | | - Anna Fournier
- Department of Infectious Diseases, Caen University Hospital, Caen, France
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
| | - Cécile Valentin
- Department of Clinical Research and Innovation, Caen University Hospital, Caen, France
| | - Sylvie Brucato
- Department of Clinical Research and Innovation, Caen University Hospital, Caen, France
| | - Renaud Verdon
- Department of Infectious Diseases, Caen University Hospital, Caen, France
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
| | - Aymeric Sève
- Department of Infectious Diseases, Orléans Regional Hospital, Orléans, France
| | - Mathilda Colin
- Department of Infectious Diseases, Orléans Regional Hospital, Orléans, France
| | - Fabien Lesne
- Department of Virology, Orléans Regional Hospital, Orléans, France
| | - Jérome Guinard
- Department of Virology, Orléans Regional Hospital, Orléans, France
| | - Meriadeg Ar Gouilh
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
- Department of Virology, Caen University Hospital, Caen, France
| | - Julia Dina
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
- Department of Virology, Caen University Hospital, Caen, France
| | - Astrid Vabret
- EA 2656 – Groupe de recherche sur l'adaptation microbienne 2.0, UNICAEN-Université de Caen Normandie, Caen, France
- Department of Virology, Caen University Hospital, Caen, France
| | - Laurent Hocqueloux
- Department of Infectious Diseases, Orléans Regional Hospital, Orléans, France
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Dolladille C, Chrétien B, Peyro-Saint-Paul L, Alexandre J, Dejardin O, Fedrizzi S, Defer G. Association Between Disease-Modifying Therapies Prescribed to Persons with Multiple Sclerosis and Cancer: a WHO Pharmacovigilance Database Analysis. Neurotherapeutics 2021; 18:1657-1664. [PMID: 34231126 PMCID: PMC8608969 DOI: 10.1007/s13311-021-01073-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/04/2023] Open
Abstract
The risk of cancer associated with persons with multiple sclerosis (pwMS) prescribed with disease modifying therapies (DMTs) is not well established. This observational, cross-sectional, pharmacovigilance cohort study examined individual case safety reports from the World Health Organization database: VigiBase®. All consecutive reports of DMTs prescribed to pwMS (alemtuzumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferon-β, natalizumab, ocrelizumab, and teriflunomide), and their serious adverse event cases were eligible, excluding those reporting immunosuppressant DMTs used as anticancer therapies. The primary outcome was the multivariate odds ratio of cancer reporting (r-OR) for DMTs prescribed to pwMS after imputation of missing data. There were 5966 cancer cases from 240,993 reports of DMTs prescribed to pwMS. After adjustments on age, sex, and geographical region, natalizumab (r-OR 1.74, 95% CI 1.63-1.87), interferon-β (r-OR 1.39, 95% CI 1.30-1.49), dimethyl fumarate (r-OR 1.35, 95% CI 1.25-1.46), and fingolimod (r-OR 1.15, 95% CI 1.06-1.24) were significantly associated with a greater cancer reporting, whereas alemtuzumab, glatiramer acetate, ocrelizumab, and teriflunomide were not, in the disproportionality analysis. As exploratory analyses, upper aerodigestive tract, breast, urinary including the male genitourinary tract, and nervous system cancers were associated with natalizumab, interferon-β, and dimethyl fumarate. Fingolimod was only associated with skin cancer types. Cancer cases reporting these four DMTs prescribed to pwMS were younger in age than for non-pwMS drugs in the VigiBase® (p < 0.0001). A close and regular cancer screening in pwMS treated with natalizumab, interferon-β, dimethyl fumarate, and fingolimod may be warranted, even for persons at a younger age. Trial Registration NCT04237337.
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Affiliation(s)
- Charles Dolladille
- Department of Pharmacology, CHU de Caen, 14000, Caen, France.
