Longitudinal study based on a safety registry for malaria patients treated with artenimol-piperaquine in six European countries

Background

European travellers to endemic countries are at risk of malaria and may be affected by a different range of co-morbidities than natives of endemic regions. The safety profile, especially cardiac issues, of artenimol (previously dihydroartemisinin)–piperaquine (APQ) Eurartesim^® during treatment of uncomplicated imported falciparum malaria is not adequately described due to the lack of longitudinal studies in this population. The present study was conducted to partially fill this gap.

Methods

Participants were recruited through Health Care Provider’s safety registry in 15 centres across 6 European countries in the period 2013–2016. Adverse events (AE) were collected, with a special focus on cardiovascular safety by including electrocardiogram QT intervals evaluated after correction with either Bazett’s (QTcB) or Fridericia’s (QTcF) methods, at baseline and after treatment. QTcB and/or QTcF prolongation were defined by a value > 450 ms for males and children and > 470 ms for females.

Results

Among 294 participants, 30.3% were women, 13.7% of Caucasian origin, 13.5% were current smoker, 13.6% current alcohol consumer and 42.2% declared at least one illness history. The mean (SD) age and body mass index were 39.8 years old (13.2) and 25.9 kg/m² (4.7). Among them, 75 reported a total of 129 AE (27 serious), 46 being suspected to be related to APQ (11 serious) and mostly labelled as due to haematological, gastrointestinal, or infection. Women and Non-African participants had significantly (p < 0.05) more AEs. Among AEs, 21 were due to cardiotoxicity (7.1%), mostly QT prolongation, while 6 were due to neurotoxicity (2.0%), mostly dizziness. Using QTcF correction, QT prolongation was observed in 17/143 participants (11.9%), only 2 of them reporting QTcF > 500 ms (milliseconds) but no clinical symptoms. Using QTcB correction increases of > 60 ms were present in 9 participants (6.3%). A trend towards increased prolongation was observed in those over 65 years of age but only a few subjects were in this group. No new safety signal was reported. The overall efficacy rate was 255/257 (99.2%).

Conclusions

APQ appears as an effective and well-tolerated drug for treatment of malaria in patients recruited in European countries. AEs and QT prolongation were in the range of those obtained in larger cohorts from endemic countries.

Trial registration This study has been registered in EU Post-Authorization Studies Register as EUPAS6942

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-021-03750-x.

High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

OBJECTIVE

Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).

RESEARCH DESIGN AND METHODS

IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.

RESULTS

Of 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control.

CONCLUSIONS

Depressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.

Translating surveillance data into incidence estimates

Monitoring a population for a disease requires the hosts to be sampled and tested for the pathogen. This results in sampling series from which we may estimate the disease incidence, i.e. the proportion of hosts infected. Existing estimation methods assume that disease incidence does not change between monitoring rounds, resulting in an underestimation of the disease incidence. In this paper, we develop an incidence estimation model accounting for epidemic growth with monitoring rounds that sample varying incidence. We also show how to accommodate the asymptomatic period that is the characteristic of most diseases. For practical use, we produce an approximation of the model, which is subsequently shown to be accurate for relevant epidemic and sampling parameters. Both the approximation and the full model are applied to stochastic spatial simulations of epidemics. The results prove their consistency for a very wide range of situations. The estimation model is made available as an online application. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.

Evaluation of a Streamlined Oncologist-Led BRCA Mutation Testing and Counseling Model for Patients With Ovarian Cancer

Purpose There is a growing demand for BRCA1/ 2 mutation ( BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors. Patients and Methods The prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway. The analysis population comprised 700 patients with ovarian cancer at 26 sites in the United States, Italy, and Spain. The primary objectives were to assess turnaround time and, using questionnaires, to evaluate stakeholder satisfaction (patients, oncologists, and geneticists or genetic counselors) with the oncologist-led BRCAm testing pathway. Results The median overall turnaround time was 9.1 weeks (range, 0.9 to 37.1 weeks), with median turnaround times in the United States, Italy, and Spain of 4.1 weeks (range, 0.9 to 37.1 weeks), 20.4 weeks (range, 2.9 to 35.4 weeks), and 12.0 weeks (range, 2.0 to 36.7 weeks), respectively. Patient satisfaction with the oncologist-led BRCAm testing pathway was high, with > 99% of patients expressing satisfaction with pre- and post- BRCAm test counseling. Oncologist satisfaction with the BRCAm testing pathway was also high, with > 80% agreeing that the process for performing BRCAm testing worked well and that counseling patients on BRCAm testing was an efficient use of their time. Oncologists expressed higher levels of satisfaction with the BRCAm testing pathway than did geneticists or genetic counselors. Conclusion The results of the ENGAGE study demonstrate that an oncologist-led BRCAm testing process is feasible in ovarian cancer. Development of local BRCAm testing guidelines similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer.

