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Mattern C, Pourette D, Andriamandimby SF, Rabarison J, Darsot A, Ralaizara B, Vray M, Shimakawa Y, Giles-Vernick T. Enjeux et difficultés de l'accès aux traitements pour la prise en charge de l'hépatite B chronique à Madagascar : étude qualitative auprès des soignants et personnes atteintes. Rev Epidemiol Sante Publique 2023; 71:102088. [PMID: 37352795 DOI: 10.1016/j.respe.2023.102088] [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: 06/30/2022] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVES Madagascar faces many difficulties in accessing diagnosis and treatment of hepatitis B. The prevalence of chronic hepatitis B infection is estimated at 6.9%. The costs associated with screening and treatment are high and not easily accessible. This article proposes a reflection on the challenges and difficulties of access to diagnosis and treatment for patients with chronic hepatitis B. METHOD The "Neo Vac" study aimed to document the life paths of people living with chronic hepatitis B, their difficulties and their perceptions of HBV. Twenty-three semi-structured interviews were conducted in 2019 in Antananarivo with patients and gastroenterologists. RESULTS The study describes the numerous obstacles that mark the therapeutic pathways of chronic HBV patients. The first result indicates lack of knowledge of the disease by chronic HBV patients and the varied circumstances in which the disease is discovered. None of the persons interviewed had been screened on their own initiative, the screening having taken place during prenatal consultations or emergency hospitalizations or during a morbidity episode. The care pathway was characterized by doubt and anxiety due to lack of knowledge about the possible disease outcome and concern about the costs of care. DISCUSSION Little known by the population and health professionals, hepatitis B is rarely the subject of voluntary screening and is most often detected during an apparently unrelated health event. The exorbitant cost of treatment for patients, the cost of medical analyses and secondary costs, and the unavailability of follow-up tests outside the capital constitute barriers to access to care that are insurmountable for the majority of the Malagasy population. CONCLUSIONS This first qualitative study on the experiences of HBV-infected persons in terms of access to care and treatment in Madagascar underlines the extent to which access to treatment remains limited, due to the absence of a national policy for the prevention, screening and management of hepatitis B, which remains a highly neglected and unrecognized disease in Madagascar as well as internationally.
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Affiliation(s)
- C Mattern
- Equipe Santé & Sciences sociales, Unité d'épidémiologie et de recherche clinique Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar.
| | - D Pourette
- Institut de recherche pour le développement, UMR Ceped (IRD, Université Paris Cité, Inserm), Institut Convergences Migrations. Paris, 75006, France
| | - S F Andriamandimby
- Unité de virologie, Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - J Rabarison
- Unité de virologie, Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - A Darsot
- Equipe Santé & Sciences sociales, Unité d'épidémiologie et de recherche clinique Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - B Ralaizara
- Equipe Santé & Sciences sociales, Unité d'épidémiologie et de recherche clinique Institut Pasteur de Madagascar, BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - M Vray
- Institut Pasteur 25 rue du Dr Roux 75015 Paris, Inserm 101 rue de Tolbiac 75013 Paris, France
| | - Y Shimakawa
- Unité d'épidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux 75015 Paris, France
| | - T Giles-Vernick
- Laboratoire d'anthropologie et écologie de l'émergence des maladies, Institut Pasteur, 25 rue du Dr Roux 75015 Paris, France
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Pierre-Audigier C, Talla C, Alame-Emane AK, Audigier B, Grall N, Ruimy R, Andremont A, Cadet-Daniel V, Sola C, Takiff H, Gicquel B, Vray M, Armand-Lefevre L. Tuberculosis trends in a hot-spot region in Paris, France. Int J Tuberc Lung Dis 2020; 24:428-435. [DOI: 10.5588/ijtld.19.0305] [Citation(s) in RCA: 4] [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] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) incidence is declining overall in France, but not in Paris where some areas remain relative hot spots for TB.OBJECTIVES: To obtain a better knowledge of local TB epidemiology in order to facilitate control measures.DESIGN: Analysis
of demographic data of TB patients diagnosed at the Bichat-Claude Bernard Hospital from 2007 to 2016, with spoligotyping of Mycobacterium tuberculosis complex isolates.RESULTS: During the study period, 1096 TB patients were analysed. The incidence of TB diagnosis was stable,
averaging 115 patients per year, predominantly males (71%), foreign-born (81%), with pulmonary TB (77%) and negative HIV serology (88%). The mean age of foreign-born TB patients decreased over the study period, most significantly in recent arrivals in France, whose average age decreased by
two years (P = 0.001). The time period between arrival in France and being diagnosed with active TB decreased annually significantly by 0.75 years (P = 0.02). The proportion of L4.6.2/Cameroon and L2/Beijing sub-lineages increased annually by 0.7% (P < 0.05). Multi-drug
resistant strains, representing 4% of all strains, increased annually by 0.75% (P = 0.03)CONCLUSION: The number of TB patients remained high in northern Paris and the surrounding suburbs, suggesting the need for increased control measures.