- Medical School, Electrophysiologie Et Imagerie Des Lesions D Ischemie Reperfusion Myocardique, Université Caen Normandie, EA 4650, Signalisation, 14000, Caen, France.
| | - Basile Chrétien
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
| | | | - Joachim Alexandre
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
- Medical School, Electrophysiologie Et Imagerie Des Lesions D Ischemie Reperfusion Myocardique, Université Caen Normandie, EA 4650, Signalisation, 14000, Caen, France
| | - Olivier Dejardin
- ANTICIPE U1086, Ligue Contre Le Cancer Team, Centre François Baclesse, INSERM-University of Caen Normandy, Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, CHU de Caen, 14000, Caen, France
| | - Gilles Defer
- MS Expert Centre Department of Neurology, CHU de Caen, 14000, Caen, France
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Gaillard C, Allain L, Rouillon C, Desgue Y, Brucato S, Peyro-Saint-Paul L, Dompmartin A. No efficacy of biofield therapy in the treatment of warts of the hands and feet in adults: a randomized controlled trial. Clin Exp Dermatol 2021; 46:874-879. [PMID: 33639007 DOI: 10.1111/ced.14623] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/27/2022]
Abstract
Although biofield therapy is unexplained by scientific evidence, it has been practised for many years in numerous cultures for a variety of medical conditions. This study aimed to determine whether one session of biofield therapy with an experienced practitioner could treat warts on the hands and feet in adults. A single-blind, assessor-blind, placebo-controlled, randomized trial was performed between April 2016 and November 2018. The enrolled participants had at least one wart on the hand or foot that had been present for at least 90 days and they were not using any other therapy for the wart. The primary outcome of this trial was the disappearance of the original wart 3 weeks after session of proximal nontouch biofield therapy vs. a sham session. No original wart had disappeared 3 weeks after intervention (0/64), which made the study impossible to conclude on the primary objective. There were no significant differences between the two groups concerning wart disappearance 3 weeks (P = 0.49) or 6 weeks (P = 0.40) after the intervention. Reduction in wart size at Week 3 tended towards a better result for biofield therapy but this was not significant (P = 0.27). No related adverse effects were observed. The major limitation of this trial was the short follow-up time for measurement of clinical outcome, which did not allow verification of the hypothesis. However, this study shows that 3 weeks after a session of proximal nontouch biofield therapy is an insufficient length of time to assess biofield therapy in comparison with a sham session. Based on this study, biofield therapy cannot be recommended to treat warts within 3 weeks.
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Affiliation(s)
| | - L Allain
- Departments of, Clinical Research
| | | | - Y Desgue
- Biofield Therapy Center, 17 rue des ormes, F-50570, Marigny, France
| | | | | | - A Dompmartin
- Dermatology, Centre Hospitalier Universitaire de Caen, Caen, France
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Peyro-Saint-Paul L, Fedrizzi S, Defer G. Drug safety in multiple sclerosis: From reporting to signal detection and benefit-risk management. Rev Neurol (Paris) 2021; 177:582-588. [PMID: 33812676 DOI: 10.1016/j.neurol.2021.01.009] [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: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pharmacovigilance (PV) rules emerged in the late 60s-early 70s. Since that time, the World Health Organization Center for International Drug Monitoring carries out the corresponding tasks. Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that generally starts in young adults between 20 and 40 years of age. Over the last 25 years, MS patients have benefited from the development of a plethora of disease modifying drugs (DMD). These changes in the therapeutic armamentarium have been associated with some serious adverse reactions challenging health authorities and neurologists involved in treatment and care for MS patients. METHODS The present review aims to describe, for MS DMDs, how adverse drug reactions are reported during clinical trials and the post-marketing period and how important signal detection and benefit-risk management have been in this disease until now. Several examples are reported to illustrate the different steps of PV processes. CONCLUSION Improvement of the PV system procedures has led to significant progress in the detection of signals, allowing better assessment of the benefit-risk balance and the implementation of risk management plans for MS treatments. The involvement of neurologists is essential to improve knowledge on the benefit-risk balance of these drugs. In addition, adverse drug reactions reporting by persons with MS should be encouraged.
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Affiliation(s)
- L Peyro-Saint-Paul
- Direction de la Recherche et de l'Enseignement, CHU de Caen Normandie, Caen, France
| | - S Fedrizzi
- Centre Régional de Pharmacovigilance, Pharmacologie, CHU de Caen Normandie, Caen, France
| | - G Defer
- Centre de Ressources et Compétences (CRC-SEP), Service de Neurologie, CHU de Caen, Normandie-Université, Caen, France; Réseau Normand pour la prise en charge de la SEP, Caen, France.
