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Elhadjene N, Grand N, Azarnoush K, Petrosyan A, Raissouni K, Campisi S, Sandri F, Palao JC, Awad S, Magand C, Molliex S, Ollier E, Morel J, Lanoiselee J. Regional anaesthesia via parasternal catheters inserted preoperatively and postoperative delirium after cardiac surgery: A prospective unrandomised clinical trial. Eur J Anaesthesiol 2024; 41:447-450. [PMID: 38357808 DOI: 10.1097/eja.0000000000001973] [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] [Indexed: 02/16/2024]
Abstract
VISUAL ABSTRACT http://links.lww.com/EJA/A927.
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Affiliation(s)
- Nory Elhadjene
- From the Département d'Anesthésie-Réanimation et Médecine Périopératoire (NE, NG, FS, JCP, SA, CM, SM, JM, JL), Département de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire de Saint-Etienne (KA, AP, KR, SC), Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne (EO), Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité (NE, JM), INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France (SM, EO, JL)
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Zufferey PJ, Chaux R, Lachaud PA, Capdevila X, Lanoiselée J, Ollier E. Dose-response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. Br J Anaesth 2024; 132:1122-1132. [PMID: 38281844 DOI: 10.1016/j.bja.2023.12.021] [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: 06/09/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Superiority of perineural over intravenous dexamethasone at extending nerve block analgesia has been suggested but without considering the dose-response relationships for each route of administration. METHODS Randomised control studies that evaluated intravenous or perineural dexamethasone as an adjuvant to unilateral peripheral nerve blocks in adults were searched up to October 2023 in MEDLINE, Central, Google Scholar, and reference lists of previous systematic reviews. The Cochrane Risk-of-Bias tool was used. A maximum effect (Emax) model-based network meta-analysis was undertaken to evaluate the dose-response relationships of dexamethasone. RESULTS A total of 118 studies were selected (9284 patients; 35 with intravenous dexamethasone; 106 with perineural dexamethasone; dose range 1-16 mg). Studies with unclear or high risk of bias overestimated the effect of dexamethasone. Bias-corrected estimates indicated a maximum fold increase in analgesia duration of 1.7 (95% credible interval (CrI) 1.4-1.9) with dexamethasone, with no difference between perineural and intravenous routes. Trial simulations indicated that 4 mg of perineural dexamethasone increased the mean duration of analgesia for long-acting local anaesthetics from 11.1 h (95% CrI 9.4-13.1) to 16.5 h (95% CrI 14.0-19.3) and halved the rate of postoperative nausea and vomiting. A similar magnitude of effect was observed with 8 mg of intravenous dexamethasone. CONCLUSIONS Used as an adjuvant for peripheral nerve block, intravenous dexamethasone can be as effective as perineural dexamethasone in prolonging analgesic duration, but is less potent, hence requiring higher doses. The evidence is limited because of the observational nature of the dose-response relationships and the quality of the included studies. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42020141689.
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Affiliation(s)
- Paul J Zufferey
- Department of Anaesthesia and Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne, France; Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Robin Chaux
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pierre-Adrien Lachaud
- Department of Anaesthesia and Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne, France; Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France; Basic Science Research Unit, INSERM UMR U1298, NeuroSciences Institute INM, Montpellier, France
| | - Julien Lanoiselée
- Department of Anaesthesia and Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne, France; Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Edouard Ollier
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1059, Vascular Dysfunction and Hemostasis, Saint-Etienne, France
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Ollier E, Pelissier C, Boissier C, Barjat T, Berthelot P, Boutet C, Gocko X, Le Hello C, Perinel S. [Systematic analysis of evaluations of Objective Structured Clinical Exam (OSCE) multiple circuits: Explanatory variables and inter-rater correlations]. Rev Med Interne 2024:S0248-8663(24)00093-6. [PMID: 38643040 DOI: 10.1016/j.revmed.2024.03.013] [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: 07/20/2023] [Revised: 01/26/2024] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Objective Structured Clinical Examinations (OSCEs) assess professional performance in a simulated environment. Following their integration into the reform of the 2nd cycle of medical studies (R2C), this pedagogical modality was implemented in France. This study investigates the variability of students' OSCE scores, as well as their inter-rater reproducibility. METHODS This single-center retrospective study covered several sessions of evaluative OSCE circuits conducted between January 2022 and June 2023. Variables collected were: baseline situation family, competency domain, presence of a standardized participant for stations; gender and professional status for evaluators; scores (global, clinical and communication skills), number of previously completed OSCE circuits and faculty scores for students. RESULTS The variability of the overall score was explained mainly (79.7%, CI95% [77.4; 82.0]) by the station factor. The student factor and the circuit factor explained 7.5% [12.9; 20.2] and<0.01% [2.10-13; 2.10-9] respectively. The inter-rater intra-class correlation coefficient was 87.2% [86.4; 87.9] for the global score. Station characteristics (starting situation, domain) and evaluator characteristics (gender, status) were significantly associated with score variations. CONCLUSION This first study on the variability of OSCE circuit scores in France shows good reproducibility with influence of station characteristics. In order to standardize circuits, variability linked to the domain competency should be considered as well.
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Affiliation(s)
- E Ollier
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - C Pelissier
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - C Boissier
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - T Barjat
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - P Berthelot
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - C Boutet
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - X Gocko
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - C Le Hello
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France
| | - S Perinel
- Groupe ECOS de la faculté de médecine Jacques-Lisfranc, université Jean-Monnet, Saint-Étienne, France; Faculté de médecine Jacques-Lisfranc, campus santé innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France.
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Gibert A, Lanoiselée J, Gouin-Thibault I, Pontis A, Azarnoush K, Petrosyan A, Grand N, Molliex S, Morel J, Gergelé L, Hodin S, Bin V, Chaux R, Delavenne X, Ollier E. Factors Influencing Unfractionated Heparin Pharmacokinetics and Pharmacodynamics During a Cardiopulmonary Bypass. Clin Pharmacokinet 2024; 63:211-225. [PMID: 38169065 DOI: 10.1007/s40262-023-01334-3] [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: 12/07/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Unfractionated heparin (UFH) is commonly used during cardiac surgery with a cardiopulmonary bypass to prevent blood clotting. However, empirical administration of UFH leads to variable responses. Pharmacokinetic and pharmacodynamic modeling can be used to optimize UFH dosing and perform real-time individualization. In previous studies, many factors that could influence UFH pharmacokinetics/pharmacodynamics had not been taken into account such as hemodilution or the type of UFH. Few covariates were identified probably owing to a lack of statistical power. This study aims to address these limitations through a meta-analysis of individual data from two studies. METHODS An individual patient data meta-analysis was conducted using data from two single-center prospective observational studies, where different UFH types were used for anticoagulation. A pharmacodynamic/pharmacodynamic model of UFH was developed using a non-linear mixed-effects approach. Time-varying covariates such as hemodilution and fluid infusions during a cardiopulmonary bypass were considered. RESULTS Activities of UFH's anti-activated factor/anti-thrombin were best described by a two-compartment model. Unfractionated heparin clearance was influenced by body weight and the specific UFH type. Volume of distribution was influenced by body weight and pre-operative fibrinogen levels. Pharmacodynamic data followed a log-linear model, accounting for the effect of hemodilution and the pre-operative fibrinogen level. Equations were derived from the model to personalize UFH dosing based on the targeted activated clotting time level and patient covariates. CONCLUSIONS The population model effectively characterized UFH's pharmacokinetics/pharmacodynamics in cardiopulmonary bypass patients. This meta-analysis incorporated new covariates related to UFH's pharmacokinetics/pharmacodynamics, enabling personalized dosing regimens. The proposed model holds potential for individualization using a Bayesian estimation.
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Affiliation(s)
- Audrick Gibert
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France.
| | - Julien Lanoiselée
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
- Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, Saint-Etienne, France
| | - Isabelle Gouin-Thibault
- Laboratory of Hematology, Pontchaillou, University Hospital of Rennes, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Adeline Pontis
- Laboratory of Hematology, Pontchaillou, University Hospital of Rennes, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Kasra Azarnoush
- Service de Chirurgie Cardiaque, CHU de Saint-Etienne, Saint-Etienne, France
| | - Andranik Petrosyan
- Service de Chirurgie Cardiaque, CHU de Saint-Etienne, Saint-Etienne, France
| | - Nathalie Grand
- Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, Saint-Etienne, France
| | - Serge Molliex
- Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, Saint-Etienne, France
| | - Jérome Morel
- Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, Saint-Etienne, France
| | - Laurent Gergelé
- Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, Saint-Etienne, France
| | - Sophie Hodin
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
| | - Valérie Bin
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
| | - Robin Chaux
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
- Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Xavier Delavenne
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
- Laboratoire de Pharmacologie Toxicologie Gaz du sang, CHU de Saint-Etienne, Saint-Etienne, France
| | - Edouard Ollier
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, 20 Rue Camelinat, 42000, Saint-Étienne, France
- Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, Saint-Etienne, France
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Chapelle C, Le Teuff G, Zufferey PJ, Laporte S, Ollier E. A framework to characterise the reproducibility of meta-analysis results with its application to direct oral anticoagulants in the acute treatment of venous thromboembolism. Res Synth Methods 2024; 15:117-129. [PMID: 37846195 DOI: 10.1002/jrsm.1676] [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: 03/14/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023]
Abstract
The number of meta-analyses of aggregate data has dramatically increased due to the facility of obtaining data from publications and the development of free, easy-to-use, and specialised statistical software. Even when meta-analyses include the same studies, their results may vary owing to different methodological choices. Assessment of the replication of meta-analysis provides an example of the variation of effect 'naturally' observed between multiple research projects. Reproducibility of results has mostly been reported using graphical descriptive representations. A quantitative analysis of such results would enable (i) breakdown of the total observed variability with quantification of the variability generated by the replication process and (ii) identification of which variables account for this variability, such as methodological quality or the statistical analysis procedures used. These variables might explain systematic mean differences between results and dispersion of the results. To quantitatively characterise the reproducibility of meta-analysis results, a bivariate linear mixed-effects model was developed to simulate both mean results and their corresponding uncertainty. Results were assigned to several replication groups, those assessing the same studies, outcomes, treatment indication and comparisons classified in the same replication group. A nested random effect structure was used to break down the total variability within each replication group and between these groups to enable calculation of an intragroup correlation coefficient and quantification of reproducibility. Determinants of variability were investigated by modelling both mean and variance parameters using covariates. The proposed model was applied to the example of meta-analyses evaluating direct oral anticoagulants in the acute treatment of venous thromboembolism.
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Affiliation(s)
- Céline Chapelle
- Université Jean-Monnet, Mines Saint-Étienne, INSERM, U1059, SAINBIOSE, F-42023; Service de pharmacologie clinique, CHU Saint-Étienne, F-42055 Saint-Étienne, France, Université Jean Monnet, Saint-Étienne, France
| | - Gwénaël Le Teuff
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Oncostat U1018, Inserm, Équipe Labellisée Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Paul Jacques Zufferey
- Département d'Anesthésie-Réanimation, Service de pharmacologie clinique, CHU Saint-Étienne, F-42055 Saint-Étienne; Université Jean-Monnet, Mines Saint- Étienne, INSERM, U1059, SAINBIOSE, F-42023, CHU Saint-Étienne, Saint-Étienne, France
| | - Silvy Laporte
- Université Jean-Monnet, Mines Saint-Étienne, INSERM, U1059, SAINBIOSE, F-42023; Service de pharmacologie clinique, CHU Saint-Étienne, F-42055 Saint-Étienne, France, Université Jean Monnet, Saint-Étienne, France
| | - Edouard Ollier
- Université Jean-Monnet, Mines Saint-Étienne, INSERM, U1059, SAINBIOSE, F-42023; Service de pharmacologie clinique, CHU Saint-Étienne, F-42055 Saint-Étienne, France, Université Jean Monnet, Saint-Étienne, France
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Mismetti V, Delavenne X, Montani D, Bezzeghoud S, Delezay O, Hodin S, Launay D, Marchand-Adam S, Nunes H, Ollier E, Reynaud-Gaubert M, Pastre J, Traclet J, Quetant S, Zeghmar S, Bertoletti L, Cottin V. Proteomic biomarkers for survival in systemic sclerosis-associated pulmonary hypertension. Respir Res 2023; 24:273. [PMID: 37936223 PMCID: PMC10629050 DOI: 10.1186/s12931-023-02578-0] [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: 07/11/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) and pulmonary hypertension (PH) represent the major causes of mortality in systemic sclerosis (SSc). Patients with systemic sclerosis and combined PH and ILD (SSc-PH-ILD) generally have a poor prognosis. Predictors of survival and of potential benefit of treatment are lacking in patients with SSc-PH-ILD. OBJECTIVE To identify specific plasma protein expression patterns associated with survival in patients with SSc-PH-ILD. MATERIALS AND METHODS Post-hoc analysis of a prospective multicenter French study in patients with PH-ILD. An untargeted proteomic analysis using mass spectrometry was performed to identify plasma protein changes associated with long-term overall survival in patients with SSc-PH-ILD. RESULTS Thirty two patients were included in the analysis, of whom 13 died during follow-up (median survival: 76.5 months). At baseline, survivors had less severe hemodynamic impairment [pulmonary vascular resistance of 4.4 Wood Units (IQR 3-5.2) vs. 6.2 Wood Units (IQR 4.2-10.7)] and higher carbon monoxide diffusing capacity [median 39% (IQR 35-44%) vs. 25% (IQR 22-30.5%)], than the 13 patients who died. Seven proteins, associated with haemostasis and fibrosis, were differentially expressed according to patients' survival. In the survivor group, two proteins were increased (ADAMTS13, SERPIND1) and five were decreased (PTGDS, OLFM1, C7, IGFBP7, FBN1) compared to the non-survivor groups. CONCLUSION The prognosis of SSc-PH-ILD patients is poor. This proteomic approach found 7 plasma proteins (involved in haemostasis and fibrosis pathways) associated with survival. These potential biomarkers may be good candidates to prognostic enrichment.
