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Tisseyre M, Collier M, Beeker N, Kaguelidou F, Treluyer JM, Chouchana L. In Utero Exposure to Antibiotics and Risk of Serious Infections in the First Year of Life. Drug Saf 2024; 47:453-464. [PMID: 38409516 DOI: 10.1007/s40264-024-01401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/22/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION AND OBJECTIVE Given the high prevalence of antibiotic prescription during pregnancy in France and previous studies suggesting an increased risk of infection in offspring with such exposures, our study aimed to investigate the association between prenatal exposure to systemic antibiotics and serious infections in full-term infants during their first year of life. METHODS We conducted a retrospective population-based cohort study on singleton, full-term liveborn non-immunocompromised infants, using the French National Health Data System (SNDS) between 2012 and 2021. Systemic antibiotic dispensing in ambulatory care settings during pregnancy defined the exposure. Outcomes concerned serious infections (i.e., infections requiring hospitalization) in offspring identified between 3 and 12 months of life, hence excluding infections of maternal origin. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariate models to control for potential confounders. RESULTS Of 2,836,630 infants included, 39.6% were prenatally exposed to systemic antibiotics. Infants prenatally exposed to antibiotics had a higher incidence of serious infections compared with unexposed infants {aOR 1.12 [95% confidence interval (95% CI) 1.11-1.13]}. Similar associations were observed according to the timing of exposure during pregnancy, antibiotic class, and site of infections. The strongest association was observed when infants were prenatally exposed to three or more antibiotic courses during pregnancy [aOR 1.21 (95% CI 1.19-1.24)]. Limitations include residual confounders, such as genetic susceptibility to infections and the role of the underlying pathogen agent. CONCLUSION Prenatal exposure to systemic antibiotics is very common and is associated with a weak yet significant associations with subsequent serious infectious events during the first year of life. While our study revealed associations, it is important to note that causation cannot be established, given the acknowledged limitations, including potential confounding by indication.
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Affiliation(s)
- Mylène Tisseyre
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France.
| | - Mathis Collier
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Nathanaël Beeker
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Florentia Kaguelidou
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Centre d'Investigations Cliniques, INSERM CIC1426, Hôpital Robert Debré, APHP.Nord, Paris, France
| | - Jean-Marc Treluyer
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Laurent Chouchana
- Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, 75014, Paris, France
- EA7323, Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Cité, Paris, France
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Louchet M, Collier M, Beeker N, Mandelbrot L, Sibiude J, Chouchana L, Treluyer JM. Trends in harmful drug exposure during pregnancy in France between 2013 and 2019: A nationwide cohort study. PLoS One 2024; 19:e0295897. [PMID: 38198446 PMCID: PMC10781191 DOI: 10.1371/journal.pone.0295897] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/05/2022] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Describe the trends of exposure to harmful drugs during pregnancy over recent years in France. DESIGN Nationwide cohort study. SETTING The French National administrative health Data System (SNDS). POPULATION Pregnancies starting between 2013 and 2019 and outcomes corresponding to live births, medical terminations of pregnancy, and stillbirths. METHODS Each pregnancy was divided into a preconceptional period of 90 days before conception and three trimesters from conception to birth. Harmful drugs were defined according to their risks to the fetus: teratogenicity or fetotoxicity. Exposure was defined using the critical period during pregnancy for each type of harmful drug: preconceptional period or first trimester for teratogenic drugs and second or third trimesters for fetotoxic drugs. MAIN OUTCOME MEASURES Prevalence of pregnancies exposed to at least one harmful drug. RESULTS Among 5,253,284 pregnancies, 204,402 (389 per 10,000) pregnancies were exposed to at least one harmful drug during the critical periods: 48,326 (92 per 10,000) pregnancies were exposed to teratogenic drugs during the preconceptional period or the first trimester, and 155,514 (299 per 10,000) pregnancies were exposed to fetotoxic drugs during the second or third trimesters. Teratogenic drugs were mainly retinoids for topical use (44 per 10,000 pregnancies), antiepileptics (13 per 10,000 pregnancies) and statins (13 per 10,000 pregnancies). Fetotoxic drugs were mainly non-steroidal anti-inflammatory drugs (NSAIDs), for systemic (128 per 10,000 pregnancies) and topical use (122 per 10,000 pregnancies). Exposure to teratogenic drugs decreased from the preconceptional period to the first trimester. Exposure to fetotoxic drugs decreased from the second to the third trimester. Between 2013 and 2019, we found a decrease in harmful drug exposure overall, mainly for topical and systemic NSAIDs and for topical retinoids. CONCLUSIONS In this nationwide study, about one in 25 pregnancies was exposed to at least one harmful drug, mainly NSAIDs and topical retinoids. Although the prevalence of harmful drug exposure decreased over the study period, NSAID exposure in the second and third trimester remains of concern.
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Affiliation(s)
- Margaux Louchet
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Fédération Hospitalo-Universitaire PREMA, Université Paris Cité, Paris, Île-de-France, France
| | - Mathis Collier
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Nathanaël Beeker
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM Infection, Antimicrobials, Modelling, Evolution U1137, Université Paris Cité, Paris, Île-de-France, France
| | - Jeanne Sibiude
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM Infection, Antimicrobials, Modelling, Evolution U1137, Université Paris Cité, Paris, Île-de-France, France
| | - Laurent Chouchana
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Department of Perinatal Pediatric and Adult Pharmacology, Regional Pharmacovigilance Center, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Jean Marc Treluyer
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
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Detroit M, Collier M, Beeker N, Willems L, Decroocq J, Deau-Fischer B, Vignon M, Birsen R, Moufle F, Leclaire C, Balladur E, Deschamps P, Chauchet A, Batista R, Limat S, Treluyer JM, Ricard L, Stocker N, Hermine O, Choquet S, Morel V, Metz C, Bouscary D, Kroemer M, Zerbit J. Predictive Factors of Response to Immunotherapy in Lymphomas: A Multicentre Clinical Data Warehouse Study (PRONOSTIM). Cancers (Basel) 2023; 15:4028. [PMID: 37627056 PMCID: PMC10452259 DOI: 10.3390/cancers15164028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Immunotherapy (IT) is a major therapeutic strategy for lymphoma, significantly improving patient prognosis. IT remains ineffective for a significant number of patients, however, and exposes them to specific toxicities. The identification predictive factors around efficacy and toxicity would allow better targeting of patients with a higher ratio of benefit to risk. PRONOSTIM is a multicenter and retrospective study using the Clinical Data Warehouse (CDW) of the Greater Paris University Hospitals network. Adult patients with Hodgkin lymphoma or diffuse large-cell B lymphoma treated with immune checkpoint inhibitors or CAR T (Chimeric antigen receptor T) cells between 2017 and 2022 were included. Analysis of covariates influencing progression-free survival (PFS) or the occurrence of grade ≥3 toxicity was performed. In total, 249 patients were included. From this study, already known predictors for response or toxicity of CAR T cells such as age, elevated lactate dehydrogenase, and elevated C-Reactive Protein at the time of infusion were confirmed. In addition, male gender, low hemoglobin, and hypo- or hyperkalemia were demonstrated to be potential predictive factors for progression after CAR T cell therapy. These findings prove the attractiveness of CDW in generating real-world data, and show its essential contribution to identifying new predictors for decision support before starting IT.