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Delavoipière E, Fourage C, Macro M, Olivier-Abbal P, Fleck C, Mouchel C, Gavard M, Petitpain N, Muller C, Franceschi MP, Savary C, Fournel F, Chaillot F, Alix A, Peyro-Saint-Paul L. [Medication errors reporting in drug clinical trials: Role of the clinical research pharmacist?]. Therapie 2021; 76:735-742. [PMID: 33676756 DOI: 10.1016/j.therap.2021.02.002] [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: 10/16/2020] [Revised: 12/21/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
The investigational drugs circuit has specific risks, and medication errors may occur in clinical trials, possibly associated with adverse reactions. These risks must therefore be managed. In fact, there are few reports of medication errors during clinical trials. In a context of regulatory interpretation difficulties on this subject, we conducted a national survey that highlighted the heterogeneity of the methods used by academic sponsors to collect, code and report medication errors and the need to develop a culture of reporting these errors in clinical trials. This is why the REVISE group (safety officers of French institutional sponsors) has issued recommendations to clarify the sponsor and investigator responsibilities and guide them in the management of medication errors. These new guidelines recommend that any serious or potentially serious medication error or other "special situation" (e.g. overdose, misuse, quality defect) should be notified immediately to the sponsor by the investigator. The clinical research pharmacist place is strategic to detect medication errors and other special situations. The integration of the pharmacist into the reporting system, in collaboration with the investigator, could be discussed with clinical research professionals and health authorities.
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Affiliation(s)
- Elodie Delavoipière
- Direction de la recherche et de l'enseignement, CHU de Caen, 14033 Caen, France.
| | | | - Margaret Macro
- Service hématologie clinique, CHU de Caen, 14033 Caen, France
| | - Pascale Olivier-Abbal
- Service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, faculté de médecine, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Direction de la recherche et de l'innovation, vigilance des essais cliniques, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Camille Fleck
- Direction de la recherche clinique et de l'innovation, université Bourgogne Franche-Comté, CHU Dijon Bourgogne, 21000 Dijon, France
| | - Catherine Mouchel
- CIC Inserm 1414 - service de pharmacologie, unité de vigilance des essais cliniques, université de Rennes 1, CHU de Rennes, 35033 Rennes, France
| | - Marylaure Gavard
- Délégation à la recherche clinique et à l'innovation, CHU Grenoble Alpes, 38043 Grenoble, France
| | - Nadine Petitpain
- Service de pharmacologie clinique, toxicologie, centre régional de pharmacovigilance, CHRU de Nancy, 54035 Nancy, France
| | - Charlotte Muller
- Direction de la recherche clinique et des innovations, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | - Marie-Paule Franceschi
- Service direction de la recherche clinique, CHU de Nîmes, université de Montpellier, 30900 Nîmes, France
| | - Christine Savary
- Service direction de la recherche clinique, CHU de Nîmes, université de Montpellier, 30900 Nîmes, France
| | - François Fournel
- Direction de la recherche et de l'enseignement, CHU de Caen, 14033 Caen, France
| | - Fabien Chaillot
- Direction de la recherche et de l'enseignement, CHU de Caen, 14033 Caen, France
| | - Antoine Alix
- Service pharmacie, CHU de Caen, 14033 Caen, France
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10
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Peyro-Saint-Paul L, Besnier P, Demessine L, Biour M, Hillaire-Buys D, de Canecaude C, Fedrizzi S, Parienti JJ. Cushing's syndrome due to interaction between ritonavir or cobicistat and corticosteroids: a case-control study in the French Pharmacovigilance Database. J Antimicrob Chemother 2020; 74:3291-3294. [PMID: 31369085 DOI: 10.1093/jac/dkz324] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 07/02/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To explore the frequent interaction between antiretroviral-boosting agents and corticosteroids causing Cushing's syndrome (CS) in the French Pharmacovigilance Database (FPVD). METHODS We conducted a retrospective case-control study describing CS recorded in the FPVD between 1996 and 2018. Case was defined as CS occurring in people living with HIV (PLWH) and control was defined as CS in uninfected individuals. Drug-drug interaction (DDI) was defined as an interaction between corticosteroids and CYP3A4 inhibitors. Data concerning the DDI, corticosteroids involved, route of administration and seriousness of the CS were described. RESULTS Among the 139 instances of CS identified, 34/35 cases (97%) had DDIs (31 with ritonavir and 3 with cobicistat) and 7/104 controls (7%) had DDIs (6 with itraconazole and 1 with verapamil). The main corticosteroid involved was inhaled fluticasone (28/35, 80%) among the cases and oral prednisone (38/104, 37%) among the controls. More CS cases (30/35, 86%) than CS controls (62/104, 60%) were serious (OR = 4.0, 95% CI = 1.4-14.4; P = 0.007). CONCLUSIONS Antiretroviral-boosting agents were responsible for one out of four iatrogenic CS cases in a French national database. Prescribers should be aware of the risk of potentially serious DDIs between antiretroviral-boosting agents and corticosteroids, including single-tablet regimens containing cobicistat.