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Affiliation(s)
- Valentine Mismetti
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Etienne, France
| | - Xavier Delavenne
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Etienne, France
| | - David Montani
- Service de Pneumologie et Soins Intensifs Thoraciques, Centre de Référence de L'Hypertension Pulmonaire, INSERM U999 Centre de Compétence Maladies Pulmonaires Rares-OrphaLung Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Souad Bezzeghoud
- Service de Médecine Vasculaire et Thérapeutique, INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - Olivier Delezay
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Etienne, France
| | - Sophie Hodin
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Etienne, France
| | - David Launay
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO) CHU Lille, Lille, France
| | | | - Hilario Nunes
- Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Hôpital Avicenne, INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Edouard Ollier
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, 42023, Saint-Etienne, France
| | - Martine Reynaud-Gaubert
- Centre de Compétence des Maladies Pulmonaires Rares (OrphaLung), Service de Pneumologie et Transplantation Pulmonaire, CHU Nord, AP-HM, Aix Marseille Université, Marseille, France
| | - Jean Pastre
- Service de Pneumologie et Soins Intensifs Centre de Compétence Maladie Pulmonaire Rare (OrphaLung) Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Department of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, 69677, Lyon, France
| | | | - Sabrina Zeghmar
- National Reference Center for Rare Pulmonary Diseases, Department of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, 69677, Lyon, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, INSERM, UMR1059, Université Jean-Monnet, INSERM, CIC-1408, CHU de Saint-Etienne, INNOVTE, 42055, Saint-Etienne, France.
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Department of Respiratory Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, 69677, Lyon, France
- Univ Lyon, INRA, UMR754, 69008, Lyon, France
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Chapelle C, Ollier E, Bonjean P, Locher C, Zufferey PJ, Cucherat M, Laporte S. Replication of systematic reviews: is it to the benefit or detriment of methodological quality? J Clin Epidemiol 2023; 162:98-106. [PMID: 37648071 DOI: 10.1016/j.jclinepi.2023.08.012] [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: 02/28/2023] [Revised: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To perform an overview of the overlap of systematic reviews (SRs) assessing direct oral anticoagulants and characterize these reviews in terms of bias and methodological quality (PROSPERO: CRD42022316273). STUDY DESIGN AND SETTING A PubMed-indexed search was performed from inception to January 31, 2022 to identify SRs evaluating direct oral anticoagulants in patients treated for an acute venous thromboembolism. The risk of bias of these SRs was assessed according to the Risk Of Bias In Systematic reviews tool. Redundancy was defined as overlap in terms of the type of population considered, the interventions compared, and the studies included. RESULTS A total of 144 SRs were evaluated, of which 26 (18.1%) were classified as original, 87 (60.4%) as conceptual replications, and 31 (21.5%) as excessive replications. The risk of bias was high in 19 (73.1%) of the original SRs, 65 (74.7%) of the conceptual replications, and 21 (67.7%) of the excessive replications. Compared to the original SRs, the overall methodological quality was not improved in either conceptual or excessive replications. CONCLUSION A large number of SRs was classified as replications; a fifth constituted excessive replications. The replications showed no improvement in overall methodological quality compared to the original SRs.
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Affiliation(s)
- Céline Chapelle
- Univ. Jean Monnet, Mines Saint- Étienne, INSERM, U1059, SAINBIOSE, CHU Saint-Étienne, Service de Pharmacologie Clinique, F-42023 Saint-Étienne, France.
| | - Edouard Ollier
- Univ. Jean Monnet, Mines Saint- Étienne, INSERM, U1059, SAINBIOSE, CHU Saint-Étienne, Service de Pharmacologie Clinique, F-42023 Saint-Étienne, France
| | - Paul Bonjean
- Département d'Information Médical, CH Roanne, F-42328 Roanne, France
| | - Clara Locher
- Univ. Rennes, CHU Rennes, INSERM, Centre d'Investigation Clinique de Rennes (CIC1414), Service de Pharmacologie Clinique, Institut de Recherche en Santé, Environnement et Travail (Irset), UMR S 1085, EHESP, 35000 Rennes, France
| | - Paul Jacques Zufferey
- CHU Saint-Étienne, Département d'Anesthésie et Réanimation, Service de Pharmacologie Clinique, Univ. Jean Monnet, Mines Saint- Étienne, INSERM, U1059, SAINBIOSE, F-42055 Saint-Étienne, France
| | - Michel Cucherat
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive-Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard, Lyon 1, F-69376 Lyon, France
| | - Silvy Laporte
- Univ. Jean Monnet, Mines Saint- Étienne, INSERM, U1059, SAINBIOSE, CHU Saint-Étienne, Service de Pharmacologie Clinique, F-42023 Saint-Étienne, France
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Guedeney P, Roule V, Mesnier J, Chapelle C, Portal JJ, Laporte S, Ollier E, Zeitouni M, Kerneis M, Procopi N, Barthelemy O, Sorrentino S, Mihalovic M, Silvain J, Vicaut E, Montalescot G, Collet JP. Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Implantation in Patients Without Indications for Chronic Oral Anticoagulation: A systematic review and network meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother 2023; 9:251-261. [PMID: 36640149 DOI: 10.1093/ehjcvp/pvad003] [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] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
AIMS As the antithrombotic regimen which may best prevent ischemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation. METHODS AND RESULTS We conducted a Prospero-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included 7 studies comprising of 4 006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared to low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95%CI 0.41-0.88) while no significant reduction was observed with SAPT versus DAPT (RR 1.02 95%CI 0.67-1.58) and SAPT and DAPT compared to apixaban or edoxaban (RR:0.60 95%CI:0.32-1.14 and RR:0.59 95%CI 0.34-1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to DAPT (RR 0.45 95%CI 0.29-0.70), apixaban or edoxaban alone (RR 0.45, 95%CI 0.25-0.79) and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95%CI 0.16-0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism. CONCLUSION Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Vincent Roule
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, UMR_S 1166, Caen, France
| | - Jules Mesnier
- French Alliance for Cardiovascular Trials (FACT); Université de Paris, INSERM Unité-1148, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Celine Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Jean-Jacques Portal
- Unité de Recherche Clinique, Lariboisière Hospital (AP-HP), ACTION Study Group, Paris, France
| | - Sylvie Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Edouard Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Niki Procopi
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Olivier Barthelemy
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Sabato Sorrentino
- Division of cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Michal Mihalovic
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Johanne Silvain
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Lariboisière Hospital (AP-HP), ACTION Study Group, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
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9
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Guedeney P, Roule V, Mesnier J, Chapelle C, Portal JJ, Laporte S, Ollier E, Zeitouni M, Kerneis M, Barthelemy O, Sorrentino S, Silvain J, Vicaut E, Montalescot G, Collet JP. Comparison of the safety and efficacy of antithrombotic regimens following TAVR in patients without having an indication for chronic oral anticoagulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To compare the safety and efficacy of antithrombotic regimens following transcatheter aortic valve replacement (TAVR) in patients without having an indication for chronic oral anticoagulation
Methods and results
We conducted a Prospero-registered systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVR antithrombotic regimens up to March 2021. We estimated the relative risk and 95% confidence intervals using a fixed effect model in a frequentist pairwise and network metanalytic approach. We included 6 studies comprising of 3,777 patients with a mean weighted follow-up of 13.3 months. Single antiplatelet therapy (SAPT) was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95% confidence interval [CI]: 0.28–0.69), apixaban (RR: 0.47, 95% CI 0.26–0.84) and low-dose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI: 0.16–0.57). Risk of all-cause death was significantly reduced with DAPT compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI: 0.41–0.88) and a consistent reduction was observed with SAPT and DAPT compared to apixaban (RR: 0.60, 95% CI: 0.31–1.16 and RR: 0.58, 95% CI: 0.32–1.04, respectively). There were no differences between the various regimens with respect to myocardial infarction and stroke. Apixaban significantly reduced the risk of pulmonary embolism, valve thrombosis and grade 3 or 4 reduced leaflet motion.
Conclusion
Following TAVR in patients without an indication for chronic oral anticoagulant, SAPT was associated with the lowest risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - V Roule
- University Hospital of Caen, Department of Cardiology , Caen , France
| | - J Mesnier
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Cardiology , Paris , France
| | - C Chapelle
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - J J Portal
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | - S Laporte
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - E Ollier
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere , Paris , France
| | - M Kerneis
- Hospital Pitie-Salpetriere , Paris , France
| | | | - S Sorrentino
- Magna Graecia University of Catanzaro, Cardiology , Catanzaro , Italy
| | - J Silvain
- Hospital Pitie-Salpetriere , Paris , France
| | - E Vicaut
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | | | - J P Collet
- Hospital Pitie-Salpetriere , Paris , France
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10
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Gibert A, Lanoiselée J, Janisset L, Pernod G, Ollier E, Delavenne X. Development of a Bayesian estimation tool to determine the optimal duration of apixaban discontinuation before a high‐bleeding risk procedure. Fundam Clin Pharmacol 2022; 36:898-907. [DOI: 10.1111/fcp.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Audrick Gibert
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase Université de Lyon Saint‐Etienne France
| | - Julien Lanoiselée
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase Université de Lyon Saint‐Etienne France
- Departement d'Anesthésie Réanimation CHU de Saint‐Etienne Saint‐Etienne France
| | - Luc Janisset
- Service des Urgences CHU de Saint‐Etienne Saint‐Etienne France
| | | | - Edouard Ollier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase Université de Lyon Saint‐Etienne France
| | - Xavier Delavenne
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase Université de Lyon Saint‐Etienne France
- Laboratoire de Pharmacologie Toxicologie CHU de Saint‐Etienne Saint‐Etienne France
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11
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Grange L, Chapelle C, Ollier E, Zufferey PJ, Douillet D, Killian M, Mismett P, Laporte S. Adjusted versus fixed doses of LMWHs in trauma patients: A systematic review and meta-analysis. Anaesth Crit Care Pain Med 2022; 41:101155. [PMID: 36087698 DOI: 10.1016/j.accpm.2022.101155] [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: 06/20/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Venous thromboembolism (VTE) causes significant morbidity and mortality in patients with traumatic injuries, despite thromboprophylaxis. To decrease both thrombotic and bleeding risks, some authors suggest adjusting the thromboprophylactic doses of low-molecular-weight heparins (LMWH), in particular according to body weight at treatment initiation or to changes in anti-factor Xa level during treatment. Our objective was to estimate in trauma patients the efficacy and safety of such adjustments, compared with the conventional strategy of fixed-dose LMWH thromboprophylaxis. SOURCE A systematic review and a meta-analysis were conducted to identify and assess randomised control trials and observational studies with prospective enrolment that included trauma patients and compared adjustment of LMWH thromboprophylaxis versus no adjustment. The primary and secondary endpoints were VTE and bleeding, respectively. The Odds Ratio (OR) and 95% Confidence Interval (95% CI) were calculated using the Mantel-Haenszel method. PRINCIPAL FINDINGS Nine studies were included in the meta-analysis. No significant reduction in the risk of VTE was observed with adjusted doses of LMWH compared with fixed doses when considering only randomised control trials (OR 1.02 [95% CI, 0.09 to 11.6]) or all trials (OR 0.70 [95% CI, 0.34 to 1.42]). Similarly, there was no significant difference in bleeding risk (OR 1.36, 95% CI 0.59 to 3.10). CONCLUSION This meta-analysis shows that, to date, there is no evidence to justify adjusting LMWH doses, in agreement with the recommendations of the American College of Chest Physicians.
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Affiliation(s)
- Lucile Grange
- Department of Internal Medicine, University Hospital of Saint-Etienne, France
| | - Céline Chapelle
- Department of Clinical Pharmacology and Clinical Research Unit, University Hospital of Saint-Etienne; UMR 1059 DVH-Sainbiose, Jean Monnet University, Saint-Etienne; INSERM F-CRIN INNOVTE Network France
| | - Edouard Ollier
- Department of Clinical Pharmacology and Clinical Research Unit, University Hospital of Saint-Etienne; UMR 1059 DVH-Sainbiose, Jean Monnet University, Saint-Etienne; INSERM F-CRIN INNOVTE Network France
| | - Paul Jacques Zufferey
- Department of Anaesthesiology and Intensive Care Medicine and Dept. of Clinical Pharmacology, University Hospital of Saint-Etienne; UMR 1059 DVH-Sainbiose, Jean Monnet University, Saint-Etienne, France
| | - Delphine Douillet
- Emergency Dept., Angers University Hospital, Health Faculty, Angers; UMR MitoVasc CNRS 6015 - INSERM 1083 Angers; INSERM F-CRIN INNOVTE Network France
| | - Martin Killian
- Department of Internal Medicine, University Hospital of Saint-Etienne, France
| | - Patrick Mismett
- Department of Vascular and Therapeutic Medicine and Dept. of Clinical Pharmacology, University Hospital of Saint-Etienne, France; UMR 1059 DVH-Sainbiose, Jean Monnet University, Saint-Etienne; INSERM F-CRIN INNOVTE Network France
| | - Silvy Laporte
- Department of Clinical Pharmacology and Clinical Research Unit, University Hospital of Saint-Etienne; UMR 1059 DVH-Sainbiose, Jean Monnet University, Saint-Etienne; INSERM F-CRIN INNOVTE Network France.