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Affiliation(s)
- C. Pierre-Audigier
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center
for Chronic Disease Control, Shenzhen, 518054, China
| | - C. Talla
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - A-K. Alame-Emane
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - B. Audigier
- Statistic Study Group, Ecole Polytechnique, Palaiseau
| | - N. Grall
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne Paris
Cité F-75018, Paris
| | - R. Ruimy
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire, Nice
| | - A. Andremont
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
| | | | - C. Sola
- Institute for Integrative Biology of the Cell (I2BC), CEA, Centre national de la Recherche scientifique, Université Paris Sud, Université Paris Saclay, Gif-sur-Yvette, France
| | - H. Takiff
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China, Instituto Venezolano de Investigaciones Cientificas (IVIC), Caracas,
Venezuela
| | - B. Gicquel
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - M. Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - L. Armand-Lefevre
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
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3
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Goujon C, Gougeon M, Bouchaud O, Pham L, Mallard A, Lévy D, Simian P, Imbert P, Consigny P, Vray M. Chronovac voyageur : étude de l’immunité vis-à-vis de la fièvre jaune et de la rougeole chez des enfants vaccinés avant un départ en zone d’endémie amarile. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Farra A, Frank T, Tondeur L, Bata P, Gody JC, Onambele M, Rafaï C, Vray M, Breurec S. High rate of faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in healthy children in Bangui, Central African Republic. Clin Microbiol Infect 2016; 22:891.e1-891.e4. [PMID: 27404368 DOI: 10.1016/j.cmi.2016.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 04/19/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 11/18/2022]
Abstract
The aim of this study was to estimate the prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in faeces of healthy children aged 0-59 months in Bangui (Central African Republic). Stool samples of 134 children, recruited for a matched case-control study, were cultured on a commercial ESBL-selective chromogenic medium (CHROMagar ESBL, France). The phenotypic resistance patterns of isolated strains were investigated, as well as the genetic basis for antibiotic resistance. The factors associated with increased risk for ESBL-E carriage were also studied. The prevalence of ESBL-E carriage was 59% (79/134), one of the highest reported worldwide. The only factor found to be associated with carriage was living in a highest-income family (p=0.03). In all, 83 ESBL-E were recovered as simultaneous carriage of two strains was detected in four children. blaCTX-M-15 was found in all strains except two, frequently associated with qnr (54/81, 66%) and aac(6')-Ib-cr (35/81, 43%) genes. Escherichia coli, the most commonly recovered species (51/83, 61%), was assigned mainly to the pandemic B2-O25b-ST131 group (39/51, 76%). Resistance transfer, which was studied in 20 randomly selected ESBL-E strains, was successful in 13 (13/20, 65%) isolates. In eight of these isolates (8/13, 62%), blaCTX-M-15 genes were found in incompatibility group FIb conjugative plasmids. We found one of the highest prevalence rates of faecal carriage of ESBL-E reported worldwide, highlighting the need to improve control of the distribution of antibiotics in limited-resource countries.