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Affiliation(s)
- Marion Detroit
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Mathis Collier
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Nathanaël Beeker
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Lise Willems
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Justine Decroocq
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Bénédicte Deau-Fischer
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marguerite Vignon
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Rudy Birsen
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Frederique Moufle
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Clément Leclaire
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Elisabeth Balladur
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Paul Deschamps
- Hematology Oncology Department, André Mignot Hospital, 78157 Le Chesnay, France;
| | - Adrien Chauchet
- Hematology Department, University Hospital of Besançon, 25000 Besançon, France;
| | - Rui Batista
- Pharmacy Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France;
| | - Samuel Limat
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Marc Treluyer
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
- Regional Pharmacovigilance Center, Pharmacology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France
| | - Laure Ricard
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Nicolas Stocker
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Olivier Hermine
- Hematology Department, Necker Hospital, AP-HP, Centre Paris-Cité University, 75015 Paris, France;
| | - Sylvain Choquet
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Véronique Morel
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Carole Metz
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Didier Bouscary
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marie Kroemer
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jérémie Zerbit
- Cancer Treatment Unit, Pharmacy Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France
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Hoertel N, Sánchez-Rico M, de la Muela P, Abellán M, Blanco C, Leboyer M, Cougoule C, Gulbins E, Kornhuber J, Carpinteiro A, Becker KA, Vernet R, Beeker N, Neuraz A, Alvarado JM, Herrera-Morueco JJ, Airagnes G, Lemogne C, Limosin F. Risk of Death in Individuals Hospitalized for COVID-19 With and Without Psychiatric Disorders: An Observational Multicenter Study in France. Biol Psychiatry Glob Open Sci 2023; 3:56-67. [PMID: 35013734 PMCID: PMC8730644 DOI: 10.1016/j.bpsgos.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/27/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Prior research suggests that psychiatric disorders could be linked to increased mortality among patients with COVID-19. However, whether all or specific psychiatric disorders are intrinsic risk factors of death in COVID-19 or whether these associations reflect the greater prevalence of medical risk factors in people with psychiatric disorders has yet to be evaluated. Methods We performed an observational, multicenter, retrospective cohort study to examine the association between psychiatric disorders and mortality among patients hospitalized for laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals. Results Of 15,168 adult patients, 857 (5.7%) had an ICD-10 diagnosis of psychiatric disorder. Over a mean follow-up period of 14.6 days (SD = 17.9), 326 of 857 (38.0%) patients with a diagnosis of psychiatric disorder died compared with 1276 of 14,311 (8.9%) patients without such a diagnosis (odds ratio 6.27, 95% CI 5.40-7.28, p < .01). When adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial, this association remained significant (adjusted odds ratio 3.27, 95% CI 2.78-3.85, p < .01). However, additional adjustments for obesity and number of medical conditions resulted in a nonsignificant association (adjusted odds ratio 1.02, 95% CI 0.84-1.23, p = .86). Exploratory analyses after the same adjustments suggested that a diagnosis of mood disorders was significantly associated with reduced mortality, which might be explained by the use of antidepressants. Conclusions These findings suggest that the increased risk of COVID-19-related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population and not by the underlying psychiatric disease.
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Affiliation(s)
- Nicolas Hoertel
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1266, Paris, France
- Université de Paris, Paris, France
| | - Marina Sánchez-Rico
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Spain
| | - Pedro de la Muela
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Spain
| | - Miriam Abellán
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Marion Leboyer
- INSERM U955, Neuro-Psychiatrie Translationnelle, Université Paris-Est, Paris, France
- Département Médico-Universitaire IMPACT, Département Médical Universitaire de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Céline Cougoule
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Toulouse, France
| | - Erich Gulbins
- Department of Molecular Biology, University Medicine Essen, Essen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich Alexander University of Erlangen Nuremberg, Erlangen, Germany
| | - Alexander Carpinteiro
- Department of Molecular Biology, University Medicine Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katrin Anne Becker
- Department of Molecular Biology, University Medicine Essen, Essen, Germany
| | - Raphaël Vernet
- Department of Medical Informatics, Biostatistics and Public Health Department, L'Assistance Publique–Hôpitaux de Paris Centre-Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Nathanaël Beeker
- Unité de Recherche clinique, L'Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Antoine Neuraz
- INSERM UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
- Department of Medical Informatics, L'Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Jesús M. Alvarado
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Spain
| | - Juan José Herrera-Morueco
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Spain
| | - Guillaume Airagnes
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Département Médico-Universitaire Psychiatrie et Addictologie, L'Assistance Publique–Hôpitaux de Paris, Hôpital Hôtel-Dieu, Université de Paris, Service de Psychiatrie de l’adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Frédéric Limosin
- Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique–Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
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Chaigne B, Tieu A, Beeker N, Zuelgaray E, Bouaziz J, Sene D, Dupin N, Mouthon L. Fasciite avec éosinophilie : une analyse rétrospective en clusters de 128 patients. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.019] [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: 12/12/2022]
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Chaigne B, Tieu A, Beeker N, Zuelgaray E, Bouaziz JD, Sène D, Dupin N, Mouthon L. Cluster analysis reveals eosinophilia and fibrosis as poor prognostic markers in 128 patients with eosinophilic fasciitis. J Am Acad Dermatol 2022; 87:997-1005. [PMID: 35995088 DOI: 10.1016/j.jaad.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Eosinophilic fasciitis (EF) is an extremely rare disease with polymorphic presentation and prognosis. OBJECTIVE To further investigate EF features. METHODS We performed a retrospective multicentre study of EF patients from 2013 to 2019, clustered patients using multivariate correspondence analysis (MCA) and sought prognosis factors. RESULTS One hundred twenty-eight patients were included. Sixty-nine (50%) patients had skin sclerosis and eosinophil count was increased in 71 (55%) patients. MCA identified 3 clusters: a "mild", a "late-onset and hypereosinophilic" and a "fibrotic" cluster. Of 109 patients followed-up for more than one year, 49 (45%) presented a relapse and 48 (44%) had sequelae. Multivariate analysis revealed that eosinophilia (hazard ratio (HR)=1.56; p=0.02) and fibrosis (HR=4.02; p=0.002) were predictive factors of relapse, whereas edema (odds ratio (OR)=0.31; p=0.03), relapse (OR=3.00; p=0.04) and fibrosis (OR=1) were predictive factors of sequelae. Following relapse, treatment modifications consisted of an increase in glucocorticoids in 40 (82%) patients and addition of methotrexate in 31 (63%) patients. These modifications led to clinical improvement and glucocorticoid withdrawal in 37 (76%) and 22 (45%) patients, respectfully. LIMITATIONS Retrospective study. CONCLUSION EF patients can be divided into three homogenous clusters, which, along with fibrosis and eosinophilia, are prognosis factors of relapse and sequelae.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