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12
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Trone MC, Garcin T, Ollier E, Thuret G, Gain P. A retrospective study of the efficacy of intense pulsed light delivered by the Lacrystim® for meibomian gland dysfunction therapy. BMC Ophthalmol 2022; 22:335. [PMID: 35933379 PMCID: PMC9356507 DOI: 10.1186/s12886-022-02531-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months. Methods Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software). Results Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], (p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted. Conclusions IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results. Trial registration This work was approved by a local ethics committee “Terre d’éthique” (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website (NCT04147962, 01/11/2019).
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Affiliation(s)
- Marie-Caroline Trone
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France. .,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - Thibaud Garcin
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Edouard Ollier
- Clinical Research, Innovation and Pharmacology Unit, University Hospital, Saint-Etienne, France.,Health engineering biology (SAINBIOSE) Inserm U1059, vascular hemostasis dysfunction (DVH) team, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Gilles Thuret
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Philippe Gain
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
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13
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Saib S, Hodin S, Mercier C, Paul M, Bin V, Ollier E, Delavenne X. TNF-α and IL-1β Exposure Modulates the Expression and Functionality of P-Glycoprotein in Intestinal and Renal Barriers. Mol Pharm 2022; 19:2327-2334. [PMID: 35674492 DOI: 10.1021/acs.molpharmaceut.2c00140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inflammation is characterized by an increased secretion of proinflammatory cytokines known to alter the expression and functionality of drug transporters. Since P-glycoprotein (P-gp) plays a key role in the pharmacokinetics of several drugs, these modulations could further affect drug exposure. In this context, this study aims to investigate the impact of in vitro cytokine exposure on the expression and activity of P-gp using the intestinal model Caco-2 and the human renal cells RPTEC/TERT1. Cells were exposed to various concentrations of tumor necrosis factor (TNF)-α and interleukin (IL)-1β for 24 or 72 h. Gene expression was then assessed by RT-qPCR followed by absolute quantification of P-gp using liquid chromatography coupled with mass spectrometry. Then, the activity of P-gp was assessed by the intracellular accumulation of rhodamine 123. TNF-α increased both the gene expression and P-gp activity by 15-40% in each model. Minor modulations were observed at the protein level with increases of up to 8% for RPTEC/TERT1 cells and 24% for Caco-2 cells. Conversely, IL-1β led to a downregulation of gene, protein, and functionality by 48 and 25% in intestinal and renal cells, respectively. Taken together, these data highlighted that gene expression levels and functional activity of P-gp are altered by the pro-inflammatory cytokines in intestinal and renal cells. Such pronounced changes in human P-gp could result in altered exposure to drug substrates. Further in vivo studies are needed to confirm the impact of inflammation on drug pharmacokinetics.
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Affiliation(s)
- Sonia Saib
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Sophie Hodin
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Clément Mercier
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Mireille Paul
- INSERM U1059, Laboratoire de Biologie Intégrative du Tissu Osseux (LBTO), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Valérie Bin
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Edouard Ollier
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France
| | - Xavier Delavenne
- INSERM U1059, Dysfonction Vasculaire et Hémostase (DVH), Université Jean Monnet, Saint-Etienne F-42023, France.,Laboratoire de Pharmacologie Toxicologie Gaz du sang, CHU de Saint-Etienne, Saint-Etienne CS 82301, France
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14
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Douillet D, Chapelle C, Ollier E, Mismetti P, Roy PM, Laporte S. Prevention of venous thromboembolic events in patients with lower leg immobilization after trauma: Systematic review and network meta-analysis with meta-epsidemiological approach. PLoS Med 2022; 19:e1004059. [PMID: 35849624 PMCID: PMC9342742 DOI: 10.1371/journal.pmed.1004059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/01/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lower limb trauma requiring immobilization is a significant contributor to overall venous thromboembolism (VTE) burden. The clinical effectiveness of thromboprophylaxis for this indication and the optimal agent strategy are still a matter of debate. Our main objective was to assess the efficacy of pharmacological thromboprophylaxis to prevent VTE in patients with isolated temporary lower limb immobilization after trauma. We aimed to estimate and compare the clinical efficacy and the safety of the different thromboprophylactic treatments to determine the best strategy. METHODS AND FINDINGS We conducted a systematic review and a Bayesian network meta-analysis (NMA) including all available randomized trials comparing a pharmacological thromboprophylactic treatment to placebo or to no treatment in patients with leg immobilization after trauma. We searched Medline, Embase, and Web of Science until July 2021. Only RCT or observational studies with analysis of confounding factors including adult patients requiring temporary immobilization for an isolated lower limb injury treated conservatively or surgically and assessing pharmacological thromboprophylactic agents or placebo or no treatment were eligible for inclusion. The primary endpoint was the incidence of major VTE (proximal deep vein thrombosis, symptomatic VTE, and pulmonary embolism-related death). We extracted data according to Preferred Reporting Items for Systematic Reviews and Meta-analyses for NMA and appraised selected trials with the Cochrane review handbook. Fourteen studies were included (8,198 patients). Compared to the control group, rivaroxaban, fondaparinux, and low molecular weight heparins were associated with a significant risk reduction of major VTE with an odds ratio of 0.02 (95% credible interval (CrI) 0.00 to 0.19), 0.22 (95% CrI 0.06 to 0.65), and 0.32 (95% CrI 0.15 to 0.56), respectively. No increase of the major bleeding risk was observed with either treatment. Rivaroxaban has the highest likelihood of being ranked top in terms of efficacy and net clinical benefit. The main limitation is that the network had as many indirect comparisons as direct comparisons. CONCLUSIONS This NMA confirms the favorable benefit/risk ratio of thromboprophylaxis for patients with leg immobilization after trauma with the highest level of evidence for rivaroxaban. TRIAL REGISTRATION PROSPERO CRD42021257669.
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Affiliation(s)
- D. Douillet
- Emergency Department, Angers University Hospital, Health Faculty, Angers, France
- UNIV Angers, UMR MitoVasc CNRS 6015 –INSERM 1083, Equipe CARME, Angers, France
- F-CRIN INNOVTE network, Saint-Etienne, France
- * E-mail:
| | - C. Chapelle
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - E. Ollier
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
- SAINBIOSE INSERM U1059, Vascular Dysfunction and Hemostasis, Jean Monnet University, Saint-Etienne, France
| | - P. Mismetti
- F-CRIN INNOVTE network, Saint-Etienne, France
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - P.-M. Roy
- Emergency Department, Angers University Hospital, Health Faculty, Angers, France
- UNIV Angers, UMR MitoVasc CNRS 6015 –INSERM 1083, Equipe CARME, Angers, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - S. Laporte
- F-CRIN INNOVTE network, Saint-Etienne, France
- Clinical Pharmacology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
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15
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Ollier E. Fast selection of nonlinear mixed effect models using penalized likelihood. Comput Stat Data Anal 2022. [DOI: 10.1016/j.csda.2021.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Chaux R, Lanoiselée J, Magand C, Zufferey P, Delavenne X, Ollier E. Robust K-PD model for activated clotting time prediction and UFH dose individualisation during cardiopulmonary bypass. Comput Methods Programs Biomed 2022; 214:106553. [PMID: 34883383 DOI: 10.1016/j.cmpb.2021.106553] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Activated clotting time (ACT) is a point-of-care test used to monitor the effect of unfractionated heparin (UFH) during cardiopulmonary bypass (CPB). This test sometimes returns aberrant values, which can lead to the administration of an inappropriate dosing regimen. The development of a population-robust K-PD model of UFH could allow the individualisation and automation of UFH therapy during CPB. METHODS We conducted a prospective observational study to collect ACT measurements from patients undergoing surgery using CPB. The ACT data were split into a development and validation cohort. The development cohort was used to estimate a standard and robust population K-PD model characterised by a residual error following a normal distribution and student's t-distribution. The ACT prediction performance using Bayesian estimates of individual K-PD parameters was evaluated by comparing predicted versus observed ACTs. Using estimates of the robust K-PD model, a Bayesian individualisation strategy to automate UFH administration was proposed and evaluated using Monte Carlo simulations. RESULTS A total of 295 patients were included in the study, and 1561 ACTs were collected. In patients without outlier values, Bayesian estimates (based on four ACT measurements) from both standard and robust K-PD models had similar performances, with a median prediction bias close to 0 s. In patients with outlier measurements, the use of the robust K-PD model greatly improved the prediction bias and root-mean-square error (RMSE), with a mean prediction bias of 3.25 s, IQR = [-19.9; 46.03] versus -86 s IQR = [-135.7; -63.8] for the standard model. Monte Carlo simulations showed that the robust Bayesian individualisation strategy allowed the ACT to be maintained above the target using only two to three ACT measurements. CONCLUSIONS The use of a robust K-PD model reduced prediction bias and RMSE in patients with outlier ACT measurements. The Bayesian individualisation strategy using robust estimates of individual parameters may help automate UFH dosing regimens. Proper clinical validation is warranted before its use in daily clinical practice.
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Affiliation(s)
- Robin Chaux
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, Saint-Etienne, France; Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne Cedex 2, Saint-Etienne F-42055, France
| | - Julien Lanoiselée
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, Saint-Etienne, France; Département d'Anesthésie-Réanimation, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France
| | - Clément Magand
- Département d'Anesthésie-Réanimation, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France
| | - Paul Zufferey
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, Saint-Etienne, France; Département d'Anesthésie-Réanimation, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France
| | - Xavier Delavenne
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, Saint-Etienne, France
| | - Edouard Ollier
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, Saint-Etienne, France; Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne Cedex 2, Saint-Etienne F-42055, France.
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Solé T, Januel L, Denneval A, Williet N, Breton C, Blanc P, Ollier E. Time impact on the anti-diabetic effects of key bariatric surgeries: a network meta-analysis of randomized controlled trials with meta-regression. Surg Obes Relat Dis 2022; 18:832-845. [DOI: 10.1016/j.soard.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/28/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
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18
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Saib S, Hodin S, Bin V, Ollier E, Delavenne X. In Vitro Evaluation of P-gp-Mediated Drug-Drug Interactions Using the RPTEC/TERT1 Human Renal Cell Model. Eur J Drug Metab Pharmacokinet 2021; 47:223-233. [PMID: 34935100 DOI: 10.1007/s13318-021-00744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES In vitro evaluation of the P-glycoprotein (P-gp) inhibitory potential is an important issue when predicting clinically relevant drug-drug interactions (DDIs). Located within all physiological barriers, including intestine, liver, and kidneys, P-gp plays a major role in the pharmacokinetics of various therapeutic classes. However, few data are available about DDIs involving renal transporters during the active tubular secretion of drugs. In this context, the present study was designed to investigate the application of the human renal cell line RPTEC/TERT1 to study drug interactions mediated by P-gp. METHODS The P-gp inhibitory potentials of a panel of drugs were first determined by measuring the intracellular accumulation of rhodamine 123 in RPTEC/TERT1 cells. Then four drugs were selected to assess the half-maximal inhibitor concentration (IC50) values by measuring the intracellular accumulation of two P-gp-substrate drugs, apixaban and rivaroxaban. Finally, according to the FDA guidelines, the [I1]/IC50 ratio was calculated for each combination of drugs to assess the clinical relevance of the DDIs. RESULTS The data showed that drugs which are known P-gp inhibitors, including cyclosporin A, ketoconazole, and verapamil, caused great increases in rhodamine 123 retention, whereas noninhibitors did not affect the intracellular accumulation of the P-gp substrate. The determined IC50 values were in accordance with the inhibition profiles observed in the rhodamine 123 accumulation assays, confirming the reliability of the RPTEC/TERT1 model. CONCLUSIONS Taken together, the data demonstrate the feasibility of the application of the RPTEC/TERT1 model for evaluating the P-gp inhibitory potentials of drugs and consequently predicting renal drug interactions.