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Affiliation(s)
- A Farra
- Institut Pasteur, Unit of Bacteriology, Bangui, Central African Republic
| | - T Frank
- Institut Pasteur, Unit of Bacteriology, Bangui, Central African Republic
| | - L Tondeur
- Institut Pasteur, Emerging Disease Epidemiology Unit, Paris, France
| | - P Bata
- Bangui Pediatric Complex, Bangui, Central African Republic
| | - J C Gody
- Bangui Pediatric Complex, Bangui, Central African Republic
| | - M Onambele
- Institut Pasteur, Unit of Bacteriology, Bangui, Central African Republic
| | - C Rafaï
- Institut Pasteur, Unit of Bacteriology, Bangui, Central African Republic
| | - M Vray
- Institut Pasteur, Emerging Disease Epidemiology Unit, Paris, France; Institut Pasteur, Infectious Disease Epidemiology Unit, Dakar, Senegal
| | - S Breurec
- Institut Pasteur, Unit of Bacteriology, Bangui, Central African Republic; Institut Pasteur, Unit of Health and Environment, Pointe-à-Pitre, France; University of Antilles, Faculty of Medicine Hyacinthe Bastaraud, Pointe-à-Pitre, France; University Hospital of Pointe-à-Pitre/Les Abymes, Unit of Clinical Microbiology, Pointe-à-Pitre, France.
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El Hasnaoui A, Vray M, Blin P, Nachit-Ouinekh F, Boureau F. Assessment of Migraine Severity Using the Migsev Scale: Relationship to Migraine Features and Quality of Life. Cephalalgia 2016; 24:262-70. [PMID: 15030534 DOI: 10.1111/j.1468-2982.2004.00660.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/30/2022]
Abstract
We have recently developed an instrument to describe and categorize severity of migraine attacks from patient self-report, the MIGSEV questionnaire. We have now performed a large prospective survey using this tool to evaluate migraine severity in 2979 patients consulting for headache in France, included by 1164 general practitioners, 174 neurologists and 82 gynaecologists. The objective of the study was to determine the prevalence of severity grades in a large population who consults for migraine, to test the concordance between severity calculated from physician-derived and patient-derived data, and to test the relevance of the concept of severity as applied to diagnosis, other measures of the burden of migraine, and to health-related quality of life. Severe attacks were reported in around one-fifth of the sample. Physician- and patient-derived data provided concordant estimates of severity in 71% of cases, the discordant cases representing principally an underestimate by the physician of headache severity. Migraine severity was associated with frequent, long-lasting and treatment-resistant attacks, and with poor quality of life. The MIGSEV questionnaire is proposed as a simple measure of severity for the diagnosis and management of migraineurs, suitable for use both by physicians and patients.
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Affiliation(s)
- A El Hasnaoui
- Epidemiology Department, GSK Laboratory, Marly le-Roi, France.
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Morizot G, Kendjo E, Mouri O, Thellier M, Pérignon A, Foulet F, Cordoliani F, Bourrat E, Laffitte E, Alcaraz I, Bodak N, Ravel C, Vray M, Grogl M, Mazier D, Caumes E, Lachaud L, Buffet PA, El Samad Y, Salle V, Gounod N, Dallot A, Belot G, Pelletier-Cunat S, Belon M, Verdon R, Rogeaux O, Grossetête G, Lesens O, Clabaut A, Maus E, Jouy L, Gener G, Perrin P, Roch N, Herve A, Le Duc D, Cuchet E, Maubon D, Hillion B, Menot E, Guillemot F, Beneton-Benhard N, Celerier P, Dupuis De Fonclare AL, Carre D, Bourgeois A, Marty P, Pomares C, Meunier L, Abergel H, Timsit F, Amoric JC, Busquet P, Karam S, Moisson YF, Mouly F, Ortoli JC, Consigny PH, Jouan M, Caby F, Datry A, Hochedez P, Rozembaum F, Dumortier C, Ancelle T, Dupin N, Paugam A, Ranque B, Bougnoux ME, Canestri A, Galezowsky MF, Hadj Rabia S, Hamel D, Schneider P, Wolter-Desfosses M, Janier M, Baccard M, Bezier M, Broissin M, Colin De Verdiere N, Durupt F, Hope Rapp E, Juillard C, Levy A, Moraillon I, Petit A, Regner S, Barthelme D, Tamarin JM, Begon E, Strady C, Gangneux JP, Carpentier O, Mechai F, Kieffer C, Dellestable P, Rebauder S. Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy. Clin Infect Dis 2013; 57:370-80. [DOI: 10.1093/cid/cit269] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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)
- G. Morizot
- Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris
| | | | - O. Mouri
- Service de Parasitologie-Mycologie
| | | | - A. Pérignon
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris
| | - F. Foulet
- Service de Parasitologie-Mycologie, Hôpital Henri Mondor, Créteil
| | | | - E. Bourrat
- Service de Dermatologie, Hôpital Saint-Louis, Paris
- Service de Pédiatrie générale, Hôpital Robert Debré, Paris, France
| | - E. Laffitte
- Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Switzerland
| | - I. Alcaraz
- Service de Maladies Infectieuses et Pathologie du voyageur, Hôpital Gustave Dron, Tourcoing
| | - N. Bodak
- Service de Dermatologie, Hôpital Necker, Paris
| | - C. Ravel
- French Reference Centre on Leishmaniasis, Montpellier
| | - M. Vray
- Unité de Recherche et d'Expertise Épidémiologie des Maladies Émergentes, Institut Pasteur de Paris/INSERM, France
| | - M. Grogl
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | - E. Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris
| | - L. Lachaud
- French Reference Centre on Leishmaniasis, Montpellier
| | - P. A. Buffet
- Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris
- Service de Parasitologie-Mycologie
- UMRs 945 INSERM–Paris 6 University, France
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Vignier N, Esmat G, Elsharkawy A, Hassany M, Bonnard P, Delarocque-Astagneau E, Said M, Raafat R, El-Hoseiny M, Fontanet A, Mohamed MK, Vray M. Reproducibility of liver stiffness measurements in hepatitis C virus (HCV)-infected patients in Egypt. J Viral Hepat 2011; 18:e358-65. [PMID: 21692948 DOI: 10.1111/j.1365-2893.2010.01433.x] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Elastometry has demonstrated good accuracy, but little is known about its reproducibility. The aim of this study was to assess the intra- and inter-operator reproducibility of liver stiffness measurement among hepatitis C virus (HCV)-infected patients in Egypt. The study was conducted among HCV-infected patients referred for treatment evaluation in two hepatitis treatment centres of Cairo. Two operators took liver stiffness measurement two times per patient the same day. Intra- and inter-reproducibility were estimated by different methods: Bland and Altman graphics, variation coefficient, intraclass correlation coefficient and Kappa coefficient; 7.1 kPa was used as the threshold of significant (≥F2) fibrosis whenever needed. Fifty-eight patients were included in the study, and 216 measurements were taken. Failure rate was 7% and associated with overweight. For a value of 7.1 kPa, the inter-operator 95% limits of agreement were estimated at ±2.88 kPa. Intra- and inter-operator coefficients of variation ranged between 11% and 15%, intraclass correlation coefficients [95% confidence interval] between 0.94 [0.86-0.97] and 0.97 [0.95-0.99], and Kappa coefficients between 0.65 [0.44-0.88] and 0.92 [0.81-1.00]. The reliability of liver stiffness measurement is questionable when considering the decision to initiate antiviral therapy because of the percentage of discordance between measurements is notable, especially in the intermediate fibrosis stages.