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Affiliation(s)
- Laure Peyro-Saint-Paul
- Department of Biostatistics and Clinical Research, University Hospital of Caen Normandy, Caen, France
| | - Paul Besnier
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Ludivine Demessine
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Michel Biour
- Centre Régional de Pharmacovigilance, University Hospital of Paris Saint-Antoine, Paris, France
| | - Dominique Hillaire-Buys
- Centre Régional de Pharmacovigilance, University Hospital of Montpellier, Montpellier, France
| | - Claire de Canecaude
- Centre Régional de Pharmacovigilance, University Hospital of Toulouse, Toulouse, France
| | - Sophie Fedrizzi
- Centre Régional de Pharmacovigilance, University Hospital of Caen Normandy, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, University Hospital of Caen Normandy, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), University of Caen Normandy, Caen, France
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11
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Peyro-Saint-Paul L, Derache N, Ficheux M, Allouche S, Parienti JJ, Calocer F, Le Caignec F, Fedrizzi S, Defer G. Severe bone pain with teriflunomide: Five case reports and review of the French pharmacovigilance database. Therapie 2020; 75:503-506. [DOI: 10.1016/j.therap.2019.07.006] [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: 03/15/2019] [Revised: 05/06/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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12
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Crepin S, Chiffoleau A, Gavard M, Olivier-Abbal P, Roussillon C, Ruault S, Muller C, Peyro-Saint-Paul L, Ouk T, Franceschi MP, Mouchel C, Duranton S, Petitpain N, Coubret-Dumas A. Compliance of French academic clinical trials with the Clinical Trial Facilitation and Coordination Group recommendations on contraception and pregnancy testing requirements. Clin Trials 2020; 17:314-322. [PMID: 32026710 DOI: 10.1177/1740774520903720] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS The Clinical Trials Coordination and Facilitation Group has issued recommendations on contraception and pregnancy testing to help sponsors meet regulatory expectations and harmonize practices to limit embryofetal risks in clinical trials. Our objective was to assess the compliance of French academic clinical trials with these recommendations and to describe the mitigation measures required by sponsors in their trials. METHODS A cross-sectional study was performed on the French academic drug trials authorized by the national competent authority between January 2015 and June 2018. We included trials which tested systemic administration of drugs and enrolled men or women of childbearing potential. RESULTS Data from 97 trials included were compiled. One-third of the trials (23.8%-43.3%, 95% confidence interval) complied with the Clinical Trial Facilitation and Coordination Group recommendations. No improvement over time or according to embryofetotoxic status or drug duration exposure was found. Contraception was required in 56.7% of trials and was more often required in case of potentially embryofetotoxic drugs (68.5% vs 41.9%, p = 0.013) or exposure over 1 month (71.7% vs 43.8%, p = 0.006). Pregnancy testing at inclusion was required in 59.1% of trials and additional testing in 17.2%. Pregnancy testing at inclusion was more often required in trials with drug exposure above 1 month (67.4% vs 45.8%, p = 0.035). CONCLUSION French academic sponsors barely met the recommendations on contraception and pregnancy testing potentially leading to potential embryofetal risks in case of pregnancy. They need to implement these recommendations quickly.