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Affiliation(s)
- Sonia Saib
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France.
| | - Sophie Hodin
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France
| | - Valérie Bin
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France
| | - Edouard Ollier
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France
| | - Xavier Delavenne
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France.,Laboratoire de Pharmacologie Toxicologie Gaz du sang, CHU de Saint-Etienne, Saint-Etienne, France
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19
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Ojardias E, Ollier E, Lafaie L, Celarier T, Giraux P, Bertoletti L. Time course response after single injection of botulinum toxin to treat spasticity after stroke: Systematic review with pharmacodynamic model-based meta-analysis. Ann Phys Rehabil Med 2021; 65:101579. [PMID: 34634514 DOI: 10.1016/j.rehab.2021.101579] [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: 07/08/2020] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The time-course response after a single injection of botulinum toxin (BoNT) for post-stroke spasticity is debated. We addressed this issue by conducting a systematic review and a pharmacodynamic model-based meta-analysis. METHODS We searched Medline, PeDro and Google Scholar databases up to March 2020, selecting randomized controlled trials of post-stroke and traumatic brain injury patients with arm or leg muscle hypertonia, comparing BoNT to placebo, or different BoNT preparations. The main outcome was change in Modified Ashworth Scale (MAS) score. A non-linear mixed effect model was used to estimate maximal toxin and placebo effects (Emax and EPlacebo), the effect disappearance half-life (T1/2off) of BoNT and the doses achieving 50 and 80% of Emax (D50 and D80). The equivalence ratios between different BoNT preparations were calculated from D50 values. Adverse events were recorded. RESULTS Altogether, 2,236 unique records were screened by 2 independent reviewers: 35 eligible trials including 3011 patients (95% post-stroke) were identified. For all BoNT preparations, the BoNT Emax of -1.11 (95% credible interval -1.31; -0.29) was reached at 5 weeks; the maximal placebo effect was -0.30 (-0.37; -0.22). Both D50 and D80 differed significantly by muscle volume. At D50, the equivalence ratio was significantly higher for abobotulinumtoxinA (3.35) than onabotulinumtoxinA and lower for letibotulinumtoxinA (0.41). T1/2off was longer for abobotulinumtoxinA than for onabotulinumtoxinA and the other preparations (13.1 weeks [95% credible interval 7.7; 19.3] vs 8.6 weeks [7.1; 10.1]). Adverse events were minor, with a weak, but significant, dose-response relation for muscle weakness. CONCLUSIONS This first pharmacodynamic model-based meta-analysis of individuals with stroke revealed that for all BoNT-A preparations, BoNT-A injections to treat spasticity have maximal effect at 5 weeks. The T1/2off was longer for abobotulinumtoxinA than other preparations. Differences between certain BoNT unit scales were also confirmed.
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Affiliation(s)
- Etienne Ojardias
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France; U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France.
| | - Edouard Ollier
- U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France; Clinical Research, Innovation and Pharmacology Unit, North Hospital, University Hospital of Saint-Étienne, France
| | - Ludovic Lafaie
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Thomas Celarier
- Clinical Gerontology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Pascal Giraux
- Physical Medicine and Rehabilitation Department, University Hospital of Saint-Étienne, Saint-Étienne, France; Lyon Neuroscience Research Center, Trajectoires team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon1 & Saint-Etienne Universities), France
| | - Laurent Bertoletti
- Vascular and Therapeutic Medicine Department, North Hospital, University Hospital of Saint-Étienne, Saint-Étienne, France; U1059 INSERM - SAINBIOSE, Innovation Campus, Saint-Étienne, France + INSERM CIC1408, University Hospital of Saint-Étienne, Saint-Etienne, France
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20
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Ollier E, Blanchard P, Le Teuff G, Michiels S. Penalized Poisson model for network meta-analysis of individual patient time-to-event data. Stat Med 2021; 41:340-355. [PMID: 34710951 DOI: 10.1002/sim.9240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
Network meta-analysis (NMA) allows the combination of direct and indirect evidence from a set of randomized clinical trials. Performing NMA using individual patient data (IPD) is considered as a "gold standard" approach as it provides several advantages over NMA based on aggregate data. For example, it allows to perform advanced modeling of covariates or covariate-treatment interactions. An important issue in IPD NMA is the selection of influential parameters among terms that account for inconsistency, covariates, covariate-by-treatment interactions or nonproportionality of treatments effect for time to event data. This issue has not been deeply studied in the literature yet and in particular not for time-to-event data. A major difficulty is to jointly account for between-trial heterogeneity which could have a major influence on the selection process. The use of penalized generalized mixed effect model is a solution, but existing implementations have several shortcomings and an important computational cost that precludes their use for complex IPD NMA. In this article, we propose a penalized Poisson regression model to perform IPD NMA of time-to-event data. It is based only on fixed effect parameters which improve its computational cost over the use of random effects. It could be easily implemented using existing penalized regression package. Computer code is shared for implementation. The methods were applied on simulated data to illustrate the importance to take into account between trial heterogeneity during the selection procedure. Finally, it was applied to an IPD NMA of overall survival of chemotherapy and radiotherapy in nasopharyngeal carcinoma.
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Affiliation(s)
- Edouard Ollier
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France.,SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France
| | - Pierre Blanchard
- Oncostat U1018, Inserm, Université Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France.,Département de Radiothérapie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Gwénaël Le Teuff
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
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21
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Delézay O, Hodin S, Hé Z, Ollier E, Delavenne X. Functional, proteomic and phenotypic in vitro studies evidence podocyte injury after chronic exposure to heparin. Toxicol Appl Pharmacol 2021; 429:115683. [PMID: 34411582 DOI: 10.1016/j.taap.2021.115683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/25/2022]
Abstract
Unfractionated heparin (UFH) is a widely used anticoagulant that possess numerous properties including anti-inflammatory, anti-viral, anti-angiogenesis, and anti-metastatic effects. The effect of this drug was evaluated on the podocyte, an important actor of the glomerular filtration. Using a functional approach, we demonstrate that heparin treatment leads to a functional podocyte perturbation characterized by the increase of podocyte monolayer permeability. This effect is enhanced with time of exposure. Proteomic study reveals that heparin down regulate focal adhesion and cytoskeletal protein expressions as well as the synthesis of glomerular basement membrane components. This study clearly demonstrates that UFH may affect podocyte function by altering cytoskeleton organization, cell-cell contacts and cell attachment.
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Affiliation(s)
- Olivier Delézay
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France.
| | - Sophie Hodin
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Zhiguo Hé
- EA 2521, Biologie, Ingénierie et Imagerie de la Greffe de Cornée (BIIGC), Saint-Etienne, France
| | - Edouard Ollier
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Xavier Delavenne
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
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22
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Le Terrier C, Vinetti M, Bonjean P, Richard R, Jarrige B, Pons B, Madeux B, Piednoir P, Ardisson F, Elie E, Martino F, Valette M, Ollier E, Breurec S, Carles M, Thiéry G. Impact of a restrictive antibiotic policy on the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an endemic region: a before-and-after, propensity-matched cohort study in a Caribbean intensive care unit. Crit Care 2021; 25:261. [PMID: 34311760 PMCID: PMC8311634 DOI: 10.1186/s13054-021-03660-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-level antibiotic consumption plays a critical role in the selection and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in the ICU. Implementation of a stewardship program including a restrictive antibiotic policy was evaluated with respect to ESBL-E acquisition (carriage and infection). METHODS We implemented a 2-year, before-and-after intervention study including all consecutive adult patients admitted for > 48 h in the medical-surgical 26-bed ICU of Guadeloupe University Hospital (French West Indies). A conventional strategy period (CSP) including a broad-spectrum antibiotic as initial empirical treatment, followed by de-escalation (period before), was compared to a restrictive strategy period (RSP) limiting broad-spectrum antibiotics and shortening their duration. Antibiotic therapy was delayed and initiated only after microbiological identification, except for septic shock, severe acute respiratory distress syndrome and meningitis (period after). A multivariate Cox proportional hazard regression model adjusted on propensity score values was performed. The main outcome was the median time of being ESBL-E-free in the ICU. Secondary outcome included all-cause ICU mortality. RESULTS The study included 1541 patients: 738 in the CSP and 803 in the RSP. During the RSP, less patients were treated with antibiotics (46.8% vs. 57.9%; p < 0.01), treatment duration was shorter (5 vs. 6 days; p < 0.01), and administration of antibiotics targeting anaerobic pathogens significantly decreased (65.3% vs. 33.5%; p < 0.01) compared to the CSP. The incidence of ICU-acquired ESBL-E was lower (12.1% vs. 19%; p < 0.01) during the RSP. The median time of being ESBL-E-free was 22 days (95% CI 16-NA) in the RSP and 18 days (95% CI 16-21) in the CSP. After propensity score weighting and adjusted analysis, the median time of being ESBL-E-free was independently associated with the RSP (hazard ratio, 0.746 [95% CI 0.575-0.968]; p = 0.02, and hazard ratio 0.751 [95% CI 0.578-0.977]; p = 0.03, respectively). All-cause ICU mortality was lower in the RSP than in the CSP (22.5% vs. 28.6%; p < 0.01). CONCLUSIONS Implementation of a program including a restrictive antibiotic strategy is feasible and is associated with less ESBL-E acquisition in the ICU without any worsening of patient outcome.
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Affiliation(s)
- Christophe Le Terrier
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France. .,Division of Intensive Care, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
| | - Marco Vinetti
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Division of Intensive Care, Saint-Pierre Clinic, Ottignies, Belgium
| | - Paul Bonjean
- Division of Clinical Epidemiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Régine Richard
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Bruno Jarrige
- Division of Hospital Infection Control, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Bertrand Pons
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Benjamin Madeux
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Pascale Piednoir
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Fanny Ardisson
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Elain Elie
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Frédéric Martino
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Marc Valette
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Edouard Ollier
- Division of Clinical Epidemiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sébastien Breurec
- Laboratory of Clinical Microbiology, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Faculty of Medecine Hyacinthe Bastaraud, University of Antilles, Pointe-à-Pitre, French West Indies, France.,INSERM Center for Clinical Investigation 1424, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, French West Indies, France
| | - Michel Carles
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Faculty of Medecine Hyacinthe Bastaraud, University of Antilles, Pointe-à-Pitre, French West Indies, France
| | - Guillaume Thiéry
- Division of Intensive Care, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France. .,University Jean Monnet, Saint-Etienne, France.
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Chapelle C, Ollier E, Girard P, Frere C, Mismetti P, Cucherat M, Laporte S. An epidemic of redundant meta-analyses. J Thromb Haemost 2021; 19:1299-1306. [PMID: 33660901 DOI: 10.1111/jth.15280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Meta-analyses are widely used to strengthen available evidence and obtain more precise estimates of treatment effect than any individual trial. Paradoxically, multiplication of meta-analyses on the same topic can lead to confusion as practitioners no longer benefit from a rapid and synthetic response. This phenomenon may appear disproportionate when the number of published meta-analyses exceeds the number of original studies. OBJECTIVES To describe an example of redundant meta-analyses published in the same area with the same randomized clinical trials (RCTs). METHODS A systematic review was performed to identify all published meta-analyses of original RCTs that compared direct oral anticoagulants with low molecular weight heparins in cancer patients with venous thromboembolism (VTE). Forest plots were used to represent the meta-analyses results for efficacy (VTE recurrence) and safety (major bleeding) endpoints. An authors' network was constructed to explore the links between the authors of the published meta-analyses. RESULTS In the past 3 years, four original RCTs were the subject of 20 published meta-analyses by 142 authors: five, four, and 11 meta-analyses pooled the data of two, three, and four RCTs, respectively. The results of meta-analyses were similar regarding the risks of VTE recurrence and major bleeding. The 11 meta-analyses of four RCTs were published within 6 months of the publication of the last RCT. CONCLUSIONS The epidemic proportions of such redundant literature and authorship could be moderated by developing "living" meta-analyses and encouraging authors of new RCTs to update the corresponding meta-analysis in the same paper as their original research.
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Affiliation(s)
- Céline Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
| | - Edouard Ollier
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
| | - Philippe Girard
- Institut Mutualiste Montsouris, Paris, France
- F-CRIN INNOVTE network, Saint Etienne, France
| | - Corinne Frere
- Sorbonne Université, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Mismetti
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Michel Cucherat
- Service de Pharmacologie, HCL, UMR CNRS 5558 Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint Etienne, France
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Tardy-Poncet B, Play B, Montmartin A, Damien P, Ollier E, Presles E, Garcin A, Tardy B. PHILEOS ( haemoPHILia and ostEoporOSis) Study: protocol of a multicentre prospective case-control study. BMJ Open 2021; 11:e042283. [PMID: 33441362 PMCID: PMC7812091 DOI: 10.1136/bmjopen-2020-042283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Two meta-analyses showed lower bone mineral density (BMD) in patients with haemophilia (haemophilia type and severity were often not specified) compared with healthy controls. This finding could be related to reduced mobility and sedentary lifestyle, and/or hepatitis C or HIV infection. The aim of this study is to determine osteoporosis prevalence in patients with haemophilia classified in function of the disease type (A or B) and severity, and to evaluate the potential role of regular prophylactic factor replacement (early vs delayed initiation) in preserving or restoring BMD. METHODS AND ANALYSIS The haemoPHILia and ostEoporOSis Study is a prospective, controlled, multicentre study that will include patients in France (13 haemophilia treatment centres), Belgium (1 centre) and Romania (1 centre). In total, 240 patients with haemophilia and 240 matched healthy controls will be recruited (1:1). The primary objective is to determine osteoporosis prevalence in patients with severe haemophilia A and B (HA and HB) without prophylaxis, compared with healthy controls. Secondary outcomes include: prevalence of osteoporosis and osteopenia in patients with mild, moderate and severe HA or HB with prophylaxis (grouped in function of their age at prophylaxis initiation), compared with healthy subjects; BMD in patients with HA and HB of comparable severity; correlation between BMD and basal factor VIII/IX levels and thrombin potential; and quantification of plasmatic markers of bone remodelling (formation and resorption) in patients with haemophilia. ETHICS AND DISSEMINATION The protocol was approved by the French Ethics Committee and by the French National Agency for Medicines and Health Products Safety (number: 2019-A03358-49). The results of this study will be actively disseminated through scientific publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04384341.