ENGAGE: Evaluation of a streamlined oncologist-led BRCA mutation (BRCAm) testing and counselling model for patients with ovarian cancer

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Background: Short BRCAm testing turnaround times (TAT) are crucial to making timely treatment decisions for patients (pts) with ovarian cancer. ENGAGE (NCT02406235; D0816R00006) evaluated a streamlined, oncologist-led germline BRCAm testing model, piloted by the Institute of Cancer Research and the Royal Marsden Hospital, London, UK. Results presented are from the final analysis (data cut-off: 30 Sep 2016). Methods: This prospective, observational study enrolled pts with ovarian cancer across sites in the US (n = 11), Italy (n = 8) and Spain (n = 7). Oncologists and nurses at participating sites were trained on genetic counselling techniques relating to BRCAm testing. Primary endpoints were BRCAm testing TAT (time from initial counselling to the provision of test results or post- BRCAm test counselling [whichever occurred latest]); pts’ satisfaction with the oncogenetic testing model, evaluated using pre- and post- BRCAm testing surveys; and clinicians’ opinion on the value of this new testing pathway, evaluated using a post- BRCAm testing survey. Results: For the 700 evaluable pts enrolled (US = 317; EU = 383), pre- BRCAm testing counselling was carried out by either an oncologist (40.7%) or clinical staff (nurse or research coordinator; 59.3%) in the US, and only by oncologists in the EU. The median overall TAT was 9.1 weeks (all pts), with 12.0 weeks in Spain, 20.4 weeks in Italy (17.4 weeks EU median) and 4.1 weeks in the US. The differences were mainly due to the time from BRCAm testing to obtaining the test results. Satisfaction with the overall counselling was high amongst pts, with a mean dimension score rating of 3.8/4 (where 4.0 = highest satisfaction). 93.6% of pts were happy to have received genetic testing as part of an existing oncologist appointment, and more than 80% of oncologists were satisfied with the screening process, agreeing that it was an efficient use of their time. Conclusions: The ENGAGE study results show that a streamlined oncologist-led BRCAm testing model can offer reduced TAT and high levels of satisfaction amongst pts and clinicians. The success of this model is enhanced by access to a BRCAm testing facility, from which results can be obtained quickly. Clinical trial information: NCT02406235; D0816R00006.

[Time for implementation of hypolipemiant treatment in patient with dyslipidemia in general medicine: results of the Prysme study]

INTRODUCTION

Despite of specific guidelines regarding the treatment of dyslipidemia, therapeutic management of patients is not optimal. The objectives of this study were to describe the time for implementation of hypolipemiant treatment and to identify the determinants.

METHODS

This was an observational, transversal, prospective, multicenter study carried out in France by general practitioners. Adult patients with dyslipidemia diagnosed since<2 years were eligible for this study. Demographic, diagnosis and disease characteristics, and treatment procedures were collected.

RESULTS

Three thousand six hundred and twenty-four patients were enrolled by 1226 physicians, and data from 3268 patients meeting the selection criteria were analyzed. Mean age was 57 years old, 64% were male. More than 45% of the patients were overweight, 26% were obese. Only 12% of the patients had no cardiovascular risk factor at the time of dyslipidemia diagnosis. The most frequent cardiovascular risk factors consisted in arterial hypertension (50%), smoking (43%), family antecedents of coronary disease (28%), HDL-cholesterol less than 0.4g/L (20%); 15% of the patients had personal antecedents of cardiovascular disease. Initial management of dyslipidemia included implementation of lifestyle changes for 98% of the patients. More than 90% of the patients were treated with a statin. The median time for implementation of hypolipemiant treatment was 2.9 months. The hypolipemiant treatment was initiated more than 3 months after dyslipidemia diagnosis for 43% of the patients. The main determinant factor of an early implementation of hypolipemiant treatment (≤3 months) was secondary prevention (OR=2.2). The number of cardiovascular risk factors had no significant impact.

CONCLUSION

This study highlights the lack of awareness towards the number of cardiovascular risk factors in the management of dyslipidemia, in primary prevention.