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Affiliation(s)
- Sabrina Crepin
- Unité de vigilance des essais cliniques, Service de Pharmacologie-Toxicologie et Pharmacovigilance, CHU de Limoges, Limoges, France
| | - Anne Chiffoleau
- Unité de vigilance des essais cliniques, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marylaure Gavard
- Cellule de vigilance des essais cliniques-délégation à la recherche clinique et à l'innovation-CHU Grenoble Alpes, Grenoble, France
| | - Pascale Olivier-Abbal
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France.,Direction de la Recherche et de l'Innovation, Unité de Vigilance des essais cliniques, Centre Hospitalier Universitaire, Toulouse, France
| | - Caroline Roussillon
- Direction de la recherche et Clinique et de l'Innovation, Unité de Sécurité et Vigilance de la Recherche Clinique, CHU de Bordeaux, Bordeaux, France
| | - Sophie Ruault
- Maison de la Recherche Clinique, CHU de Rouen, Rouen, France
| | - Charlotte Muller
- Vigilance des essais cliniques, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Thavarak Ouk
- Cellule Vigilance, Direction de la Recherche et de l'Innovation, CHU Lille, Lille, France
| | - Marie-Paule Franceschi
- Direction de la Recherche, des Partenariats Hospitalo-Universitaires et Internationaux, CHU de Nîmes, Université de Montpellier, Nîmes, France
| | - Catherine Mouchel
- Vigilance des essais cliniques-CIC Inserm 1414-Service de pharmacologie-CHU de Rennes, Rennes, France
| | - Sophie Duranton
- Unité de Vigilance des Essais Cliniques, Direction de la Recherche, CHU Poitiers, Poitiers, France
| | - Nadine Petitpain
- Service de Pharmacologie Clinique et de Toxicologie, Centre Régional de Pharmacovigilance, CHRU de Nancy, Nancy, France
| | - Anne Coubret-Dumas
- Centre régional de pharmacovigilance, Service de Pharmacologie-Toxicologie et Pharmacovigilance, CHU de Limoges, Limoges, France
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13
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Vernant M, Lepoupet M, Creveuil C, Alix A, Gourio C, Peyro-Saint-Paul L, Lelong-Boulouard V, Guillaumé C. Intravenous versus subcutaneous route pharmacokinetics of paracetamol (acetaminophen) in palliative care patients: study protocol for a randomized trial (ParaSCIVPallia). Trials 2020; 21:138. [PMID: 32019598 PMCID: PMC6998185 DOI: 10.1186/s13063-019-3969-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among palliative care (PC) patients who are administered paracetamol, the subcutaneous (SC) route is often an alternative to the intravenous (IV) route. Yet pharmacological and clinical data on whether these are equivalent pharmacokinetically are lacking. Many French palliative teams are now empirically using paracetamol by the SC route, but there are no data to support this practice. This trial aims to compare the pharmacokinetic (PK) parameters of paracetomol between the IV and SC routes in PC patients. METHODS/DESIGN This is a randomized, open, crossover study in two PC centers. The primary endpoints are AUC0-t, AUC0-∞, Cmax, Vd, and t1/2. All adverse events will be reported for a safety analysis. Twenty adult PC patients with an IV device having spontaneous pain not related to care, with a numeric pain rate scale > 3/10, or having a systematic prescription of paracetamol as the usual treatment will be included. All patients also have to meet all eligibility criteria. CONCLUSION This is the first study comparing PK parameters for IV paracetamol versus SC paracetamol in PC patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03944044. Registered on 4 June 2019. Committee for the protection of persons (CPP) 18.09.05.58206 approval 4 October 2018. National Drug Safety Agency (ANSM; Agence Nationale de Sécurité Médicament) MEDAECNAT-2018-09-00009 approval 29 November 2018.
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Affiliation(s)
- Marine Vernant
- Pain and Palliative Care Department and Regional Palliative Care Unit (RPCU) Maurice Abiven of Fondation de la Miséricorde, Caen University Hospital, CHU de Caen- avenue de la côte de Nacre, 14000, Caen, France.
| | - Marie Lepoupet
- Pain and Palliative Care Department, Caen University Hospital, 14000, Caen, France
| | - Christian Creveuil
- Clinical Research Department, Caen University Hospital, 14000, Caen, France
| | - Antoine Alix
- Caen University Hospital, Pharmacy, 14000, Caen, France
| | | | | | | | - Cyril Guillaumé
- Pain and Palliative Care Department, Caen University Hospital, 14000, Caen, France
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14
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Demessine L, Peyro-Saint-Paul L, Gardner EM, Ghosn J, Parienti JJ. Risk and Cost Associated With Drug-Drug Interactions Among Aging HIV Patients Receiving Combined Antiretroviral Therapy in France. Open Forum Infect Dis 2019; 6:ofz051. [PMID: 30949521 PMCID: PMC6440683 DOI: 10.1093/ofid/ofz051] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to describe the frequency, risk factors, and costs attributable to drug–drug interactions (DDIs) among an aging French HIV population. Methods We conducted a retrospective cohort study using French nationwide health care e-records: the SNIIRAM database. People living with HIV (PLWH) aged >65 years and receiving combined antiretroviral treatment (cART) during 2016 were included. A DDI was defined as “These drugs should not be co-administered,” represented by a red symbol on the University of Liverpool website. Attributable DDIs’ cost was defined as the difference between individuals with and without DDIs regarding all reimbursed health care acts. Results Overall, 9076 PLWH met the study criteria. Their baseline characteristics were: mean age, 71.3 ± 4.9 years; 25% female; median HIV duration (interquartile range [IQR]), 16.2 (9.5–20.3) years; median comorbidities (IQR), 2 (1–3). During 2016, they received a median (IQR) of 14 (9–21) comedications (non-cART), and 1529 individuals had at least 1 DDI (16.8%; 95% confidence interval [CI], 16.1–17.6). In multivariate analysis, raltegravir or dolutegravir plus 2 nucleoside reverse-transcriptase inhibitors (NRTIs) significantly and independently reduced the risk of DDIs (adjusted odds ratio [aOR], 0.02; 95% CI, 0.005–0.050; P < .0001) compared with non-nucleoside reverse-transcriptase inhibitor plus 2 NRTIs, whereas cART with boosted agents (protease inhibitors or elvitegravir) significantly increased the risk (aOR, 4.12; 95% CI, 3.34–5.10; P < .0001). Compared with propensity score–matched PLWH without DDIs, the presence of DDIs was associated with a $2693 additional cost per year (P < .0001). Conclusions The presence of DDIs is frequent and significantly increases health care costs in the aging population of PLWH.