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Affiliation(s)
- Brigitte Tardy-Poncet
- Inserm CIC 1408, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
- Hemophilia Treatment Center, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
- Inserm U1059, Sainbiose, University of Lyon, Saint-Etienne, Auvergne-Rhône-Alpes, France
| | - Barbara Play
- Regional Medical Coagulation & Intensive Care, CSL Behring SA, Paris, Île-de-France, France
| | - Aurélie Montmartin
- Inserm U1059, Sainbiose, University of Lyon, Saint-Etienne, Auvergne-Rhône-Alpes, France
| | - Pauline Damien
- Inserm CIC 1408, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
| | - Edouard Ollier
- Clinical Research Unit Innovation and Pharmacology, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
| | - Emilie Presles
- Inserm CIC 1408, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
- Clinical Research Unit Innovation and Pharmacology, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
| | - Arnauld Garcin
- Clinical Research Unit Innovation and Pharmacology, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
| | - Bernard Tardy
- Inserm CIC 1408, Saint-Etienne University Hospital Center, Saint-Etienne, Rhône-Alpes, France
- Inserm U1059, Sainbiose, University of Lyon, Saint-Etienne, Auvergne-Rhône-Alpes, France
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Safieddine M, Chapelle C, Ollier E, Ferdynus C, Bertoletti L, Mismetti P, Cucherat M, Laporte S. Compared to randomized studies, observational studies may overestimate the effectiveness of DOACs: a metaepidemiological approach. J Clin Epidemiol 2020; 130:49-58. [PMID: 33080342 DOI: 10.1016/j.jclinepi.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Randomized controlled trials (RCTs) are criticized for including patients who are overselected. Health authorities consequently encourage "real-world" postmarketing cohort studies. Our objective was to determine the differences between RCTs and observational studies as regards their populations and efficacy/safety results. METHODS A systematic review was conducted to identify RCTs and observational studies including patients with venous thromboembolism receiving direct oral anticoagulants or conventional treatment. Ratios of hazard ratio (RHR) comparing epidemiological studies (prospective and retrospective cohort studies and studies using living databases) with RCTs were computed. RESULTS Six RCTs (27,121 patients) and twenty observational studies (248,971 patients) were identified and analyzed. Prospective cohort studies seemed to recruit patients who were no less selected than those of RCTs whereas other types of observational studies may reflect the population treated in real life. Among observational studies, prospective cohort studies yielded the most favorable estimates of treatment effect compared with RCTs. These studies were associated with a nonsignificant 33% increase in efficacy estimate (RHR 0.67, [95% CI, 0.39-1.18]) but no effect on safety estimate. Studies using living databases were associated with nonsignificant trends toward a greater effect on efficacy (RHR 0.82, [0.66-1.01]) and a smaller effect on safety (RHR 1.33, [0.96-1.84]). DISCUSSION Overall, in this clinical setting, an exaggeration of the treatment efficacy estimate was seen with observational studies compared with RCTs. CONCLUSIONS As the presence of residual confounding cannot be excluded, these results should be interpreted cautiously.
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Affiliation(s)
- Maissa Safieddine
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, F-42055 Saint-Etienne, France; Unité de Soutien Méthodologique, INSERM, CIC1410, CHU de la Réunion, Saint-Denis, France
| | - Celine Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, F-42055 Saint-Etienne, France; SAINBIOSE U1059, Université Jean Monnet, University of Lyon, INSERM, F-CRIN INNOVTE Network, F-42023 Saint-Etienne, France
| | - Edouard Ollier
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, F-42055 Saint-Etienne, France; SAINBIOSE U1059, Université Jean Monnet, University of Lyon, INSERM, F-CRIN INNOVTE Network, F-42023 Saint-Etienne, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, INSERM, CIC1410, CHU de la Réunion, Saint-Denis, France
| | - Laurent Bertoletti
- SAINBIOSE U1059, Université Jean Monnet, University of Lyon, INSERM, F-CRIN INNOVTE Network, F-42023 Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, F-40255 Saint-Etienne, France
| | - Patrick Mismetti
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, F-42055 Saint-Etienne, France; SAINBIOSE U1059, Université Jean Monnet, University of Lyon, INSERM, F-CRIN INNOVTE Network, F-42023 Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, F-40255 Saint-Etienne, France
| | - Michel Cucherat
- Service de Pharmacologie, HCL, UMR CNRS 5558 Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, F-42055 Saint-Etienne, France; SAINBIOSE U1059, Université Jean Monnet, University of Lyon, INSERM, F-CRIN INNOVTE Network, F-42023 Saint-Etienne, France.
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Trone JC, Ollier E, Chapelle C, Mismetti P, Cucherat M, Magné N, Zuffrey PJ, Laporte S. Assessment of non-inferiority with meta-analysis: example of hypofractionated radiation therapy in breast and prostate cancer. Sci Rep 2020; 10:15415. [PMID: 32963332 PMCID: PMC7508968 DOI: 10.1038/s41598-020-72088-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/31/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to propose a methodology for the assessment of non-inferiority with meta-analysis. Assessment of hypofractionated RT in prostate and breast cancers is used as an illustrative example. Non-inferiority assessment of an experimental treatment versus an active comparator should rely on two elements: (1) an estimation of experimental treatment’s effect versus the active comparator based on a meta-analysis of randomized controlled trials and (2) the value of an objective non-inferiority margin. This margin can be defined using the reported effect of active comparator and the percentage of the active comparator’s effect that is desired to be preserved. Non-inferiority can then be assessed by comparing the upper bound of the 95% confidence interval of experimental treatment’s effect to the value of the objective non-inferiority margin. Application to hypofractionated RT in breast cancer showed that hypofractionated whole breast irradiation (HWBI) appeared to be non-inferior to conventionally fractionated RT for local recurrence. This was not the case for accelerated partial breast irradiation (APBI). Concerning overall survival, non-inferiority could not be claimed for either HWBI or APBI. For prostate cancer, the lack of demonstrated significant superiority of conventional RT versus no RT precluded any conclusion regarding non-inferiority of hypofractionated RT.
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Affiliation(s)
- Jane-Chloé Trone
- Département de radiothérapie, Institut de Cancérologie Lucien Neuwirth - Saint Etienne, 42270, St Priest-en-Jarez, France. .,SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.
| | - Edouard Ollier
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.,Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Céline Chapelle
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.,Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Patrick Mismetti
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.,Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.,Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Michel Cucherat
- UMR CNRS 5558 Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Magné
- Département de radiothérapie, Institut de Cancérologie Lucien Neuwirth - Saint Etienne, 42270, St Priest-en-Jarez, France
| | - Paul Jacques Zuffrey
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.,Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.,Département d'Anesthésie-Réanimation, Hôpital Nord, CHU de Saint-Etienne, 42055, Saint-Etienne, France
| | - Silvy Laporte
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet, Saint-Etienne, France.,Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.,Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
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Chaux R, Sanchez O, Couturaud F, Meneveau N, Chopard R, Mismetti P, Laporte S, Ollier E. Association between initial and residual pulmonary vascular obstruction and pulmonary embolism recurrence, a pooled analysis. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Laporte S, Chapelle C, Trone JC, Bertoletti L, Girard P, Meyer G, Safieddine M, Cucherat M, Ollier E, Mismetti P. Early detection of the existence or absence of the treatment effect: A cumulative meta-analysis. J Clin Epidemiol 2020; 124:24-33. [DOI: 10.1016/j.jclinepi.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023]
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Catella J, Bertoletti L, Mismetti P, Ollier E, Samperiz A, Soler S, Suriñach JM, Mahé I, Lorente MA, Braester A, Monreal M. Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism. J Thromb Haemost 2020; 18:1728-1737. [PMID: 32299150 DOI: 10.1111/jth.14837] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 08/31/2023]
Abstract
BACKGROUND Detection of severe renal impairment in patients with venous thromboembolism (VTE) is mandatory both for selecting anticoagulant therapy and for evaluating major bleeding risk, increased by severe renal impairment. OBJECTIVES To determine whether the Cockcroft and Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas identify severe renal impairment in the same VTE patients presenting the same risk of major bleeding. PATIENTS/METHODS We compared clinical characteristics and outcomes during the first 3 months of anticoagulation between VTE patients in the RIETE registry with severe renal impairment according to the CG and/or CKD-EPI formula (estimated glomerular filtration rate <30 mL/min and <30 mL/min/1.73 m2 , respectively). The primary outcome was major bleeding. RESULTS Up to October 2017, 41 796 patients were included in RIETE. Among the 4676 patients with severe renal impairment according to at least one of the formulas, this was not confirmed by the other formula in 1904 (40.7%). Major bleeding risk was increased in every patient subgroup with severe renal impairment vs patients without this condition (CG or CKD-EPI < 30: odds ratio [OR] = 2.26, 95% confidence interval [CI 2.01-2.53], only CG < 30: OR = 1.72, 95% CI [1.37-2.13], only CKD-EPI < 30: OR = 2.34, 95% CI [1.77-3.05], CG+CKD-EPI < 30: OR = 2.47, 95% CI [2.16-2.83], all vs CG+CKD-EPI > 30). CONCLUSION The CG and CKD-EPI formulas identify different subgroups of patients with severe renal impairment, leading to discordant results in 40.7% of these patients. Irrespective of the formula used for their identification, patients with severe renal impairment have a higher risk of major bleeding under anticoagulant therapy.
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Affiliation(s)
- Judith Catella
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Edouard Ollier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- URCIP, CHU de St-Etienne, Saint-Etienne, France
| | - Angel Samperiz
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - José Maria Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabelle Mahé
- F-CRIN INNOVTE network, Saint-Etienne, France
- Department of Internal Medicine, Hôpital Louis Mourier (APHP), University Paris 7, Colombes, France
| | | | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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Trone JC, Vallard A, Sotton S, Ben Mrad M, Jmour O, Magné N, Pommier B, Laporte S, Ollier E. Survival after hypofractionation in glioblastoma: a systematic review and meta-analysis. Radiat Oncol 2020; 15:145. [PMID: 32513205 PMCID: PMC7278121 DOI: 10.1186/s13014-020-01584-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Glioblastoma multiforme (GBM) has a poor prognosis despite a multi modal treatment that includes normofractionated radiotherapy. So, various hypofractionated alternatives to normofractionated RT have been tested to improve such prognosis. There is need of systematic review and meta-analysis to analyse the literature properly and maybe generalised the use of hypofractionation. The aim of this study was first, to perform a meta-analysis of all controlled trials testing the impact of hypofractionation on survival without age restriction and secondly, to analyse data from all non-comparative trials testing the impact of hypofractionation, radiosurgery and hypofractionated stereotactic RT in first line. MATERIALS/METHODS We searched Medline, Embase and Cochrane databases to identify all publications testing the impact of hypofractionation in glioblastoma between 1985 and March 2020. Combined hazard ratio from comparative studies was calculated for overall survival. The impact of study design, age and use of adjuvant temozolomide was explored by stratification. Meta-regressions were performed to determine the impact of prognostic factors. RESULTS 2283 publications were identified. Eleven comparative trials were included. No impact on overall survival was evidenced (HR: 1.07, 95%CI: 0.89-1.28) without age restriction. The analysis of non-comparative literature revealed heterogeneous outcomes with limited quality of reporting. Concurrent chemotherapy, completion of surgery, immobilization device, isodose of prescription, and prescribed dose (depending on tumour volume) were poorly described. However, results on survival are encouraging and were correlated with the percentage of resected patients and with patients age but not with median dose. CONCLUSIONS Because few trials were randomized and because the limited quality of reporting, it is difficult to define the place of hypofactionation in glioblastoma. In first line, hypofractionation resulted in comparable survival outcome with the benefit of a shortened duration. The method used to assess hypofractionation needs to be improved.
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Affiliation(s)
- Jane-Chloe Trone
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Alexis Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Sandrine Sotton
- University Departement of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Majed Ben Mrad
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Omar Jmour
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- University Departement of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Benjamin Pommier
- Department of Neurosurgery, University Hospital, Saint-Etienne, France
| | - Silvy Laporte
- SAINBIOSE U1059, Jean Monnet University, Saint-Etienne, France
| | - Edouard Ollier
- SAINBIOSE U1059, Jean Monnet University, Saint-Etienne, France
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Guedeney P, Sorrentino S, Giustino G, Chapelle C, Laporte S, Claessen BE, Ollier E, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Lattuca B, Zeitouni M, Kerneis M, Silvain J, Collet JP, Mehran R, Montalescot G. Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis. Eur Heart J Cardiovasc Pharmacother 2020; 7:225-235. [PMID: 32275743 DOI: 10.1093/ehjcvp/pvaa024] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/03/2020] [Accepted: 04/04/2020] [Indexed: 12/22/2022]
Abstract
AIMS Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab. METHODS AND RESULTS We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66-0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65-1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99-1.34), stroke (RR 0.96, 95% CI 0.71-1.28), or coronary revascularization (RR 1.13, 95% CI 0.99-1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes. CONCLUSION Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.