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Affiliation(s)
- N Vignier
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
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Sire JM, Sow PS, Chartier L, Ndiaye B, Ndaye M, Sarr FD, Vray M, Boye CS, M'boup S, L'her P, Debonne JM, Mayaud C, Diop B. [Aetiology of AFB negative pneumonias in hospitalized HIV patients in Dakar]. Rev Mal Respir 2010; 27:1015-21. [PMID: 21111271 DOI: 10.1016/j.rmr.2010.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 09/27/2009] [Indexed: 11/28/2022]
Abstract
A prospective study was carried out in two tertiary hospitals in Dakar to determine the main causes of sputum acid-fast bacillus (AFB) smear-negative pneumonia in HIV-infected patients. All clinical and microbiological records were reviewed by experts. Seventy patients were finally enrolled. Most of them were hospitalized at an advanced stage of AIDS. The median CD4 cell count was 62/mm(3) and the median body mass index (BMC) was 18 kg/m(2). Thirty-one patients (44 %) were known as seropositive for HIV infection prior to admission. Radiological opacities were localized in 70 % of patients and diffuse in 21 %. Fiberoptic bronchoscopy was performed in 50 patients (71 %). A definite or probable diagnosis was obtained in 55 patients (79 %). Bacterial pneumonia (usually due to Enterobacteriaceae and Pseudomonas aeruginosa), tuberculosis, Pneumocystis pneumoniae and other causes (Kaposi's sarcoma, atypical mycobacteria) were diagnosed in 67 %, 24 %, 5 %, and 13 % of these patients respectively. In conclusion, pneumonia of bacterial origin and tuberculosis can be incriminated in the majority of cases of AFB negative pneumonia observed in HIV patients in Dakar.
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Affiliation(s)
- J M Sire
- Laboratoire de biologie médicale, Institut Pasteur, Dakar, Sénégal
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Hayem C, Bourlière M, Barbaza MO, Cotton C, Pau D, Pinta A, Montestruc F, Vray M. Utilisation du Peginterferon alpha-2a chez 2101 patients atteints d’hépatite C chronique : méthodologie et résultats de la cohorte HEPATYS. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.160] [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: 11/24/2022] Open
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10
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Yazdanpanah Y, Vray M, Meynard J, Losina E, Weinstein MC, Morand-Joubert L, Goldie SJ, Hsu HE, Walensky RP, Dalban C, Sax PE, Girard PM, Freedberg KA. The long-term benefits of genotypic resistance testing in patients with extensive prior antiretroviral therapy: a model-based approach. HIV Med 2008; 8:439-50. [PMID: 17760736 PMCID: PMC3073616 DOI: 10.1111/j.1468-1293.2007.00491.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Resistance testing in HIV disease may provide long-term benefits that are not evident from short-term data. Our objectives were to estimate the long-term effectiveness, cost and cost-effectiveness of genotype testing in patients with extensive antiretroviral exposure. METHODS We used an HIV simulation model to estimate the long-term effectiveness and cost-effectiveness of genotype testing. Clinical data incorporated into the model were from NARVAL, a randomized trial of resistance testing in patients with extensive antiretroviral exposure, and other randomized trials. Each simulated patient was eligible for up to three sequential regimens of antiretroviral therapy (i.e. two additional regimens beyond the trial-based regimen) using drugs not available at the time of the study, such as lopinavir/ritonavir, darunavir/ritonavir and enfuvirtide. RESULTS In the long term, projected undiscounted life expectancy increased from 132.2 months with clinical judgement alone to 147.9 months with genotype testing. Median survival was estimated at 11.9 years in the resistance testing arm vs 10.4 years in the clinical judgement alone arm. Because of increased survival, the projected lifetime discounted cost of genotype testing was greater than for clinical judgement alone (euro313,900 vs euro263,100; US$399,000 vs US$334,400). Genotype testing cost euro69,600 (US$88,500) per quality-adjusted life year gained compared with clinical judgement alone. CONCLUSIONS In patients with extensive prior antiretroviral exposure, genotype testing is likely to increase life expectancy in the long term as a result of the increased likelihood of receiving two active new drugs. Genotype testing is associated with cost-effectiveness comparable to that of strategies accepted in patients with advanced HIV disease, such as enfuvirtide use.
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Affiliation(s)
- Y Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France.