Simple and rapid high-performance liquid chromatographic method for nelfinavir, M8 nelfinavir metabolite, ritonavir and saquinavir assay in plasma

A simple reversed-phase liquid chromatographic method has been developed to determine protease inhibitors concentrations in plasma. Plasma samples (250 micro l) containing protease inhibitors were prepared by a simple deproteinization (recovery: 92, 91, 91 and 90.5% for ritonavir, saquinavir, nelfinavir and M8 nelfinavir metabolite, respectively). Chromatography was accomplished using a Hypersil octadecylsilyl column (100 x 4.6 mm I.D.) and a mobile phase composed of acetonitrile, tetrahydrofuran and dihydrogenophosphate buffer (pH 4) (32:10:58, v/v). Ultraviolet detection at 210 nm was used. The limit of detection was 200 ng/ml for ritonavir, saquinavir, nelfinavir and M8 nelfinavir metabolite. Calibration curves were linear up to 20000 ng/ml, with correlation coefficients better than 0.997 for all compounds. Intra- and inter-day coefficients of variation of the assay were <or=6% for all compounds. This method was used to analyse protease inhibitors plasma concentrations after oral administration within the framework of therapeutic drug monitoring and pharmacokinetic studies in AIDS patients.

[Efficacy and toxicity of aminoglycoside therapy in the elderly: combined effect of both once-daily regimen and therapeutic drug monitoring]

This study was aimed to compare with previous results (Grillot et al., 1994), the efficacy of amikacin adaptive optimal control in a geriatric hospital.

PATIENTS

During six months, 32 patients (aged of 82 +/- 8 years) were included versus 51 during two years (aged of 80 +/- 5). The mean age was not different between the two populations (NS, Student test). They received amikacin initial dosage of 17.7 +/- 5.1 mg/kg/d (vs 13.3 +/- 3.5 for the reference study) and maintenance dosage of 15.1 +/- 4.8 mg/kg/d (vs 11.8 +/- 5.1 for the reference study).

METHOD

Two efficacy outcomes (E1 and E2) and 1 toxicity outcome (T) were taken into account: E1 estimated the effect of adaptive control on maximal drug level, E2: overall recovery. Toxicity outcome was used: T the nephrotoxicity (increasing creatininémia over 44 mumol/l).

RESULTS

All the results are given versus the reference study. 57.6% versus 29.4% of adaptive strategy were once-a-day. E1: Chi square test show that initial dosage and maintenance dosage are greater our study than the previous one (p < 0.05: 78.8% versus 5.9% for initial dosage, 84.4% versus 13.8% for maintenance dosage). E2: 73.6% overall of recovery versus 77% (NS, Chi square test). T: 94% versus 85% (p < 0.05, Chi square test) of creatininemia variation are lower than 44 mumol/l. Duration of treatment is 9.8 +/- 4.8 versus 15 +/- 9 days (p < 0.5, Student test).

CONCLUSIONS

Once-a-day strategy in amikacin therapeutic regimen is no more efficient but decreases toxicity and duration treatment.

Renal elimination of amikacin and the aging process

OBJECTIVE

Although amikacin is primarily eliminated via glomerular filtration, drug concentrations are not consistently predicted in all patients. To better describe the relationship between amikacin clearance and both age and renal function, we used a new heuristic approach involving statistical analysis of dependence.

DESIGN AND SETTING

Retrospective pharmacokinetic study using data from seven centres in France.

PARTICIPANTS

634 patients with sepsis aged between 18 and 98 years of age who received intravenous amikacin.

METHODS

Clearance of amikacin was modelled using the NonParametric EM algorithm for a two-compartment model (NPEM2) with intravenous infusion.

RESULTS

A total of 2499 serum amikacin determinations was available for analysis. The relationship between the clearance of amikacin and age was weak. Interestingly, the Z method, which filters data based on dependence criteria, selected data that were best fitted by a polynomial function (r = 0.90; p < 0.001). This representation of the polynomial function was similar to a previously proposed theoretical model describing covariations between the clearance of amikacin and age. However, the polynomial function applied to only 33% of the patients that were selected by the Z method. The correlation between the clearance of amikacin and renal function was also relatively low (r = 0.39). The Z method exhibited a continuous and strong dependence pattern between the clearance of amikacin and age for 49% of the patients.

CONCLUSIONS

The Z methodology, which filters data using dependence criteria, confirms that age, renal function and amikacin clearance are strongly related, but only in less than half of a large sample of patients with sepsis without renal pathology. These results suggest that other variables should be taken into account in order to improve the description of the behaviour of amikacin. The Z methodology improved the classical description of relationships between variables, and should be applied to better select pertinent variables in pharmacokinetic studies.