| | - Ashley Tieu
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Elina Zuelgaray
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Jean-David Bouaziz
- Service de Dermatologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Damien Sène
- Département de Médecine Interne et d'Immunologie clinique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Dupin
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France; Service de Dermatologie, Hôpital Cochin, Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
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Moltó A, Pinson P, Beeker N, Roux C. POS0196 NINE PERCENT OF PATIENTS PRESENT WITH MUSCULOSKELETAL SYMPTOMS AFTER A SEVERE SARS-CoV2 INFECTION: A DESCRIPTIVE ANALYSIS OF THE ASSISTANCE PUBLIQUE - HÔPITAUX DE PARIS CLINICAL DATA WAREHOUSE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1558] [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] [Indexed: 11/04/2022]
Abstract
Backgroundthe main and most severe manifestation of the SARS-CoV2 infection is pneumonia, but other organ-specific symptoms have been described (myocarditis, encephalitis,..), and some sparse cases have reported musculoskeletal (MSK) symptoms following such an infection.Objectivesto determine the prevalence of MSK symptoms appearing after a SARS-CoV2 infection.Methodsthis was an observational cohort based on data available at the Assistance Publique-Hôpitaux de Paris (APHP) Clinical Data Warehouse (which includes data from patients admitted in the 39 APHP hospitals). Data collected included both ICD-10 codes in discharge summaries, and ‘key-words’ search on electronic medical records (EMR). To be included in the analysis, patients had to have a positive RT-PCR for SARS-CoV2 performed in APHP and be admitted in any APHP department between 1st March 2020 until 31st December 2020. Patients with past history of any MSK condition were excluded. MSK conditions were considered only if coded or reported in an EMR up to 90 days after the positive RT-PCR. Demographics and disease characteristics including treatment were compared in both groups (MSK yes/no) by T-test or ChiSquare test, accordingly.ResultsAmong the 55872 patients with a positive SARS-CoV2 RT-PCR performed in APHP, 17771 were admitted in APHP hospitals. Among them, 2170 had a previous history of MSK condition and were therefore excluded from this analysis. Among the remaining 15601 patients, 1370 (8.8%) presented with MSK symptoms. The most prevalent MSK symptoms were low back pain (32.9%), followed by joint pain (29.9%), radicular pain (20.2%) and joint effusion/arthritis (22.8%). Patients with MSK symptoms were older (67y vs. 64y, p<0.01), more frequently obese (29% vs. 25%, p=0.03), hypertensive (34% vs. 30%, p<0.01) and with diabetes (21% vs. 18%, p<0.01). There were no differences on gender nor on the ICU admission rate between groups (31% vs. 29%, NS); 30-days mortality was significantly lower in the MSK+ group probably due to selection bias (i.e. only patients who survived could present with MSK symptoms up to 90 days later) (7.8% vs. 16.9%, p<0.01). Treatment for SARS-CoV2 was slightly different in both groups, with higher corticosteroids (40.7% vs. 29.0%, p<0.01), antivirals (21.5% vs. 15.3%, p<0.01) and immunosuppressive drugs (8.5% vs. 4.5%, p<0.01) prescription rates in the MSK+ group.ConclusionMSK symptoms occurred in almost 9% of patients admitted to the hospital after a SARS-CoV2 infection, particularly in older and more comorbid patients. Further analysis evaluating the persistence of these symptoms are needed.AcknowledgementsWe would like to acknowledge all departments of Rheumatology of APHPDisclosure of InterestsAnna Moltó Consultant of: abbvie, MSD, BMS, Pfizer, Lilly, UCB, GIlead, Jansenn, NOvartis, Grant/research support from: UCB, Pierre Pinson: None declared, Nathanael Beeker: None declared, Christian Roux: None declared
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Vernet R, Beeker N, Neuraz A, Blanco C, Olfson M, Airagnes G, Lemogne C, Alvarado JM, Arnaout M, Cougoule C, Meneton P, Limosin F. Association between benzodiazepine receptor agonist use and mortality in patients hospitalised for COVID-19: a multicentre observational study. Epidemiol Psychiatr Sci 2022; 31:e18. [PMID: 35352674 PMCID: PMC8967698 DOI: 10.1017/s2045796021000743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW). RESULTS Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74-3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31-1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08-2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment. CONCLUSIONS BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.
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Affiliation(s)
- N. Hoertel
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - M. Sánchez-Rico
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - E. Gulbins
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - J. Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - R. Vernet
- Medical Informatics, Biostatistics and Public Health Department, AP-HP, Centre-Université de Paris, Hôpital Européen Georges Pompidou, F-75015Paris, France
| | - N. Beeker
- Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - A. Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
- Department of Medical Informatics, AP-HP, Centre-Université de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - C. Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD20852, USA
| | - M. Olfson
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY10032, USA
| | - G. Airagnes
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
- INSERM, UMS 011, Population-based Epidemiologic Cohorts, Villejuif, France
| | - C. Lemogne
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
- AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, Paris, France
| | - J. M. Alvarado
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - M. Arnaout
- Anesthesia and Intensive Care Department, Hôpitaux Universitaires Paris Île-de-France Ouest, Boulogne-Billancourt, France
| | - C. Cougoule
- Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - P. Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - F. Limosin
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France
- Université de Paris, Paris, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Abellán M, de la Muela P, Vernet R, Beeker N, Neuraz A, Delcuze A, Alvarado JM, Cougoule C, Meneton P, Limosin F. Association between FIASMA psychotropic medications and reduced risk of intubation or death in individuals with psychiatric disorders hospitalized for severe COVID-19: an observational multicenter study. Transl Psychiatry 2022; 12:90. [PMID: 35241663 PMCID: PMC8892828 DOI: 10.1038/s41398-022-01804-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
The acid sphingomyelinase (ASM)/ceramide system may provide a useful framework for better understanding SARS-CoV-2 infection and the repurposing of psychotropic medications functionally inhibiting the acid sphingomyelinase/ceramide system (named FIASMA psychotropic medications) against COVID-19. We examined the potential usefulness of FIASMA psychotropic medications in patients with psychiatric disorders hospitalized for severe COVID-19, in an observational multicenter study conducted at Greater Paris University hospitals. Of 545 adult inpatients, 164 (30.1%) received a FIASMA psychotropic medication upon hospital admission for COVID-19. We compared the composite endpoint of intubation or death between patients who received a psychotropic FIASMA medication at baseline and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, psychiatric and other medical comorbidity, and other medications. FIASMA psychotropic medication use at baseline was significantly associated with reduced risk of intubation or death in both crude (HR = 0.42; 95%CI = 0.31-0.57; p < 0.01) and primary inverse probability weighting (IPW) (HR = 0.50; 95%CI = 0.37-0.67; p < 0.01) analyses. This association was not specific to one FIASMA psychotropic class or medication. Patients taking a FIASMA antidepressant at baseline had a significantly reduced risk of intubation or death compared with those taking a non-FIASMA antidepressant at baseline in both crude (HR = 0.57; 95%CI = 0.38-0.86; p < 0.01) and primary IPW (HR = 0.57; 95%CI = 0.37-0.87; p < 0.01) analyses. These associations remained significant in multiple sensitivity analyses. Our results show the potential importance of the ASM/ceramide system framework in COVID-19 and support the continuation of FIASMA psychotropic medications in these patients and the need of large- scale clinical trials evaluating FIASMA medications, and particularly FIASMA antidepressants, against COVID-19.