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Affiliation(s)
- Paul Guedeney
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France.,Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sabato Sorrentino
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Gennaro Giustino
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celine Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Silvy Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Bimmer E Claessen
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edouard Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Anton Camaj
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah N Kalkman
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Birgit Vogel
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Benoit Lattuca
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Michel Zeitouni
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Mathieu Kerneis
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Johanne Silvain
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Roxana Mehran
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilles Montalescot
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
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Delavenne X, Ollier E, Lienhart A, Dargaud Y. A new paradigm for personalized prophylaxis for patients with severe haemophilia A. Haemophilia 2020; 26:228-235. [PMID: 32100950 PMCID: PMC7154752 DOI: 10.1111/hae.13935] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/12/2019] [Accepted: 01/17/2020] [Indexed: 02/04/2023]
Abstract
AIM For patients with severe haemophilia A, guidelines recommend prophylactic treatment with FVIII, with dose calculations targeting a predetermined FVIII trough level. However, this pharmacokinetic (PK) approach is suboptimal, with some patients experiencing breakthrough bleeds. We aimed to improve FVIII dosing by incorporating the thrombin generation assay, a global haemostasis assay whose main pharmacodynamic (PD) parameter, endogenous thrombin potential (ETP), predicts spontaneous bleeding risk. METHODS We performed post hoc combined PK-PD modelling using data from 66 adults who received human-cl rhFVIII (Nuwiq® , Octapharma AG) in a phase IIIb study. Time-to-event analyses simulated the probability of spontaneous bleeding for different FVIII exposures and baseline ETPs. RESULTS Ninety-one spontaneous bleeds occurred in 20/66 patients. The relationship between FVIII:C and ETP was non-linear, and the sigmoid Emax model adequately described the data. Individual PK-PD Bayesian estimation significantly improved predictive performance. Simulations showed that the mean spontaneous annual bleeding rate decreased with increasing baseline ETP or dosing: with ETP values of 200, 400 and 600 (nmol/L)·min annual bleeding rates were 2.36, 1.25 and 0.66, respectively, on 40 IU/kg human-cl rhFVIII every 3 days; and annual bleeding rates were 2.09, 1.10, and 0.60, respectively, on 60 IU/kg every 3 days. CONCLUSION Prophylactic FVIII dosing is more clinically meaningful when incorporating ETP alongside FVIII level. For the first time, FVIII dosing can be personalized with the aim of eliminating spontaneous breakthrough bleeds.
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Affiliation(s)
- Xavier Delavenne
- Institut national de la santé et de la recherche médicale (Inserm), UMR 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint Etienne, France
| | - Edouard Ollier
- Institut national de la santé et de la recherche médicale (Inserm), UMR 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint Etienne, France
| | - Anne Lienhart
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Université Lyon 1, Lyon, France
| | - Yesim Dargaud
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Université Lyon 1, Lyon, France
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Trone JC, Ollier E, Chapelle C, Bertoletti L, Cucherat M, Mismetti P, Magné N, Laporte S. Statistical controversies in clinical research: limitations of open-label studies assessing antiangiogenic therapies with regard to evaluation of vascular adverse drug events-a meta-analysis. Ann Oncol 2019; 29:803-811. [PMID: 29415169 DOI: 10.1093/annonc/mdy035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Previous meta-analyses have shown paradoxical increased risk of bleeding and thrombotic events in patients receiving antiangiogenics (AA) that may be simply explained by the studies design included. By a meta-epidemiological approach, we aim to investigate the impact of double-blind (DB) and open-label study designs on the risks of bleeding, venous thrombotic events (VTE) and arterial thrombotic events (ATE) in cancer patients treated with AA. Materials and methods We searched Medline, Cochrane, ClinicalTrials.gov databases and proceedings of major oncology congresses for clinical trials published from January 2003 to January 2016. Randomized clinical trials that assigned patients with solid cancers to AA or control groups were eligible for inclusion. Combined odds ratios (ORs) for the risks of bleeding events, VTE and ATE were calculated for open and DB trials. Estimation bias of the treatment effect was determined by the ratio of OR, by dividing the OR values obtained in open-label trials by those obtained in DB trials. Results The literature-based meta-analysis included 166 trials (72 024 patients). For bleeding events, comparison of AA versus control yielded an overall OR of 2.41 [95% confidence interval (95% CI) 2.12-2.73; P < 0.001], but this risk was overestimated by 1.68 (95% CI 1.33-2.13) in open-label studies. Concerning VTE, the OR was 1.19 (95% CI 1.04-1.35; P = 0.012) overall with AA, but this effect disappears when considering only DB trials (OR 0.99, 95% CI 0.83-1.17). The corresponding ratio of OR showed a significant overestimation of 1.53 (95% CI 1.19-1.96) in open-label trials. For ATE, an OR of 1.59 (95% CI 1.30-1.94; P < 0.001) was observed, associated with a significant overestimation of 1.65 (95% CI 1.13-2.43) in open-label trials. Conclusions Open-label studies overestimated the risk of vascular adverse events with AA by at least 50%. Meta-analyses assessing adverse drug events should therefore be restricted to DB randomized trials.
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Affiliation(s)
- J C Trone
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet - Saint-Etienne, Saint-Etienne, France.
| | - E Ollier
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet - Saint-Etienne, Saint-Etienne, France
| | - C Chapelle
- Clinical Research Unit, Innovation, Pharmacologie, France
| | - L Bertoletti
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet - Saint-Etienne, Saint-Etienne, France; Department of Vascular and Therapeutic Medicine, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France; INSERM CIE1408, Saint-Etienne, France
| | - M Cucherat
- UMR CNRS 5558 Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - P Mismetti
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet - Saint-Etienne, Saint-Etienne, France; Clinical Research Unit, Innovation, Pharmacologie, France; Department of Vascular and Therapeutic Medicine, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - N Magné
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
| | - S Laporte
- SAINBIOSE U1059, Equipe DVH, Université Jean Monnet - Saint-Etienne, Saint-Etienne, France; Clinical Research Unit, Innovation, Pharmacologie, France; INSERM CIE1408, Saint-Etienne, France
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Guedeney P, Sorrentino S, Giustino G, Chapelle C, Claessen B, Ollier E, Laporte S, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Collet JP, Mehran R, Montalescot G. P5367Indirect comparison of the safety and efficacy of alirocumab and evolocumab: from a comprehensive meta-analysis of 30 randomized controlled trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Alirocumab and evolocumab, two proprotein convertase subtilisin–kexin type 9 inhibitors, have both been associated with improved outcomes in patients with atherosclerotic cardiovascular disease in addition to standard lipid-lowering therapies. However, their comparative safety and efficacy profiles are unknown.
Purpose
To compare the safety and efficacy of alirocumab versus evolocumab.
Methods
We conducted a systematic review and network meta-analysis of placebo-controlled randomized trials available up to November 2018 evaluating the safety and efficacy of alirocumab and evolocumab. We estimated risk ratio and 95% confidence intervals using fixed effect model in a frequentist pairwise and network metanalytic approach. The primary safety endpoints were any adverse events leading to treatment-discontinuation, injection site reaction, systemic allergic reaction, neurocognitive events, ophthalmologic events and new-onset of diabetes mellitus (DM) or worsening of pre-existing DM. The primary efficacy endpoints were all-cause and cardiovascular (CV) death, myocardial infarction (MI) and stroke. This study was registered in PROSPERO (CRD42018090768).
Results
A total of 30 trials, enrolling 59,026 patients were included in this analysis, of whom 13,607 received alirocumab and 17,931 received evolocumab. Mean weighted follow-up time was 2.5 years, with an exposure time of 144,907 patients-years. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. There were no significant differences between alirocumab and evolocumab in terms of safety endpoints, except for injection site reaction with a 27% increased risk of injection site reaction with alirocumab compared to evolocumab (Figure). Compared with evolocumab, alirocumab was associated with a reduction of all-cause death but not CV death. There were no significant differences in MI or stroke between alirocumab and evolocumab.
Conclusion
Alirocumab and evolocumab share a similar safety profile. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to heterogeneity of the studied populations between the two drugs.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - S Sorrentino
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - G Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - C Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - B Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - E Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - S Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - A Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - D N Kalkman
- University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - B Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - S De Rosa
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
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Trone JC, Langrand-Escure J, Ollier E, Jmour O, Ben Mrad M, Nevesny S, Lei Q, Benna M, Yazid D, Guy JB, Vallard A, Magné N. Chemoradiation phase II trials: re-exploring a world of missed opportunities. Acta Oncol 2019; 58:1158-1162. [PMID: 31074314 DOI: 10.1080/0284186x.2019.1605194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Phase II trials are designed to assess the efficacy/toxicity ratio of experimental treatments and select those worth being tested in phase III trials. Although crucial limitations were identified when concurrent chemoradiation (cCRT) phase III trials characteristics were assessed, features of cCRT phase II trials have never been reported. The objective was to describe features of all cCRT phase II trials. Methods and material: Requests were performed in the Medline database (via PubMed). The latest update was performed in April 2016, using the following MESH terms: 'clinical trials: phase II as topic', 'chemoradiotherapy'. Results: Four hundred and fifty-eight cCRT phase II trials were identified. They were mainly multicenter (51.5%), single arm studies (77.7%) published after 2011 (55.0%). The median number of included patients was 52. Primary endpoints were mainly response rate (20.5%), pathological complete response (14.4%) and overall survival (12.6%). The primary endpoint was not defined in 22% of studies. Tumors were mostly lung (23.1%), head and neck (20.3%), colorectal (16.6%) and esophagogastric cancer (14.6%) treated at a locally advanced setting (81.7%). 55.2% of trials used 3D-conformal radiotherapy and 9.1% intensity-modulated radiotherapy, mainly with normo-fractionation (82.0% of the 573 arms with radiotherapy). Radiation technique was not reported in 19.9% of studies. Associated anticancer drugs (563 arms) were mainly conventional chemotherapies (559 arms): cisplatin (46.2%) and 5-fluorouracil (28.3%). Non cytotoxic agents (targeted therapies, immunotherapies) were tested in 97 arms (17%). With a median follow-up of 31 months, acute grades 3-5 were reported in 98.5% of studies and late toxicities in 44.5%. Follow-up was not reported in 17% of studies. Conclusions: cCRT phase II trials featured severe limitations, with outdated radiation techniques, insufficient reporting of crucial data and a small number of included patients. This certainly limited the impact of conclusions and hindered the development of successful phase III trials.
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Affiliation(s)
- Jane-Chloé Trone
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Julien Langrand-Escure
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Edouard Ollier
- SAINBIOSE U1059, Jean Monnet University, Saint-Etienne, France
| | - Omar Jmour
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Majed Ben Mrad
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Stéphane Nevesny
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Qianqian Lei
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Marouan Benna
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Dalia Yazid
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Jean-Baptiste Guy
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Alexis Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
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Claisse G, Zufferey PJ, Trone JC, Maillard N, Delavenne X, Laporte S, Ollier E. Predicting the dose of vancomycin in ICU patients receiving different types of RRT therapy: a model-based meta-analytic approach. Br J Clin Pharmacol 2019; 85:1215-1226. [PMID: 30768726 DOI: 10.1111/bcp.13904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/28/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022] Open
Abstract
AIM Previous pharmacokinetic (PK) studies have proposed various dosing regimens for vancomycin in intensive care unit (ICU) patients undergoing renal replacement therapy (RRT), but all are restricted to specific RRT modalities. To be useful in practice, a population PK model would need to predict vancomycin clearance during any RRT modality. Development of such a model is feasible using meta-analysis of published summarized estimates of vancomycin PK parameters. Our aims were: (i) to develop and validate a population PK model for vancomycin that takes into account any RRT modalities, and (ii) to predict vancomycin dosing for RRT patients in ICU. METHODS Vancomycin pharmacokinetics were assumed to be two-compartmental, total body clearance being the sum of non-RRT clearance and RRT-induced clearance. Drug disposition and non-RRT clearance parameters were estimated by systematic review and meta-analysis of previously published parameter estimates. The relationship between RRT-induced clearance and RRT flowrate settings was assessed using a model-based meta-analysis. Prediction performances of the PK model were assessed using external data. RESULTS The meta-analyses of disposition parameters, non-RRT clearance and RRT-induced clearance included 11, 6 and 38 studies (84 RRT clearance measurements) respectively. The model performed well in predicting external individual PK data. Individual vancomycin concentrations during RRT were accurately predicted using Bayesian estimation based solely on pre-RRT measurements. CONCLUSIONS The PK model allowed accurate prediction of the vancomycin pharmacokinetics during RRT in ICU patients. Based on the model of RRT-induced clearance, an appropriate adjustment of the vancomycin dosing regimen could be proposed for any kind of flowrate settings.