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Vray M, Hamelin B, Jaillon P, Andréjak M, Benamouzig R, Boissel JP, Bremard-Oury C, Brun-Strang C, Caulin E, Cellier D, Costagliola D, Daurat V, El Hasnaoui A, Goehrs JM, Hamelin B, Jaillon P, Jouan-Flahault C, Montastruc JL, Moore N, Puech A, Ricatte M, Ricordeau P, Rodde-Dunet MH, Rouffiac E, Simon T, Simon P, Spriet A, Van Ganse E, Velicitat P, Vray M. The Respective Roles of Controlled Clinical Trials and Cohort Monitoring Studies in the Pre- and Postmarketing Assessment of Drugs. Therapie 2005. [DOI: 10.2515/therapie:2005048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vray M, Girault D, Hoog-Labouret N, Porcher R, Thalabard JC, Auriche C, Bernard J, Boichut D, Bouhassira M, Boutouyrie P, Chaumet-Riffaud P, Chiron C, Costa Y, de Crémiers F, Etienne S, Fender P, Giorgi R, Girard F, Girault D, Grosskopf C, Gueyffier F, Labouret NH, Juillet Y, Lechat P, Leroy S, Parmentier L, Ropers J, Salanave B, Simon T, Van Ganse E, Vray M. Methodology for Small Clinical Trials. Therapie 2004. [DOI: 10.2515/therapie:2004055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lastere S, Dalban C, Collin G, Descamps D, Girard PM, Clavel F, Costagliola D, Brun-Vezinet F, Brun-Vezinet F, Clavel F, Costagliola D, Dalban C, Girard PM, Matheron S, Meynard JL, Morand-Joubert L, Peytavin G, Vray M, Beguinot I, Waldner A, Beumont M, Semaille C, Bentata M, Berlureau P, Gérard L, Molina JM, Hor R, Bayol-Honnet G, Lascoux-Combe C, Drobacheff C, Hoen B, Dupon M, Lacut JY, Goujard C, Rousseau C, Vincent V, Diemer M, Lepeu G, Zerazhi H, de Truchis P, Berthé H, Jeantils V, Tazi CT, Vittecoq D, Escaut L, Dupont B, Nait-Ighil L, Rozenbaum W, Nguyen TH, Boué F, Galanaud P, Kazatchkine M, Piketty C, Bernasconi C, Salmon-Ceron D, Michon C, Chandemerle C, Lascaux AS, Magnier JD, Schneider L, Ait-Mohand H, Simon A, Herson S, Bollens D, Picard O, Tangre P, Bonarek M, Morlat P, Trépo C, Cotte L, Gastaut JA, Poizot-Martin I, Moran G, Masson S, Bennai Y, Belarbi L, Prevot MH, Fournier I, Reynes J, Baillat V, Raffi F, Esnault JL, Ceppi C, Cassuto JP, Arvieux C, Chapplain JM, Rey D, Krantz V, Besnier JM, Bastides F, Obadia M, Aquilina C, Bazin C, Verdon R, Piroth L, Grappin M, Sissoko D, Valette M, May T, Burty C, Debab Y, Caron F, Elharrar B, Launay O, Winter C, Chapuis L, Auperin I, Gilquin J. Impact of Insertions in the HIV-1 P6 Ptapp Region on the Virological Response to Amprenavir. Antivir Ther 2004. [DOI: 10.1177/135965350400900215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the impact of genetic changes within p6Gag gene on the virological response (VR, mean decrease in plasma viral load at week 12) to unboosted amprenavir (APV). Gag-protease fragments, including gag p2, p7, p1, p6 regions and whole protease (PR) were sequenced from baseline plasma specimens of 84 highly pre-treated but APV-naive patients included in the NARVAL (ANRS 088) trial. The correlation between baseline p6Gag polymorphism, PR mutations, baseline characteristics and VR to APV was analysed in univariate analysis. Insertions (P459Ins) within p6 protein, leading to partial or complete duplication of the PTAPP motif, were significantly associated with a decreased VR (P459Ins versus wild-type; –0.3 ±0.8 vs –1.1 ±1.2 log copies/ml, P=0.007) and were more frequent when the V82A/F/T/S PR mutation was present ( P=0.020). In multivariate analysis, after adjustment on the predictive factors of the VR in the NARVAL trial and on the PR mutations linked with response, there was a strong trend to an association ( P=0.058) between the presence of P459Ins and an altered VR. In conclusion, these results suggest that insertions in the p6 region of HIV-1 gag gene may affect the VR, in highly pre-treated patients receiving an unboosted APV-containing regimen.