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Affiliation(s)
- Nicolas Hoertel
- AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France. .,Université de Paris, Paris, France. .,INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Paris, France.
| | - Marina Sánchez-Rico
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Erich Gulbins
- grid.5718.b0000 0001 2187 5445Institute for Molecular Biology, University Medicine Essen, University of Duisburg- Essen, Essen, Germany
| | - Johannes Kornhuber
- grid.5330.50000 0001 2107 3311Department of Psychiatry and Psychotherapy, University Hospital, Friedrich- Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Carpinteiro
- grid.5718.b0000 0001 2187 5445Institute for Molecular Biology, University Medicine Essen, University of Duisburg- Essen, Essen, Germany ,grid.410718.b0000 0001 0262 7331Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Miriam Abellán
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France
| | - Pedro de la Muela
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Raphaël Vernet
- grid.414093.b0000 0001 2183 5849AP-HP.Centre-Université de Paris, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, Paris, France
| | - Nathanaël Beeker
- grid.411784.f0000 0001 0274 3893Assistance Publique-Hopitaux de Paris, Unité de Recherche clinique, Hopital Cochin, Paris, France
| | - Antoine Neuraz
- grid.417925.cINSERM, UMR S1138, Cordeliers Research Center, Université de Paris, Paris, France ,grid.412134.10000 0004 0593 9113AP-HP.Centre-Université de Paris, Department of Medical Informatics, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - Aude Delcuze
- ORPEA - CLINEA, Clinique Les Orchidées, Service de Psychiatrie, Andilly, France
| | - Jesús M. Alvarado
- grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Céline Cougoule
- grid.508721.9Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Pierre Meneton
- grid.462844.80000 0001 2308 1657INSERM U1142 LIMICS, UMR S1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Frédéric Limosin
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.508487.60000 0004 7885 7602Université de Paris, Paris, France ,grid.512035.0INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266 Paris, France
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Sánchez-Rico M, Limosin F, Vernet R, Beeker N, Neuraz A, Blanco C, Olfson M, Lemogne C, Meneton P, Daniel C, Paris N, Gramfort A, Lemaitre G, De La Muela P, Salamanca E, Bernaux M, Bellamine A, Burgun A, Hoertel N. Hydroxyzine Use and Mortality in Patients Hospitalized for COVID-19: A Multicenter Observational Study. J Clin Med 2021; 10:5891. [PMID: 34945186 PMCID: PMC8707307 DOI: 10.3390/jcm10245891] [Citation(s) in RCA: 6] [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: 11/17/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Based on its antiviral activity, anti-inflammatory properties, and functional inhibition effects on the acid sphingomyelinase/ceramide system (FIASMA), we sought to examine the potential usefulness of the H1 antihistamine hydroxyzine in patients hospitalized for COVID-19. (2) Methods: In a multicenter observational study, we included 15,103 adults hospitalized for COVID-19, of which 164 (1.1%) received hydroxyzine within the first 48 h of hospitalization, administered orally at a median daily dose of 25.0 mg (SD = 29.5). We compared mortality rates between patients who received hydroxyzine at hospital admission and those who did not, using a multivariable logistic regression model adjusting for patients' characteristics, medical conditions, and use of other medications. (3) Results: This analysis showed a significant association between hydroxyzine use and reduced mortality (AOR, 0.51; 95%CI, 0.29-0.88, p = 0.016). This association was similar in multiple sensitivity analyses. (4) Conclusions: In this retrospective observational multicenter study, the use of the FIASMA hydroxyzine was associated with reduced mortality in patients hospitalized for COVID-19. Double-blind placebo-controlled randomized clinical trials of hydroxyzine for COVID-19 are needed to confirm these results, as are studies to examine the potential usefulness of this medication for outpatients and as post-exposure prophylaxis for individuals at high risk for severe COVID-19.
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Affiliation(s)
- Marina Sánchez-Rico
- Département de Psychiatrie, Hôpital Corentin-Celton, AP-HP.Centre-Université de Paris, 92130 Issy-les-Moulineaux, France; (F.L.); (C.L.); (P.D.L.M.); (N.H.)
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas Universidad Complutense de Madrid, 28223 Pozuelo de Alarcon, Spain
| | - Frédéric Limosin
- Département de Psychiatrie, Hôpital Corentin-Celton, AP-HP.Centre-Université de Paris, 92130 Issy-les-Moulineaux, France; (F.L.); (C.L.); (P.D.L.M.); (N.H.)
- Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, UMR_S1266, INSERM, 75014 Paris, France
- UFR de Médecine, Faculté de Santé, Université de Paris, 75006 Paris, France
| | - Raphaël Vernet
- Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, AP-HP.Centre-Université de Paris, 75015 Paris, France;
| | - Nathanaël Beeker
- Unité de Recherche Clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 75004 Paris, France;
| | - Antoine Neuraz
- Cordeliers Research Center, Université de Paris, UMRS 1138, INSERM, 75006 Paris, France; (A.N.); (A.B.)
- Department of Medical Informatics, Necker-Enfants Malades Hospital, AP-HP, Centre-Université de Paris, 75015 Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD 20852, USA;
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA;
| | - Cédric Lemogne
- Département de Psychiatrie, Hôpital Corentin-Celton, AP-HP.Centre-Université de Paris, 92130 Issy-les-Moulineaux, France; (F.L.); (C.L.); (P.D.L.M.); (N.H.)
- Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, UMR_S1266, INSERM, 75014 Paris, France
- UFR de Médecine, Faculté de Santé, Université de Paris, 75006 Paris, France
| | - Pierre Meneton
- Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances en e-Santé, UMR 1142, INSERM, Sorbonne Université, Université Paris 13, 93017 Paris, France;
| | - Christel Daniel
- AP-HP, DSI-WIND (Web Innovation Données), 75184 Paris, France; (C.D.); (N.P.)
- Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances en e-Santé, Sorbonne University, University Paris 13, Sorbonne Paris Cité, INSERM UMRS 1142, 75012 Paris, France
| | - Nicolas Paris
- AP-HP, DSI-WIND (Web Innovation Données), 75184 Paris, France; (C.D.); (N.P.)
- LIMSI, CNRS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay, France
| | - Alexandre Gramfort
- Institut National de Recherche en Sciences et Technologies du Numérique (INRIA), Université Paris-Saclay, INRIA, CEA, 75012 Palaiseau, France; (A.G.); (G.L.)
| | - Guillaume Lemaitre
- Institut National de Recherche en Sciences et Technologies du Numérique (INRIA), Université Paris-Saclay, INRIA, CEA, 75012 Palaiseau, France; (A.G.); (G.L.)
| | - Pedro De La Muela
- Département de Psychiatrie, Hôpital Corentin-Celton, AP-HP.Centre-Université de Paris, 92130 Issy-les-Moulineaux, France; (F.L.); (C.L.); (P.D.L.M.); (N.H.)
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas Universidad Complutense de Madrid, 28223 Pozuelo de Alarcon, Spain
| | - Elisa Salamanca
- Banque Nationale de Données Maladies Rares (BNDMR), Campus Picpus, Département WIND (Web Innovation Données), AP-HP, 75012 Paris, France;
| | - Mélodie Bernaux
- Direction de la Stratégie et de la Transformation, AP-HP, 75004 Paris, France;
| | - Ali Bellamine
- Unité de Recherche Clinique, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France;
| | - Anita Burgun
- Cordeliers Research Center, Université de Paris, UMRS 1138, INSERM, 75006 Paris, France; (A.N.); (A.B.)
| | - Nicolas Hoertel
- Département de Psychiatrie, Hôpital Corentin-Celton, AP-HP.Centre-Université de Paris, 92130 Issy-les-Moulineaux, France; (F.L.); (C.L.); (P.D.L.M.); (N.H.)
- Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, UMR_S1266, INSERM, 75014 Paris, France
- UFR de Médecine, Faculté de Santé, Université de Paris, 75006 Paris, France
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Mettler C, Beeker N, Mathis C, Treluyer J, Le Guern V, Chouchana L, Terrier B. La survenue d’une naissance prématurée chez les femmes enceintes atteintes de vascularite systémique: une étude de cohorte nationale. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.256] [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: 10/19/2022]
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Mettler C, Beeker N, Mathis C, Treluyer J, Le Guern V, Chouchana L, Terrier B. Utilisation des traitements immunosuppresseurs pendant la grossesse chez les femmes atteintes de vascularite systémique : une étude de cohorte nationale. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.257] [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: 10/19/2022]
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Lenze EJ, Reiersen AM, Abellán M, de la Muela P, Vernet R, Blanco C, Cougoule C, Beeker N, Neuraz A, Gorwood P, Alvarado JM, Meneton P, Limosin F. Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study. Clin Pharmacol Ther 2021. [PMID: 34050932 DOI: 10.1002/cpt.2317.10.1002/cpt.2317] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the ASM/ceramide system may be central to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe coronavirus disease 2019 (COVID-19) in an observational multicenter study conducted at Greater Paris University hospitals. Of 2,846 adult patients hospitalized for severe COVID-19, 277 (9.7%) were taking an FIASMA medication at the time of their hospital admission. The primary end point was a composite of intubation and/or death. We compared this end point between patients taking vs. not taking an FIASMA medication in time-to-event analyses adjusted for sociodemographic characteristics and medical comorbidities. The primary analysis was a Cox regression model with inverse probability weighting (IPW). Over a mean follow-up of 9.2 days (SD = 12.5), the primary end point occurred in 104 patients (37.5%) receiving an FIASMA medication, and 1,060 patients (41.4%) who did not. Despite being significantly and substantially associated with older age and greater medical severity, FIASMA medication use was significantly associated with reduced likelihood of intubation or death in both crude (hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.58-0.87, P < 0.001) and primary IPW (HR = 0.58, 95%CI = 0.46-0.72, P < 0.001) analyses. This association remained significant in multiple sensitivity analyses and was not specific to one particular FIASMA class or medication. These results show the potential importance of the ASM/ceramide system in COVID-19 and support the continuation of FIASMA medications in these patients. Double-blind controlled randomized clinical trials of these medications for COVID-19 are needed.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
| | - Marina Sánchez-Rico
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Erich Gulbins
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Carpinteiro
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany.,Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eric J Lenze
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Angela M Reiersen
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Miriam Abellán
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
| | - Pedro de la Muela
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Raphaël Vernet
- Medical Informatics, Biostatistics and Public Health Department, Assistance Publique-Hopitaux de Paris, Centre-Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, North Bethesda, Maryland, USA
| | - Céline Cougoule
- Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Antoine Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France.,Department of Medical Informatics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Centre-Université de Paris, Paris, France
| | - Philip Gorwood
- INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Université de Paris, Paris, France
| | - Jesús M Alvarado
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Pierre Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
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14
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Hoertel N, Sánchez‐Rico M, Vernet R, Beeker N, Neuraz A, Alvarado JM, Daniel C, Paris N, Gramfort A, Lemaitre G, Salamanca E, Bernaux M, Bellamine A, Burgun A, Limosin F. Dexamethasone use and mortality in hospitalized patients with coronavirus disease 2019: A multicentre retrospective observational study. Br J Clin Pharmacol 2021; 87:3766-3775. [PMID: 33608891 PMCID: PMC8013383 DOI: 10.1111/bcp.14784] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/30/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS To examine the association between dexamethasone use and mortality among patients hospitalized for COVID-19. METHODS We examined the association between dexamethasone use and mortality at AP-HP Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was time to death. We compared this endpoint between patients who received dexamethasone and those who did not in time-to-event analyses adjusted for patient characteristics (such as age, sex and comorbidity) and clinical and biological markers of clinical severity of COVID-19, and stratified by the need for respiratory support, i.e. mechanical ventilation or oxygen. The primary analysis was a multivariable Cox regression model. RESULTS Of 12 217 adult patients hospitalized with a positive COVID-19 reverse transcriptase-polymerase chain reaction test, 171 (1.4%) received dexamethasone orally or by intravenous perfusion during the visit. Among patients who required respiratory support, the end-point occurred in 10/63 (15.9%) patients who received dexamethasone and 298/1129 (26.4%) patients who did not. In this group, there was a significant association between dexamethasone use and reduced mortality in the primary analysis (hazard ratio, 0.46; 95% confidence interval 0.22-0.96, P = .039). Among patients who did not require respiratory support, there was no significant association between dexamethasone use and the endpoint. CONCLUSIONS In this multicentre observational study, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was associated with reduced mortality among patients with COVID-19 requiring respiratory support.