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Affiliation(s)
- Guillaume Claisse
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, Saint-Etienne, France
| | - Paul J Zufferey
- Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, Saint-Etienne, France.,Département d'Anesthésie-Réanimation, Hôpital Nord, Saint-Etienne, France
| | - Jane C Trone
- Département de radiothérapie, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, France.,INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Nicolas Maillard
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, Saint-Etienne, France.,Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Saint-Etienne, France
| | - Xavier Delavenne
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, Saint-Etienne, France.,INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Edouard Ollier
- Unité de Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, Saint-Etienne, France.,INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
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Delavenne X, Dargaud Y, Ollier E, Négrier C. Dose tailoring of human cell line-derived recombinant factor VIII simoctocog alfa: Using a limited sampling strategy in patients with severe haemophilia A. Br J Clin Pharmacol 2019; 85:771-781. [PMID: 30633808 DOI: 10.1111/bcp.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023] Open
Abstract
AIMS The use of factor VIII (FVIII) prophylaxis in haemophilia A is considered the standard of care, particularly in children. Despite adjustment of doses for body weight and/or age, a large pharmacokinetic (PK) variability between patients has been observed. PK-tailored prophylaxis may help clinicians adjust coagulation factor FVIII activity (FVIII:C) to the desired level, which may differ in individual patients. The objective was to develop a population PK model for simoctocog alfa based on pooled clinical trial data and to develop a Bayesian estimator to allow PK parameters in individual patients to be estimated using a reduced number of blood samples. METHODS PK data from 86 adults and 29 children/adolescents with severe haemophilia A were analysed. The FVIII data measured using 2 different assays (chromogenic and the 1-stage clotting assay) were fit to separate develop population PK models using nonlinear mixed-effect models. A Bayesian estimator was then developed to estimate the time above the threshold of 1%. RESULTS The PK data for chromogenic and the 1-stage clotting assays were both best described by a 2-compartment models. Simulations demonstrated good predictive capacity. The limited sampling strategy using blood sample at 3 and 24 hours allowed an accurate estimation of the time above the threshold of 1% FVIII:C (mean bias 0.01 and 0.11, mean precision 0.18 and 0.45 for 2 assay methods). CONCLUSION In this study, we demonstrated that a Bayesian approach can help to reduce the number of samples required to estimate the time above the threshold of 1% FVIII:C with good accuracy.
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Affiliation(s)
- Xavier Delavenne
- INSERM, UMR 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint Etienne, France
| | - Yesim Dargaud
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Université Lyon 1, Lyon, France
| | - Edouard Ollier
- INSERM, UMR 1059, Dysfonction Vasculaire et de l'Hémostase, Université de Lyon, Saint Etienne, France
| | - Claude Négrier
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Université Lyon 1, Lyon, France
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Mercier M, Dangin A, Ollier E, Bonin N. Does acetabular dysplasia affect outcome in arthroscopic treatment of cam femoroacetabular impingement? Case-control study with and without acetabular dysplasia. Orthop Traumatol Surg Res 2019; 105:7-10. [PMID: 30630740 DOI: 10.1016/j.otsr.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic management of femoroacetabular impingement (FAI) is classically contraindicated when acetabular dysplasia is associated, although this is controversial in case of moderate dysplasia or isolated cam effect. A case-control study was therefore conducted comparing borderline (center-edgeangle (CEA), 20-24°), moderate (15-19°) and severe dysplasia (<15°) (group D) versus a control group with normal acetabular cover (CEA, 25-30°). The aims were 1) to determine functional results and satisfaction, and 2) to correlate functional results with severity of dysplasia and of cam effect. HYPOTHESIS Improvement in functional scores and satisfaction is lower in group D than in controls, due to non-correction of dysplasia. MATERIAL AND METHOD A single-center, single-surgeon retrospective comparative case-control study included all patients with isolated cam-effect FAI and dysplasia but without osteoarthritis (group D) or with isolated cam-effect FAI without dysplasia (controls) operated on during the study period. Cases of mixed impingement were excluded. Preoperative and last-follow-up functional variables included McCarthy's modified Harris Hip Score (mHHS) and Christensen's Non-Arthritic Hip Score (NAHS). RESULTS Between 2011 and 2014, details of 407 patients operated on by arthroscopy were entered in a data-base. Twenty patients (22 hips) were included in group D, with CEA<25° (mean, 19±3.1; range, 10-23°). The control group comprised 23 patients (25 hips) with CEA>25° (mean, 29±2.1°; range, 25-30°) matched for gender, age and body-mass index. Mean follow-up was 29.6±14.1 months (range, 14-58 months) in group D and 31.4±10.6 months (range, 15-57 months) in the control group (p=0.66). For functional scores, the two groups showed respectively 9.9 (-34 to +47) (p=0.038) and 10.4 (-20 to +48) (p=0.0038) gain in mHHS (non-significant: p=0.943). Mean gain in NAHS was 16.6 (-19 to +33) (p=0.0001) and 13.7 (-11 to +47) (p=0.0002), respectively (non-significant: p=0.56) CONCLUSION: Short-term functional results for cam FAI treatment were equivalent with<25° acetabular cover (mean, 19°; range, 13-24°) or normal cover. Longer-term assessment is indispensable to determine the impact of dysplasia and its severity. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Marcelle Mercier
- Service de chirurgie orthopédique et traumatologique, CHU Lyon Sud, 165, Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Antoine Dangin
- Chirurgie orthopédique et de traumatologie, CHU Nord Saint-Étienne, 42270 Saint Priest en Jarez, France
| | - Edouard Ollier
- Unité de recherche clinique, innovation, pharmacologie, CHU Nord Saint-Etienne, 42055 Saint-Étienne, France
| | - Nicolas Bonin
- Lyon Ortho Clinic, clinique de la Sauvegarde, 29, avenue des Sources (Bât B), 69009 Lyon, France
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Goutte J, Ollier E, Cathébras P. Attitudes et représentations des internistes et rhumatologues vis-à-vis de plaintes douloureuses chroniques. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zufferey PJ, Ollier E, Delavenne X, Laporte S, Mismetti P, Duffull SB. Incidence and risk factors of major bleeding following major orthopaedic surgery with fondaparinux thromboprophylaxis. A time-to-event analysis. Br J Clin Pharmacol 2018; 84:2242-2251. [PMID: 29877590 DOI: 10.1111/bcp.13663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Increased exposure to fondaparinux, as observed in patients with renal impairment, may increase bleeding risk. This study aims to determine the time course of major bleeding after major orthopaedic surgery, identify predictors of bleeding and simulate the effect of a reduced dose of fondaparinux on bleeding for patients with moderate renal impairment (creatinine clearance = 20-50 ml min-1 ). METHODS Data including fondaparinux anti-Xa activities from two multicentre prospective cohorts were used. In the first cohort, patients (n = 957) received fondaparinux 2.5 mg once a day. In the second, patients with moderate renal impairment (n = 436) received 1.5 mg once per day. The time-to-major bleeding after the end of surgery was modelled using a parametric survival analysis in NONMEM. RESULTS The observed rate of major bleeding up to day 11 was 5.2%. The time-to-event analysis indicated that the hazard of bleeding was highest in the first days following surgery and then remained low thereafter. Independent significant predictors of an increased hazard of major bleeding were male sex, lower body weight and increased drug exposure. Simulated rates of major bleeding up to day 11 in patients with moderate renal impairment were 6.5% with fondaparinux 2.5 mg once daily and 3.8% with fondaparinux 1.5 mg once daily. CONCLUSION The hazard of major bleeding is highest in the first postoperative days and increases with fondaparinux exposure. To reduce the risk of bleeding in patients with moderate renal impairment, this study supports the use of a lower dose of fondaparinux 1.5 mg once daily.
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Affiliation(s)
- P J Zufferey
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand.,U1059, Dysfonction Vasculaire et Hémostase, INSERM, F-42023, Saint-Etienne, France.,Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, F-42055, Saint-Etienne, France.,Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, F-42055, Saint Etienne, France
| | - E Ollier
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, F-42023, Saint-Etienne, France
| | - X Delavenne
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, F-42023, Saint-Etienne, France.,Universtité de Lyon, Saint-Etienne, F-42023, France.,Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - S Laporte
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, F-42023, Saint-Etienne, France.,Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, F-42055, Saint Etienne, France.,Universtité de Lyon, Saint-Etienne, F-42023, France
| | - P Mismetti
- U1059, Dysfonction Vasculaire et Hémostase, INSERM, F-42023, Saint-Etienne, France.,Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, F-42055, Saint Etienne, France.,Universtité de Lyon, Saint-Etienne, F-42023, France
| | - S B Duffull
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand
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Safieddine M, Chapelle C, Ollier E, Bertoletti L, Bellet F, Mismett P, Cucherat M, Laporte S. Quel apport des études de vraie vie par rapport aux études randomisées avec les anticoagulants oraux directs (AOD) ? Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Claisse G, Maillard N, Dinic M, Mariat C, Ollier E. SP466MODEL BASED META-ANALYSIS OF VANCOMYCIN CLEARANCE DURING RENAL REPLACEMENT THERAPY: APPLICATION TO VANCOMYCIN PHARMACOKINETIC DURING SLED IN ICU PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guillaume Claisse
- Nephrology, Dialysis, Transplantation, University Hospital Saint Etienne, Saint-Priest en Jarez, France
| | - Nicolas Maillard
- Nephrology, Dialysis, Transplantation, University Hospital of Saint Etienne, SAint Etienne, France
| | - Miriana Dinic
- Nephrology, Dialysis and Transplantation, University Hospital of Saint Etienne, Saint Etienne, France
| | - Christophe Mariat
- Nephrology, Dialysis and Transplantation, University Hospital of Saint Etienne, Saint Etienne, France
| | - Edouard Ollier
- Pharmalogy, University Hospital of Saint Etienne, Saint Etienne, France
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Chambard L, Girard N, Ollier E, Rousseau JC, Duboeuf F, Carlier MC, Brevet M, Szulc P, Pialat JB, Wegrzyn J, Clezardin P, Confavreux CB. Bone, muscle, and metabolic parameters predict survival in patients with synchronous bone metastases from lung cancers. Bone 2018; 108:202-209. [PMID: 29337225 DOI: 10.1016/j.bone.2018.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/11/2017] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. PATIENTS AND METHODS POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. RESULTS Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). CONCLUSIONS In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.
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Affiliation(s)
- Lauriane Chambard
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
| | - Nicolas Girard
- Respiratory Medicine Department, Hospices Civils de Lyon, Bron F-69500, France.
| | - Edouard Ollier
- Université Claude Bernard Lyon 1, Villeurbanne F-69100, France
| | | | | | | | - Marie Brevet
- Pathology Department, Hospices Civils de Lyon, Bron F-69500, France.
| | - Pawel Szulc
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France.
| | - Jean-Baptiste Pialat
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Radiology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
| | - Julien Wegrzyn
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Orthopedic Department, Hospices Civils de Lyon, Lyon F-69003, France.
| | | | - Cyrille B Confavreux
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
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Batailler C, Bonin N, M Wettstein, Nogier A, Martres S, Ollier E, May O, Lustig S. Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: Retrospective study of 46 patients. Orthop Traumatol Surg Res 2017; 103:1147-1153. [PMID: 28951281 DOI: 10.1016/j.otsr.2017.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impingement of the ilio-psoas tendon on the acetabular component is a cause of pain after total hip arthroplasty (THA). Studies of cup revision for ilio-psoas impingement (IPI) are scarce and limited in size. We therefore conducted a large multicentre retrospective study with the following objectives: to assess the effectiveness of cup replacement in resolving the impingement syndrome, to determine the frequency and nature of complications after cup revision for IPI, and to identify pre-operative factors associated with good outcomes of cup revision for IPI. HYPOTHESIS Cup revision is effective in resolving the pain due to IPI in selected patients. METHODS This retrospective multicentre study included 46 patients who underwent cup revision because of IPI. Before the revision, 38 (83%) patients had prominence of the anterior cup rim (mean, 9.9±4.5mm (range, 2-22mm) by radiography and 35 (76%) had cup malposition (anteversion<10° and/or inclination>50°). Mean follow-up was 21months (range, 6months to 6 years) and no patient was lost to follow-up. Outcomes at last follow-up were assessed based on the Oxford Hip Score (OHS), patient satisfaction index, complications, and revisions. RESULTS At last follow-up, 39 (85%) patients were satisfied with the revision procedure, a significant improvement versus baseline was noted in the OHS (mean, 43±6; range, 25-48; P<0.001), and 41 patients were free of pain during hip flexion (P<0.001 versus baseline). Complications occurred in 3 (6.5%) patients, but only one complication was severe (deep infection). Recurrent groin pain was reported by 4 (8.7%) patients at last follow-up. None of the factors studied predicted the outcome of revision surgery. DISCUSSION Cup revision for IPI after THA is effective in relieving the groin pain in 80% of patients with anterior cup rim prominence and/or cup malposition. However, complications can occur. Tenotomy may be preferable when the diagnosis is in doubt and/or cup position is acceptable. LEVEL OF EVIDENCE IV, retrospective observational study.