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Affiliation(s)
| | - Stephane Lastere
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Cecile Dalban
- INSERM EMI0214, Universite Pierre et Marie Curie – Paris 6, Paris, France
| | - Gilles Collin
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Diane Descamps
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Pierre-Marie Girard
- Service des Maladies Infectieuses et Tropicales, Hopital Saint Antoine, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Hor
- Hôpital Saint-Louis, Paris
| | | | | | | | - B Hoen
- Hôpital Saint-Jacques, Besançon
| | | | | | - C Goujard
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | | | | | | | - G Lepeu
- Hôpital Henri Duffaut, Avignon
| | | | | | - H Berthé
- Hôpital Raymond Poincaré, Garches
| | | | | | | | | | - B Dupont
- Institut Pasteur/Hôpital Necker, Paris
| | | | | | | | - F Boué
- Hôpital Antoine Béclère, Clamart
| | | | | | - C Piketty
- Hôpital Européen Georges Pompidou, Paris
| | | | | | | | | | | | | | | | | | - A Simon
- Hôpital Pitié-Salpétrière, Paris
| | - S Herson
- Hôpital Pitié-Salpétrière, Paris
| | | | | | | | | | | | | | | | | | | | - G Moran
- Hôpital Bichat Claude Bernard, Paris
| | - S Masson
- Hôpital Bichat Claude Bernard, Paris
| | - Y Bennai
- Hôpital Bichat Claude Bernard, Paris
| | - L Belarbi
- Hôpital Bichat Claude Bernard, Paris
| | - MH Prevot
- Hôpital Bichat Claude Bernard, Paris
| | | | - J Reynes
- Hôpital Gui de Chauliac, Montpellier
| | - V Baillat
- Hôpital Gui de Chauliac, Montpellier
| | | | | | | | | | | | | | - D Rey
- Centre Hospitalier Universitaire, Strasbourg
| | - V Krantz
- Centre Hospitalier Universitaire, Strasbourg
| | | | | | | | | | - C Bazin
- Centre Hospitalier Universitaire de Caen
| | - R Verdon
- Centre Hospitalier Universitaire de Caen
| | | | | | - D Sissoko
- Centre Hospitalier Univeristaire, Tourcoing
| | - M Valette
- Centre Hospitalier Univeristaire, Tourcoing
| | - T May
- Hôpital de Brabois, Nancy
| | | | - Y Debab
- Hôpital Charles Nicolle, Rouen
| | - F Caron
- Hôpital Charles Nicolle, Rouen
| | - B Elharrar
- Centre Hospitalier Intercommunal, Créteil
| | - O Launay
- Centre Hospitalier Intercommunal, Créteil
| | - C Winter
- Hôpital André Grégoire, Montreuil
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Le Galès C, El Hasnaoui A, Goehrs JM, Banzet M, Blachier C, Blin P, Bouhassira M, Bouvenot G, Bréart G, Daurès J, de Cremiers F, Duguay C, Eschwege E, Fagnani F, Fontbonne-Bayner A, Giri I, Hotton J, Ichou F, Jolliet P, Joubert J, Koen R, Lagarde D, Le Jeunne C, Leutenegger E, Marquet T, Massol J, Meyer F, Micallef J, Paulmier-Bigot S, Ploin P, Ract Y, Rauss A, Ricatte M, Sainte-Marie H, Tardieu S, Vesque D, Vetel J, Vray M, Watteau P. Postmarketing Evaluation of Drugs. Therapie 2003. [DOI: 10.2515/therapie:2003034] [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: 11/20/2022]
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Vray M, Szafir D, Jaillon P. [Pharmaco-epidemiology: identification of needs, databases, and study quality criteria]. Therapie 2001; 56:349-53. [PMID: 11677851] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Reference data on pathologies, their management, risk factors and the use of drugs in real life is necessary. In France, there are no existing databases of a set of systematically recorded data which associate information on drugs and morbidity/mortality. In contrast, there are a great number of studies focused on pathologies, their management or on drugs. A directory that could identify these databases and a means of accessing them would be desirable. Pharmaco-epidemiology studies must answer epidemiologically specific quality criteria, which must be planned at study conception. The protocol must be developed with a scientific committee on which there are epidemiologically experienced people. It is a prerequisite that a committee of experts with epidemiological competence should give advice on the 'acceptability' of the protocol, that is on the aim and the methodology. Data collection must be the subject of specific quality control of both the study and its aims. Cross-checking with other sources of data is recommended when possible. The coordinator of each study must send a final report to investigators and publish the results.