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Affiliation(s)
- Nicolas Hoertel
- Département de PsychiatrieAP‐HP.Centre, Hôpital Corentin‐CeltonIssy‐les‐MoulineauxFrance
- Institut de Psychiatrie et Neurosciences de ParisUniversité de Paris, INSERMParisFrance
- Faculté de Santé, UFR de MédecineUniversité de ParisParisFrance
| | - Marina Sánchez‐Rico
- Département de PsychiatrieAP‐HP.Centre, Hôpital Corentin‐CeltonIssy‐les‐MoulineauxFrance
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of PsychologyUniversidad Complutense de Madrid, Campus de SomosaguasPozuelo de AlarconSpain
| | - Raphaël Vernet
- Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health DepartmentAP‐HP.Centre‐Université de ParisParisFrance
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hopital Cochin, Assistance Publique‐Hopitaux de ParisParisFrance
| | - Antoine Neuraz
- INSERM, UMR_S 1138, Cordeliers Research CenterUniversité de ParisFrance
- Department of Medical Informatics, Necker‐Enfants Malades Hospital, AP‐HP. Centre‐Université de ParisParisFrance
| | - Jesús M. Alvarado
- Department of Psychobiology & Behavioural Sciences Methods, Faculty of PsychologyUniversidad Complutense de Madrid, Campus de SomosaguasPozuelo de AlarconSpain
| | - Christel Daniel
- AP‐HP, DSI‐WIND (Web Innovation Données), ParisFrance
- Sorbonne University, University Paris 13, Sorbonne Paris CitéINSERM UMR_S 1142ParisFrance
| | - Nicolas Paris
- AP‐HP, DSI‐WIND (Web Innovation Données), ParisFrance
- LIMSI, CNRSUniversité Paris‐SudUniversité Paris‐SaclayOrsayFrance
| | | | | | - Elisa Salamanca
- Banque Nationale de Données Maladies Rares (BNDMR), Campus PicpusDépartement WIND (Web Innovation Données)ParisFrance
| | - Mélodie Bernaux
- Direction de la stratégie et de la transformation, AP‐HPParisFrance
| | - Ali Bellamine
- Unité de Recherche clinique, Hôpital Cochin, AP‐HP.Centre‐Université de ParisParisFrance
| | - Anita Burgun
- INSERM, UMR_S 1138, Cordeliers Research CenterUniversité de ParisFrance
| | - Frédéric Limosin
- Département de PsychiatrieAP‐HP.Centre, Hôpital Corentin‐CeltonIssy‐les‐MoulineauxFrance
- Institut de Psychiatrie et Neurosciences de ParisUniversité de Paris, INSERMParisFrance
- Faculté de Santé, UFR de MédecineUniversité de ParisParisFrance
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15
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Hoertel N, Sánchez-Rico M, Vernet R, Beeker N, Jannot AS, Neuraz A, Salamanca E, Paris N, Daniel C, Gramfort A, Lemaitre G, Bernaux M, Bellamine A, Lemogne C, Airagnes G, Burgun A, Limosin F. Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study. Mol Psychiatry 2021; 26:5199-5212. [PMID: 33536545 DOI: 10.1038/s41380-021-01021-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Abstract
A prior meta-analysis showed that antidepressant use in major depressive disorder was associated with reduced plasma levels of several pro-inflammatory mediators, which have been associated with severe COVID-19. Recent studies also suggest that several antidepressants may inhibit acid sphingomyelinase activity, which may prevent the infection of epithelial cells with SARS-CoV-2, and that the SSRI fluoxetine may exert in-vitro antiviral effects on SARS-CoV-2. We examined the potential usefulness of antidepressant use in patients hospitalized for COVID-19 in an observational multicenter retrospective cohort study conducted at AP-HP Greater Paris University hospitals. Of 7230 adults hospitalized for COVID-19, 345 patients (4.8%) received an antidepressant within 48 h of hospital admission. The primary endpoint was a composite of intubation or death. We compared this endpoint between patients who received antidepressants and those who did not in time-to-event analyses adjusted for patient characteristics, clinical and biological markers of disease severity, and other psychotropic medications. The primary analysis was a multivariable Cox model with inverse probability weighting. This analysis showed a significant association between antidepressant use and reduced risk of intubation or death (HR, 0.56; 95% CI, 0.43-0.73, p < 0.001). This association remained significant in multiple sensitivity analyses. Exploratory analyses suggest that this association was also significant for SSRI and non-SSRI antidepressants, and for fluoxetine, paroxetine, escitalopram, venlafaxine, and mirtazapine (all p < 0.05). These results suggest that antidepressant use could be associated with lower risk of death or intubation in patients hospitalized for COVID-19. Double-blind controlled randomized clinical trials of antidepressant medications for COVID-19 are needed.
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Affiliation(s)
- Nicolas Hoertel
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Département Médico-Universitaire de Psychiatrie et Addictologie, 92130, Issy-les-Moulineaux, France. .,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France. .,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.
| | - Marina Sánchez-Rico
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Département Médico-Universitaire de Psychiatrie et Addictologie, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Raphaël Vernet
- AP-HP.Centre-Université de Paris, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, F-75015, Paris, France
| | - Nathanaël Beeker
- AP-HP.Centre-Université de Paris, Unité de Recherche clinique, Hôpital Cochin, Paris, France
| | - Anne-Sophie Jannot
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, F-75015, Paris, France.,INSERM, UMR_S1138, Cordeliers Research Center, Université de Paris, Paris, France
| | - Antoine Neuraz
- INSERM, UMR_S1138, Cordeliers Research Center, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Necker-Enfants Malades Hospital, Department of Medical Informatics, 75015, Paris, France
| | - Elisa Salamanca
- Banque Nationale de Données Maladies Rares, Campus Picpus, Département WIND (Web Innovation Données), Paris, France
| | - Nicolas Paris
- AP-HP, DSI-WIND (Web Innovation Données), Paris, France.,LIMSI, CNRS, Université Paris-Sud and Université Paris-Saclay, F-91405, Orsay, France
| | - Christel Daniel
- AP-HP, DSI-WIND (Web Innovation Données), Paris, France.,Sorbonne University, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S1142, F-75012, Paris, France
| | | | | | - Mélodie Bernaux
- Direction de la stratégie et de la transformation, AP-HP, Paris, France
| | - Ali Bellamine
- AP-HP.Centre-Université de Paris, Unité de Recherche clinique, Hôpital Cochin, Paris, France
| | - Cédric Lemogne
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Département Médico-Universitaire de Psychiatrie et Addictologie, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
| | - Guillaume Airagnes
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Département Médico-Universitaire de Psychiatrie et Addictologie, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
| | - Anita Burgun
- INSERM, UMR_S1138, Cordeliers Research Center, Université de Paris, Paris, France
| | - Frédéric Limosin
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Département Médico-Universitaire de Psychiatrie et Addictologie, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
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16
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Lenze EJ, Reiersen AM, Abellán M, de la Muela P, Vernet R, Blanco C, Cougoule C, Beeker N, Neuraz A, Gorwood P, Alvarado JM, Meneton P, Limosin F. Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study. Clin Pharmacol Ther 2021; 110:1498-1511. [PMID: 34050932 PMCID: PMC8239599 DOI: 10.1002/cpt.2317] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/31/2022]
Abstract
Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the ASM/ceramide system may be central to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe coronavirus disease 2019 (COVID‐19) in an observational multicenter study conducted at Greater Paris University hospitals. Of 2,846 adult patients hospitalized for severe COVID‐19, 277 (9.7%) were taking an FIASMA medication at the time of their hospital admission. The primary end point was a composite of intubation and/or death. We compared this end point between patients taking vs. not taking an FIASMA medication in time‐to‐event analyses adjusted for sociodemographic characteristics and medical comorbidities. The primary analysis was a Cox regression model with inverse probability weighting (IPW). Over a mean follow‐up of 9.2 days (SD = 12.5), the primary end point occurred in 104 patients (37.5%) receiving an FIASMA medication, and 1,060 patients (41.4%) who did not. Despite being significantly and substantially associated with older age and greater medical severity, FIASMA medication use was significantly associated with reduced likelihood of intubation or death in both crude (hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.58–0.87, P < 0.001) and primary IPW (HR = 0.58, 95%CI = 0.46–0.72, P < 0.001) analyses. This association remained significant in multiple sensitivity analyses and was not specific to one particular FIASMA class or medication. These results show the potential importance of the ASM/ceramide system in COVID‐19 and support the continuation of FIASMA medications in these patients. Double‐blind controlled randomized clinical trials of these medications for COVID‐19 are needed.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
| | - Marina Sánchez-Rico
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Erich Gulbins
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Carpinteiro
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany.,Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eric J Lenze
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Angela M Reiersen
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Miriam Abellán
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
| | - Pedro de la Muela
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Raphaël Vernet
- Medical Informatics, Biostatistics and Public Health Department, Assistance Publique-Hopitaux de Paris, Centre-Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, North Bethesda, Maryland, USA