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Affiliation(s)
- Ludivine Demessine
- Biostatistics and Clinical Research, Caen University Hospital, Caen, France
- Faculty of Pharmacy, Caen Normandy University, Caen, France
| | | | | | - Jade Ghosn
- INSERM UMR 1137, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- APHP, Department of Infectious Diseases, Bichat University Hospital, Paris, France
| | - Jean-Jacques Parienti
- Biostatistics and Clinical Research, Caen University Hospital, Caen, France
- Department of Infectious Diseases, Caen University Hospital, Caen, France
- Caen Normandy University, EA2656 Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Caen, France
- Correspondence: Jean-Jacques Parienti, MD, PhD, CHU de Caen Normandie, Avenue de la Côte de Nacre, F-14000, France ()
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15
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Gaberel T, Gakuba C, Fournel F, Le Blanc E, Gaillard C, Peyro-Saint-Paul L, Chaillot F, Tanguy P, Parienti JJ, Emery E. FIVHeMA: Intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: A randomized controlled trial. Neurochirurgie 2019; 65:14-19. [PMID: 30638547 DOI: 10.1016/j.neuchi.2018.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/17/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke, which often causes acute hydrocephalus requiring the insertion of an external ventricular drain (EVD). A major complication of aneurysmal SAH is delayed cerebral ischemia (DCI). As DCI is linked to the presence of blood within the subarachnoid space, it has been hypothesized that removing this blood may decrease the risk of DCI. This could be achieved by injecting a fibrinolytic agent through the EVD, a strategy called intraventricular fibrinolysis (IVF). Here, we propose to conduct a phase III trial to directly evaluate the impact of IVF after aneurysmal SAH. MATERIALS AND METHODS We will perform an open-label randomized controlled trial comparing the standard of care, i.e. EVD alone, to the experimental treatment, i.e. IVF. We plan to include 440 patients to be able to show a 10% increase in the rate of good functional outcomes in the EVD+IVF group compared to the EVD alone group (α=0.05 and β=0.8). To obtain such sample, a multicenter trial is required, and to date 17 research sites in France have agreed to participate. PERSPECTIVE FIVHeMA would be the first phase III trial evaluating the relevance of IVF in aneurysmal SAH. If IVF is shown to be beneficial, then a new therapeutic tool will be available to improve the outcomes of aneurysmal SAH patients.
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Affiliation(s)
- T Gaberel
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Université Caen Normandie, Medical School, 14000 Caen, France.