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Affiliation(s)
- C Batailler
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - N Bonin
- Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France
| | - M Wettstein
- ITOLS, clinique de Genolier, route du Muids 3, 1272 Genolier, Switzerland
| | - A Nogier
- Nollet Institute, 23, rue Brochant, 75017 Paris, France
| | - S Martres
- Orthopaedic Department, Hôpital Renée-Sabran, boulevard Edouard-Herriot, 83406 Hyères, France
| | - E Ollier
- U1059, Inserm, dysfonction vasculaire et hémostase, 42023 Saint-Etienne, France
| | - O May
- Centre de chirurgie de la hanche, Médipôle Garonne, 45, rue de Gironis, 31100 Toulouse, France
| | - S Lustig
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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- Société francophone d'arthroscopie, 15, rue Ampère, 92500 Rueil Malmaison, France
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Lanoiselée J, Zufferey PJ, Ollier E, Hodin S, Delavenne X. Is tranexamic acid exposure related to blood loss in hip arthroplasty? A pharmacokinetic-pharmacodynamic study. Br J Clin Pharmacol 2017; 84:310-319. [PMID: 29193211 DOI: 10.1111/bcp.13460] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 06/16/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022] Open
Abstract
AIMS Tranexamic acid (TXA) is an antifibrinolytic agent, decreasing blood loss in hip arthroplasty. The present study investigated the relationship between TXA exposure markers, including the time above the in vitro threshold reported for inhibition of fibrinolysis (10 mg l-1 ), and perioperative blood loss. METHODS Data were obtained from a prospective, double-blind, parallel-arm, randomized superiority study in hip arthroplasty. Patients received a preoperative intravenous bolus of TXA 1 g followed by a continuous infusion of either TXA 1 g or placebo over 8 h. A population pharmacokinetic study was conducted to quantify TXA exposure. RESULTS In total, 827 TXA plasma concentrations were measured in 166 patients. A two-compartment model fitted the data best, total body weight determining interpatient variability in the central volume of distribution. Creatinine clearance accounted for interpatient variability in clearance. At the end of surgery, all patients had TXA concentrations above the therapeutic target of 10 mg l-1 . The model-estimated time during which the TXA concentration was above 10 mg l-1 ranged from 3.3 h to 16.3 h. No relationship was found between blood loss and either the time during which the TXA concentration exceeded 10 mg l-1 or the other exposure markers tested (maximum plasma concentration, area under the concentration-time curve). CONCLUSION In hip arthroplasty, TXA plasma concentrations were maintained above 10 mg l-1 during surgery and for a minimum of 3 h with a preoperative TXA dose of 1 g. Keeping TXA concentrations above this threshold up to 16 h conferred no advantage with regard to blood loss.
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Affiliation(s)
- Julien Lanoiselée
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, F-42023, Saint-Etienne, France.,Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, F-42055, Saint-Etienne, France
| | - Paul J Zufferey
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, F-42023, Saint-Etienne, France.,Département d'Anesthésie-Réanimation, CHU de Saint-Etienne, F-42055, Saint-Etienne, France.,Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, F-42055, Saint Etienne, France
| | - Edouard Ollier
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, F-42023, Saint-Etienne, France.,Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Sophie Hodin
- Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Xavier Delavenne
- INSERM, U1059, Dysfonction Vasculaire et Hémostase, F-42023, Saint-Etienne, France.,Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne, F-42055, Saint-Etienne, France.,Université de Lyon, Saint-Etienne, F-42023, France
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Trone JC, Espenel S, Rehailia-Blanchard A, Guillaume E, Vial N, Rancoule C, Rodriguez-Lafrasse C, Ben Mrad M, El Meddeb Hamrouni A, Ollier E, Chargari C, Deutsch E, Vallard A, Magné N. Navigating the highlights of phase III trials: a watchful eye on evidence-based radiotherapy. Ann Oncol 2017; 28:2691-2697. [PMID: 29045516 DOI: 10.1093/annonc/mdx347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Phase III randomized controlled trials (RCTs) are the cornerstone of evidence-based oncology. However, there is no exhaustive review describing the radiotherapy RTCs characteristics. The objective of the present study was to describe features of all phase III RCTs including at least a radiation therapy. METHODS AND MATERIALS Requests were performed in the Medline database (via PubMed). The latest update was performed in April 2016, using the following MESH terms: 'clinical trials: phase III as topic', 'radiotherapy', 'brachytherapy', as keywords. RESULTS A total of 454 phase III RCTs were identified. Studies were mainly based on open (92.1%) multicenter (77.5%) designs, analyzed in intend to treat (67.6%), aiming at proving superiority (91.6%) through overall survival assessment (46.5%). Most frequently studied malignancies were head and neck (21.8%), lung (14.3%) and prostate cancers (9.9%). Patients were mainly recruited with a locally advanced disease (73.7%). Median age was 59 years old. Out of 977 treatment arms, 889 arms experienced radiotherapy, mainly using 3D-conformal radiotherapy (288 arms, 32.4%). Intensity-modulated techniques were tested in 12 arms (1.3%). The intervention was a non-cytotoxic agent addition in 89 studies (19.6%), a radiation dose/fractionation modification in 74 studies (16.3%), a modification of chemotherapy regimen in 63 studies (13.9%), a chemotherapy addition in 63 studies (13.9%) and a radiotherapy addition in 53 trials (11.7%). With a median follow-up of 50 months, acute all-grade and grade 3-5 toxicities were reported in 49.6% and 69.4% of studies, respectively. Radiotherapy technique, follow-up and late toxicities were reported in 60.1%, 74%, and 31.1% of studies, respectively. CONCLUSION Phase III randomized controlled trials featured severe limitations, since a third did not report radiotherapy technique, follow-up or late toxicities. The fast-paced technological evolution creates a discrepancy between literature and radiotherapy techniques performed in daily-routine, suggesting that phase III methodology needs to be reinvented.
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Affiliation(s)
- J C Trone
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - S Espenel
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez;; Laboratory of Cellular and Molecular Radiobiology, Institut de Physique Nucléaire de Lyon, IPNL, Villeurbanne
| | - A Rehailia-Blanchard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - E Guillaume
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - N Vial
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - C Rancoule
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez;; Laboratory of Cellular and Molecular Radiobiology, Institut de Physique Nucléaire de Lyon, IPNL, Villeurbanne
| | - C Rodriguez-Lafrasse
- Laboratory of Cellular and Molecular Radiobiology, Institut de Physique Nucléaire de Lyon, IPNL, Villeurbanne
| | - M Ben Mrad
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - A El Meddeb Hamrouni
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - E Ollier
- SAINBIOSE U1059, Jean Monnet University, Saint-Etienne
| | - C Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - E Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez;; Laboratory of Cellular and Molecular Radiobiology, Institut de Physique Nucléaire de Lyon, IPNL, Villeurbanne;.
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez;; Laboratory of Cellular and Molecular Radiobiology, Institut de Physique Nucléaire de Lyon, IPNL, Villeurbanne
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Laporte S, Chapelle C, Bertoletti L, Ollier E, Zufferey P, Lega JC, Merah A, Décousus H, Schulman S, Meyer G, Cucherat M, Mismetti P. Assessment of clinically relevant bleeding as a surrogate outcome for major bleeding: validation by meta-analysis of randomized controlled trials. J Thromb Haemost 2017; 15:1547-1558. [PMID: 28544422 DOI: 10.1111/jth.13740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/23/2016] [Indexed: 01/27/2023]
Abstract
Essentials Surrogacy of clinically relevant bleeding (CRB) for major bleeding has never been validated. Our meta-analysis evaluated CRB surrogacy in trials of new versus traditional anticoagulants. Surrogacy was not validated in orthopedic surgery, venous thromboembolism or atrial fibrillation The difficulty in demonstrating the surrogacy may reflect a lack of homogeneity in its definition SUMMARY: Background Clinically relevant bleeding (CRB), comprising major bleeding and clinically relevant non-major bleeding, has been used as a surrogate for major bleeding in most anticoagulant trials. The validity of this surrogate to estimate trade-off between thrombotic and bleeding events in clinical trials was never assessed. Methods We systematically reviewed randomized phase III trials comparing new anticoagulants with the standard of care for venous thromboembolism prevention following major orthopedic surgery, venous thromboembolism (VTE) treatment, or stroke and systemic embolism prevention in atrial fibrillation (AF), and reporting both major bleeding and CRB rates. The validity of CRB as a surrogate for major bleeding was assessed according to the strength of the association between the relative risks of major bleeding and CRB, measured by the use of R2trial and its 95% confidence interval (CI). Results In the postoperative prophylactic setting (13 studies), major bleeding and CRB rates were 1.12% and 3.56%, respectively, and R2trial was 0.69 (95% CI 0.34-0.93). For acute VTE studies (n = 12), major bleeding and CRB rates were 1.87% and 9.07%; the corresponding R2trial values were 0.28 (95% CI 0.01-0.80) and 0.68 (95% CI 0.09-1.00) when only double-blind studies were considered (n = 7). For AF studies (n = 7; 22 strata), major bleeding and CRB rates were 4.82% and 15.3%, and R2trial was 0.59 (95% CI 0.15-0.82). Conclusion Despite an apparent correlation between CRB and major bleeding in major orthopedic surgery, AF, and double-blind acute VTE studies, the wide CIs suggest that CRB might not be an acceptable surrogate outcome in any of these settings.
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Affiliation(s)
- S Laporte
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - C Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - L Bertoletti
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - E Ollier
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Laboratoire de Pharmacologie, Toxicologie et Gaz du sang, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - P Zufferey
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique Innovation, Pharmacologie, and Service d'Anesthésie Réanimation, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - J-C Lega
- Département de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, CHU Lyon, Pierre-Bénite, France
- UMR CNRS 5558 Evaluation et Modelisation des Effets Therapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - A Merah
- Inserm CIE1408, F-CRIN INNOVTE Network, Paris, France
| | - H Décousus
- Inserm CIE1408, F-CRIN INNOVTE Network, Paris, France
| | - S Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - G Meyer
- Hopital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRs 970, CIE1418, F-CRIN INNOVTE Network, Paris, France
| | - M Cucherat
- UMR CNRS 5558 Evaluation et Modelisation des Effets Therapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - P Mismetti
- SAINBIOSE U1059, Université Jean Monnet, Université de Lyon, INSERM, Saint-Etienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
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Trone JC, Chapelle C, Ollier E, Bertoletti L, Cucherat M, Mismetti P, Magné N, Laporte S. Hemorrhagic and thrombotic events in oncology patients treated with antiangiogenic therapy: Impact of study design on the results assessed by meta-analysis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14058 Background: Antiangiogenic (AA) therapies emerge as a new cornerstone for cancer treatment, but carry their own particular risk profile. Several previous meta-analyses have showed increasing risk of bleeding and paradoxically thrombosis in cancer patients receiving antiangiogenic. The aim of the meta-analysis is to investigate the impact of studies design (open or double blind (DB)), on the incidence and the occurrence of bleeding, venous thrombotic events (VTE) and arterial thrombotic events (ATE) in cancer patients treated by AA therapies. Methods: We searched Medline, Cochrane, ClinicalTrial databases, meeting abstracts of the American Society of Clinical Oncology and the European Society of Medical Oncology for relevant clinical trials. We included prospective phase II and III clinical trials that randomly assigned patients with solid cancer to AA therapy or control. Statistical analyses were conducted to calculate the summary incidence, ORs, and 95% CIs, using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: A total of 166 trials (72,024 patients) were included. For bleeding events, comparison on AA treatment versus control yielded an OR of 2.41 (95% CI 2.07 to 2.71; p < 0.001) with an exaggeration of treatment effects by 68% (95% CI, 33 to 113) in open-label studies compared with DB trials. Concerning VTE, an OR of 1.18 (95% CI 1.04 to 1.35; p = 0.0115) was noted, with a significant enhancement of 53% (95% CI, 19 to 96) of treatment side effects with open trials compared with DB trials. AA don’t increase significantly the frequency of VTE when considering only DB trials. For ATE, an OR of 1.59 (95% CI 1.30 to 1.94; p < 0.001) was observed, associated with a significant exaggeration of 65% (95% CI, 13 to 143) with open trials compared with DB trials. Conclusions: The present meta-analysis showed a significant interaction of study design for the tolerance assessment in the AA therapies in cancers. The increasing risk of hemorrhagic events, VTE and ATE appear to have been overestimated in the previous meta-analyses. In the future, meta-analyses should be restricted to DB trials for analysis of toxicity profile.
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Affiliation(s)
- Jane-Chloe Trone
- Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest En Jarez, France
| | - Céline Chapelle
- INSERM UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - Edouard Ollier
- INSERM UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | | | - Patrick Mismetti
- INSERM UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
| | - Nicolas Magné
- Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest En Jarez, France
| | - Silvy Laporte
- INSERM UMR 1059, SAINBIOSE, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, Saint-Etienne, France
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Trone J, Chapelle C, Ollier E, Bertoletti L, Cucherat M, Mismetti P, Magné N, Laporte S. Exaggeration of the bleeding risk and thrombotic risk with antiangiogenic therapies in open-label trials compared to double-blind trials in cancer patients: A systematic review and meta-analysis. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.025] [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] Open
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Delavenne X, Ollier E, Chollet S, Sandri F, Lanoiselée J, Hodin S, Montmartin A, Fuzellier JF, Mismetti P, Gergelé L. Pharmacokinetic/pharmacodynamic model for unfractionated heparin dosing during cardiopulmonary bypass. Br J Anaesth 2017; 118:705-712. [DOI: 10.1093/bja/aex044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/14/2022] Open
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