| | - Céline Cougoule
- Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Antoine Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France.,Department of Medical Informatics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Centre-Université de Paris, Paris, France
| | - Philip Gorwood
- INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Université de Paris, Paris, France
| | - Jesús M Alvarado
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Pierre Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France
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17
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Chouchana L, Beeker N, Garcelon N, Rance B, Paris N, Salamanca E, Polard E, Burgun A, Treluyer JM, Neuraz A. Correction to: Association of Antihypertensive Agents with the Risk of In-Hospital Death in Patients with Covid-19. Cardiovasc Drugs Ther 2021; 36:1255. [PMID: 33661434 PMCID: PMC7930889 DOI: 10.1007/s10557-021-07164-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laurent Chouchana
- Centre Régional de Pharmacovigilance, Département de, Pharmacologie, Hôpital Cochin, AP-HP.Centre - Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hôpital Cochin, AP-HP.Centre - Université de Paris, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team, 22, Université de Paris, Paris, France
- Institut Imagine, Université de Paris, Paris, France
| | - Bastien Rance
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team, 22, Université de Paris, Paris, France
- Département d'informatique médicale, Hôpital Européen Georges Pompidou, AP-HP.Centre - Université de Paris, Paris, France
| | - Nicolas Paris
- Département Web Innovation Données (WIND), Direction des systèmes d'information, AP-HP, Paris, France
| | - Elisa Salamanca
- Département Web Innovation Données (WIND), Direction des systèmes d'information, AP-HP, Paris, France
| | - Elisabeth Polard
- Centre Régional de Pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Rennes, Rennes, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team, 22, Université de Paris, Paris, France
- Département d'informatique médicale, Hôpital Européen Georges Pompidou, AP-HP.Centre - Université de Paris, Paris, France
- Département d'informatique médicale, Hôpital Necker-Enfants Malades, AP-HP.Centre - Université de Paris, Paris, France
| | - Jean-Marc Treluyer
- Centre Régional de Pharmacovigilance, Département de, Pharmacologie, Hôpital Cochin, AP-HP.Centre - Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Unité de Recherche clinique, Hôpital Cochin, AP-HP.Centre - Université de Paris, Paris, France
| | - Antoine Neuraz
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team, 22, Université de Paris, Paris, France
- Département d'informatique médicale, Hôpital Necker-Enfants Malades, AP-HP.Centre - Université de Paris, Paris, France
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18
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Hoertel N, Sánchez-Rico M, Vernet R, Jannot AS, Neuraz A, Blanco C, Lemogne C, Airagnes G, Paris N, Daniel C, Gramfort A, Lemaitre G, Bernaux M, Bellamine A, Beeker N, Limosin F. Observational study of haloperidol in hospitalized patients with COVID-19. PLoS One 2021; 16:e0247122. [PMID: 33606790 PMCID: PMC7895415 DOI: 10.1371/journal.pone.0247122] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Haloperidol, a widely used antipsychotic, has been suggested as potentially useful for patients with COVID-19 on the grounds of its in-vitro antiviral effects against SARS-CoV-2, possibly through sigma-1 receptor antagonist effect. METHODS We examined the associations of haloperidol use with intubation or death and time to discharge home among adult patients hospitalized for COVID-19 at Assistance Publique-Hôpitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was a composite of intubation or death and the secondary endpoint was discharge home among survivors in time-to-event analyses. In the primary analyses, we compared these two outcomes between patients receiving and not receiving haloperidol using univariate Cox regression models in matched analytic samples based on patient characteristics and other psychotropic medications. Sensitivity analyses included propensity score analyses with inverse probability weighting and multivariable Cox regression models. RESULTS Of 15,121 adult inpatients with a positive COVID-19 PT-PCR test, 39 patients (0.03%) received haloperidol within the first 48 hours of admission. Over a mean follow-up of 13.8 days (SD = 17.9), 2,024 patients (13.4%) had a primary end-point event and 10,179 patients (77.6%) were discharged home at the time of study end on May 1st. The primary endpoint occurred in 9 patients (23.1%) who received haloperidol and 2,015 patients (13.4%) who did not. The secondary endpoint of discharge home occurred in 16 patients (61.5%) who received haloperidol and 9,907 patients (85.8%) who did not. There were no significant associations between haloperidol use and the primary (HR, 0.80; 95% CI, 0.39 to 1.62, p = 0.531) and secondary (HR, 1.30; 95% CI, 0.74 to 2.28, p = 0.355) endpoints. Results were similar in multiple sensitivity analyses. CONCLUSION Findings from this multicenter observational study suggest that haloperidol use prescribed at a mean dose of 4.5 mg per day (SD = 5.2) for a mean duration of 8.4 days (SD = 7.2) may not be associated with risk of intubation or death, or with time to discharge home, among adult patients hospitalized for COVID-19.
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Affiliation(s)
- Nicolas Hoertel
- Département de Psychiatrie, Hôpital Corentin-Celton, Centre Université de Paris, AP-HP, Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Marina Sánchez-Rico
- Département de Psychiatrie, Hôpital Corentin-Celton, Centre Université de Paris, AP-HP, Issy-les-Moulineaux, France
- Faculty of Psychology, Department of Psychobiology & Behavioural Sciences Methods, Universidad Complutense de Madrid, Madrid, Spain
| | - Raphaël Vernet
- Biostatistics and Public Health Department, Hôpital Européen Georges Pompidou, Medical Informatics, AP-HP, Centre-Université de Paris, Paris, France
| | - Anne-Sophie Jannot
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
- Biostatistics and Public Health Department, Hôpital Européen Georges Pompidou, Medical Informatics, AP-HP, Centre-Université de Paris, Paris, France
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
| | - Antoine Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
- Department of Medical Informatics, Necker-Enfants Malades Hospital, AP-HP, Centre-Université de Paris, Paris, France
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, United States of America
| | - Cédric Lemogne
- Département de Psychiatrie, Hôpital Corentin-Celton, Centre Université de Paris, AP-HP, Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Guillaume Airagnes
- Département de Psychiatrie, Hôpital Corentin-Celton, Centre Université de Paris, AP-HP, Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Nicolas Paris
- AP-HP, DSI-WIND, Paris, France
- LIMSI, CNRS, Université Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Christel Daniel
- AP-HP, DSI-WIND, Paris, France
- Sorbonne University, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S 1142, Paris, France
| | | | | | - Mélodie Bernaux
- Direction de la stratégie et de la transformation, AP-HP, Paris, France
| | - Ali Bellamine
- Unité de Recherche clinique, Hôpital Cochin, AP-HP, Centre-Université de Paris, Paris, France
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hôpital Cochin, AP-HP, Centre-Université de Paris, Paris, France
| | - Frédéric Limosin
- Département de Psychiatrie, Hôpital Corentin-Celton, Centre Université de Paris, AP-HP, Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
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19
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Chouchana L, Beeker N, Garcelon N, Rance B, Paris N, Salamanca E, Polard E, Burgun A, Treluyer JM, Neuraz A. Association of Antihypertensive Agents with the Risk of In-Hospital Death in Patients with Covid-19. Cardiovasc Drugs Ther 2021; 36:483-488. [PMID: 33595761 PMCID: PMC7887412 DOI: 10.1007/s10557-021-07155-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The role of angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), or other antihypertensive agents in the case of Covid-19 remains controversial. We aimed to investigate the association between antihypertensive agent exposure and in-hospital mortality in patients with Covid-19. METHODS We performed a retrospective multicenter cohort study on patients hospitalized between February 1 and May 15, 2020. All patients had been followed up for at least 30 days. RESULTS Of the 8078 hospitalized patients for Covid-19, 3686 (45.6%) had hypertension and were included in the study. In this population, the median age was 75.4 (IQR, 21.5) years and 57.1% were male. Overall in-hospital 30-day mortality was 23.1%. The main antihypertensive pharmacological classes used were calcium channel blockers (CCB) (n=1624, 44.1%), beta-blockers (n=1389, 37.7%), ARB (n=1154, 31.3%), and ACEi (n=998, 27.1%). The risk of mortality was lower in CCB (aOR, 0.83 [0.70-0.99]) and beta-blockers (aOR, 0.80 [0.67-0.95]) users and non-significant in ARB (aOR, 0.88 [0.72-1.06]) and ACEi (aOR, 0.83 [0.68-1.02]) users, compared to non-users. These results remain consistent for patients receiving CCB, beta-blocker, or ARB as monotherapies. CONCLUSION This large multicenter retrospective of Covid-19 patients with hypertension found a reduced mortality among CCB and beta-blockers users, suggesting a putative protective effect. Our findings did not show any association between the use of renin-angiotensin-aldosterone system inhibitors and the risk of in-hospital death. Although they need to be confirmed in further studies, these results support the continuation of antihypertensive agents in patients with Covid-19, in line with the current guidelines.