| | - C Gakuba
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Department of intensive care medicine, CHU de Caen, 14000 Caen, France
| | - F Fournel
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - E Le Blanc
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - C Gaillard
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | | | - F Chaillot
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - P Tanguy
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - J-J Parienti
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - E Emery
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Université Caen Normandie, Medical School, 14000 Caen, France
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16
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Defer G, Le Caignec F, Fedrizzi S, Montastruc F, Chevanne D, Parienti JJ, Peyro-Saint-Paul L. Dedicated mobile application for drug adverse reaction reporting by patients with relapsing remitting multiple sclerosis (Vigip-SEP study): study protocol for a randomized controlled trial. Trials 2018; 19:174. [PMID: 29523169 PMCID: PMC5845183 DOI: 10.1186/s13063-018-2560-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/26/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The reporting of adverse drug reactions (ADR) by patients represents an interesting challenge in the field of pharmacovigilance, but the reporting system is not adequately implemented in France. In 2015, only 20 MS patients in France reported ADR due to first-line disease-modifying drugs (DMD), while more than 3000 patients were initiated on DMD. The aim of this study is to validate a proof-of-concept as to whether the use of a mobile application (App) increases ADR reporting among patients with relapsing-remitting multiple sclerosis (RR-MS) receiving DMD. METHODS/DESIGN We designed a multi-centric, open cluster-randomized controlled trial, called the Vigip-SEP study (NCT03029897), using the App My eReport France® to report ADR to the appropriate authorities in E2B language, in accordance with European regulations. RR-MS patients who were initiated on, or switched, first-line DMD will be included. In the experimental arm, a neurologist will introduce the patient to the App to report ADR to the appropriate French authorities. In the control arm, the patient will be informed of the existence of the App but will not be introduced to its use and will then report ADR according to the usual reporting procedures. Primary assessment criteria are defined as the average number of ADR per patient and per center. We assume that the App will increase patient reporting by 10-fold. Therefore, we will require 24 centers (12 per arm: 6 MS academic expert centers, 3 general hospitals, 3 private practice neurologists), allowing for an expected enrollment of 180 patients (alpha risk 5%, power 90% and standard deviation 4%). DISCUSSION Increasing patient reporting of ADR in a real-life setting is extremely important for therapeutic management of RR-MS, particularly for monitoring newly approved DMD to gain better knowledge of their safety profiles. To increase patient involvement, teaching patients to use tools, such as mobile applications, should be encouraged, and these tools should be tested rigorously. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT03029897 . Registered on 20 January 2017.
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Affiliation(s)
- Gilles Defer
- Neurology Department, CHU de Caen, 14000 Caen, France
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17
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Gaillard C, Allain L, Legros H, Brucato S, Desgue Y, Rouillon C, Peyro-Saint-Paul L, Dompmartin A. Real versus sham proximal biofield therapy in the treatment of warts of the hands and feet in adults: study protocol for a randomized controlled trial (MAGNETIK study). Trials 2017; 18:263. [PMID: 28592299 PMCID: PMC5463300 DOI: 10.1186/s13063-017-1994-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Despite the lack of scientific studies on biofield therapies, they are widely acclaimed by patients. The mechanisms of action are not explained by current allopathic medical approaches. Warts are common and contagious viral lesions that may be refractory to standard dermatologic treatments such as cryotherapy, laser therapy, and keratolytic ointments. Biofield therapies are efficient in various pathologies. Their ability to treat warts has never been demonstrated in a scientific study with a robust methodology. Patients with refractory warts often place their trust in these alternative therapies because of the poor results obtained from traditional medicine. We propose a prospective, randomized, single-blind, assessor-blind trial to evaluate the efficacy of treatment of warts by biofield therapy. Methods/design Subjects with warts on their feet or hands will be randomized into two groups: real biofield therapy versus sham therapy. The diagnosis will be made at the time of inclusion, and follow-up will take place in week 3. Comparison of pictures of the warts at baseline and after 3 weeks will be used as the primary outcome measure. The hypothesis is that the extent of the disappearance of the original wart in the group treated by real biofield therapy will be 70% and that it will be 30% in the group treated by sham therapy. Using 90% power and an alpha risk of 5%, 31 subjects are required in each group for a two-tailed proportion comparison test. Discussion To our knowledge, this is the first study to evaluate the efficacy of biofield therapy on warts. Therefore, the aim of this study is to extend knowledge of biofield therapy to another area of medicine such as dermatology and to propose complementary or alternative practices to improve patient well-being. The main strength of the study is that it is a randomized, single-blind, assessor-blind, placebo-controlled study. Trial registration ClinicalTrials.gov identifier: NCT02773719. Registered on 22 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1994-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cathy Gaillard
- Délégation à la Recherche Clinique et à l'Innovation, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France.