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Affiliation(s)
- Laurent Chouchana
- Centre Régional de Pharmacovigilance, Département de Pharmacologie, Hôpital Cochin, AP-HP.Centre - Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hôpital Cochin, AP-HP.Centre - Université de Paris, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team 22, Université de Paris, Paris, France.,Institut Imagine, Université de Paris, Paris, France
| | - Bastien Rance
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team 22, Université de Paris, Paris, France.,Département d'informatique médicale, Hôpital Européen Georges Pompidou, AP-HP.Centre - Université de Paris, Paris, France
| | - Nicolas Paris
- Département Web Innovation Données (WIND), Direction des systèmes d'information, AP-HP, Paris, France
| | - Elisa Salamanca
- Département Web Innovation Données (WIND), Direction des systèmes d'information, AP-HP, Paris, France
| | - Elisabeth Polard
- Centre Régional de Pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Rennes, Rennes, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team 22, Université de Paris, Paris, France.,Département d'informatique médicale, Hôpital Européen Georges Pompidou, AP-HP.Centre - Université de Paris, Paris, France.,Département d'informatique médicale, Hôpital Necker-Enfants Malades, AP-HP.Centre - Université de Paris, Paris, France
| | - Jean-Marc Treluyer
- Centre Régional de Pharmacovigilance, Département de Pharmacologie, Hôpital Cochin, AP-HP.Centre - Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Unité de Recherche clinique, Hôpital Cochin, AP-HP.Centre - Université de Paris, Paris, France
| | - Antoine Neuraz
- Centre de Recherche des Cordeliers, INSERM UMRS_1138 Team 22, Université de Paris, Paris, France.,Département d'informatique médicale, Hôpital Necker-Enfants Malades, AP-HP.Centre - Université de Paris, Paris, France
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20
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Hoertel N, Sánchez-Rico M, Vernet R, Jannot AS, Neuraz A, Blanco C, Lemogne C, Airagnes G, Paris N, Daniel C, Gramfort A, Lemaitre G, Bernaux M, Bellamine A, Beeker N, Limosin F. Observational Study of Chlorpromazine in Hospitalized Patients with COVID-19. Clin Drug Investig 2021; 41:221-233. [PMID: 33559821 PMCID: PMC7871023 DOI: 10.1007/s40261-021-01001-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
Abstract
Introduction Chlorpromazine has been suggested as being potentially useful in patients with coronavirus disease 2019 (COVID-19) on the grounds of its potential antiviral and anti-inflammatory effects. Objective The aim of this study was to examine the association between chlorpromazine use and mortality among adult patients hospitalized for COVID-19. Methods We conducted an observational, multicenter, retrospective study at Assistance Publique-Hôpitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of first prescription of chlorpromazine during hospitalization for COVID-19. The primary endpoint was death. Among patients who had not been hospitalized in intensive care units (ICUs), we compared this endpoint between those who received chlorpromazine and those who did not, in time-to-event analyses adjusted for patient characteristics, clinical markers of disease severity, and other psychotropic medications. The primary analysis used a Cox regression model with inverse probability weighting. Multiple sensitivity analyses were performed. Results Of the 14,340 adult inpatients hospitalized outside ICUs for COVID-19, 55 patients (0.4%) received chlorpromazine. Over a mean follow-up of 14.3 days (standard deviation [SD] 18.2), death occurred in 13 patients (23.6%) who received chlorpromazine and 1289 patients (9.0%) who did not. In the primary analysis, there was no significant association between chlorpromazine use and mortality (hazard ratio [HR] 2.01, 95% confidence interval [CI] 0.75–5.40; p = 0.163). Sensitivity analyses included a Cox regression in a 1:5 ratio matched analytic sample that showed a similar result (HR 1.67, 95% CI 0.91–3.06; p = 0.100) and a multivariable Cox regression that indicated a significant positive association (HR 3.10, 95% CI 1.31–7.34; p = 0.010). Conclusion Our results suggest that chlorpromazine prescribed at a mean daily dose of 70.8 mg (SD 65.3) was not associated with reduced mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-021-01001-0.
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Affiliation(s)
- Nicolas Hoertel
- DMU Psychiatrie et Addictologie, AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Marina Sánchez-Rico
- DMU Psychiatrie et Addictologie, AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France. .,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain.
| | - Raphaël Vernet
- Medical Informatics, Biostatistics and Public Health Department, AP-HP. Centre-Université de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Anne-Sophie Jannot
- Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France.,Medical Informatics, Biostatistics and Public Health Department, AP-HP. Centre-Université de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France.,INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France
| | - Antoine Neuraz
- INSERM, UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France.,Department of Medical Informatics, AP-HP. Centre-Université de Paris, Necker-Enfants Malades Hospital, 75015, Paris, France
| | | | - Cédric Lemogne
- DMU Psychiatrie et Addictologie, AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Guillaume Airagnes
- DMU Psychiatrie et Addictologie, AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
| | - Nicolas Paris
- AP-HP. Département Web Innovation Données (DSI-WIND), Paris, France.,LIMSI, CNRS, Université Paris-Sud, Université Paris-Saclay, 91405, Orsay, France
| | - Christel Daniel
- AP-HP. Département Web Innovation Données (DSI-WIND), Paris, France.,Sorbonne University, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S 1142, 75012, Paris, France
| | | | | | - Mélodie Bernaux
- AP-HP, Direction de la stratégie et de la transformation, Paris, France
| | - Ali Bellamine
- Unité de Recherche clinique, Hôpital Cochin, AP-HP. Centre-Université de Paris, Paris, France
| | - Nathanaël Beeker
- Unité de Recherche clinique, Hôpital Cochin, AP-HP. Centre-Université de Paris, Paris, France
| | - Frédéric Limosin
- DMU Psychiatrie et Addictologie, AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, Paris, France
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