| | - Laure Allain
- Centre de Recherche Clinique, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
| | - Hélène Legros
- Centre de Recherche Clinique, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
| | - Sylvie Brucato
- Centre de Recherche Clinique, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
| | - Yohann Desgue
- Biofield Therapy Center, 17 rue des ormes, F-50570, Marigny, France
| | - Christophe Rouillon
- Centre de Recherche Clinique, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
| | - Laure Peyro-Saint-Paul
- Délégation à la Recherche Clinique et à l'Innovation, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
| | - Anne Dompmartin
- Service de Dermatologie, Centre Hospitalier Régional Universitaire (CHU) de Caen, Avenue de la Côte de Nacre, CS 30001, F-14000, Caen, France
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18
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Sassier M, Peyro-Saint-Paul L, Clarisse B, Leconte A, Coquerel A, Alexandre J, Fedrizzi S, Leroy-Terquem E, Madroszyk A, Gervais R. Chemotherapy (platinum and pemetrexed) in combination with erlotinib in non-small cell lung cancer induces major gastrointestinal toxicity: two case reports from the FLARE/GFPC 03-2013 study. J Clin Pharm Ther 2016; 41:447-448. [PMID: 27306517 DOI: 10.1111/jcpt.12406] [Citation(s) in RCA: 2] [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: 03/25/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE A randomized phase III study was designed to assess the efficacy and safety of second-line platinum-based chemotherapy with or without erlotinib in non-small cell lung cancer (NSCLC) with EGFR-activating mutation after secondary resistance to EGFR-TKIs (epidermal growth factor receptor tyrosine kinase inhibitors). CASE SUMMARY We report herein two of the first three patients who presented with major gastrointestinal toxicities in the experimental arm of the trial. WHAT IS NEW AND CONCLUSION Pending further data, it would seem safer to administer EGFR-TKIs and chemotherapy sequentially rather than concomitantly.
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Affiliation(s)
- M Sassier
- Department of Pharmacology, CHU de Caen, Caen, France.,Department of Clinical Research, Centre François Baclesse, Caen, France
| | - L Peyro-Saint-Paul
- Department of Clinical Research, Centre François Baclesse, Caen, France.,Department of Clinical Research, CHU de Caen, Caen, France
| | - B Clarisse
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - A Leconte
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - A Coquerel
- Department of Pharmacology, CHU de Caen, Caen, France
| | - J Alexandre
- Department of Pharmacology, CHU de Caen, Caen, France
| | - S Fedrizzi
- Department of Pharmacology, CHU de Caen, Caen, France
| | - E Leroy-Terquem
- Department of Pneumology, Meulan-Les Mureaux Intercommunal Hospital, Meulan en Yvelines, France
| | - A Madroszyk
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - R Gervais
- Department of Oncology, Centre François Baclesse, Caen, France
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Lux AL, Mouriaux F, Guillois B, Fedrizzi S, Peyro-Saint-Paul L, Denion E. [Serious adverse side effects after pupillary dilation in preterm infants]. J Fr Ophtalmol 2015; 38:193-8. [PMID: 25726252 DOI: 10.1016/j.jfo.2014.10.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed at investigating serious side effects of the pupillary dilation protocol used in Caen University Hospital for the screening of retinopathy of prematurity. This protocol includes one drop of phenylephrine 5% and two drops of tropicamide 0.5% instilled at a 5-minute interval. PATIENTS AND METHODS This retrospective study included all premature infants with a birth weight less than or equal to 1500 g and/or a gestational age less than or equal to 30 gestational weeks, hospitalized in the neonatal intensive care unit of Caen University Medical Center, having ocular fundus examinations for retinopathy of prematurity screening between 2009 and 2014. The medical records of patients who died or developed necrotizing enterocolitis were reviewed to analyze the imputability of the two eye drops used for pupil dilation. RESULTS Five-hundred and twelve infants were included, corresponding to 1033 ocular fundus examinations. No case of death could be ascribed to the use of eye drops. Two cases of necrotizing enterocolitis could be ascribed to the use of tropicamide with a doubtful and plausible intrinsic imputability according to French imputability criteria. CONCLUSION The pupillary dilation protocol used in Caen University Hospital for screening of retinopathy of prematurity might be implicated in two cases of necrotizing enterocolitis with an uncertain imputability of tropicamide 0.5% eye drops. No serious side effect could be ascribed to the use of phenylephrine 5% eye drops in this study.
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Affiliation(s)
- A-L Lux
- CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen cedex, France.
| | - F Mouriaux
- CHU Pontchaillou de Rennes, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Guillois
- CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen cedex, France
| | - S Fedrizzi
- CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen cedex, France
| | | | - E Denion
- CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen cedex, France
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Peyro-Saint-Paul L, Roberge C, Auclair V, Mosquet B, Guillemard C. Surveillance d’une neutropénie iatrogène : importance de l’analyse de pharmacovigilance. Therapie 2004; 59:655-7. [PMID: 15789833 DOI: 10.2515/therapie:2004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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