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Affiliation(s)
- M Vray
- Hôpital Paul Brousse, Service des Maladies Infectieuses, 14 avenue Paul Vaillant Couturier, 94804 Villejuif, France
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Boden WE, Vray M, Eschwege E, Lauret D, Scheldewaert R. Heart rate-lowering and -regulating effects of once-daily sustained-release diltiazem. Clin Cardiol 2001; 24:73-9. [PMID: 11195610 PMCID: PMC6655104 DOI: 10.1002/clc.4960240112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 10/26/1999] [Accepted: 03/29/2000] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Epidemiologic evidence suggests that an elevated heart rate (HR) is an adverse and independent prognostic factor in arterial hypertension and other cardiovascular diseases. Although diltiazem is characterized as an HR-lowering calcium antagonist, no studies have quantified the magnitude of HR changes in patients with angina or hypertension. HYPOTHESIS The study was undertaken to explore the magnitude of proportional HR reduction at varying levels of resting HR with the sustained-release formulation of diltiazem (SR diltiazem) at the usual clinical doses of 200 or 300 mg once daily. METHODS This meta-analysis was conducted on six comparative double-blind studies including 771 patients with angina or hypertension in which SR diltiazem 200-300 mg once daily was compared either with placebo or with other agents known not to influence HR (angiotensin-converting enzyme inhibitors, diuretics). Sustained-release diltiazem decreases elevated baseline HR, with an increasing effect at higher initial rates. RESULTS Multiple comparisons by baseline HR category showed a significant difference between both groups for baseline HR of 74-84 beats/min and > or = 85 beats/min (p = 0.001). Sustained-release diltiazem had no significant HR-decreasing effect on baseline HR < or =74 beats/min but appears to have a genuine regulating effect on HR: it reduces tachycardia without inducing excessive bradycardia. These findings are in contrast to those with dihydropyridine calcium antagonists, which tend to increase HR and have been associated with an adverse outcome in acute cardiovascular conditions. At the same time, there is evidence to suggest that HR-lowering calcium-channel blockers decrease cardiovascular event rates following myocardial infarction. CONCLUSION When calcium antagonists are indicated for use in patients with angina or hypertension, an HR-lowering agent, that is, diltiazem rather than dihydropyridine, should be recommended.
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Affiliation(s)
- W E Boden
- State University of New York Health Science Center and the Syracuse VA Medical Centre, Syracuse, New York, USA
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Maillard G, Charles MA, Lafay L, Thibult N, Vray M, Borys JM, Basdevant A, Eschwège E, Romon M. Macronutrient energy intake and adiposity in non obese prepubertal children aged 5-11 y (the Fleurbaix Laventie Ville Santé Study). Int J Obes (Lond) 2000; 24:1608-17. [PMID: 11126213 DOI: 10.1038/sj.ijo.0801446] [Citation(s) in RCA: 48] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate associations between adiposity indices and food intake in nonobese prepubertal free-living children. SUBJECTS Five-hundred and one children, 280 boys and 221 girls aged 5-11 y in two little towns in northern France. DESIGN Cross-sectional survey. MAIN OUTCOME MEASURES Height and weight, four skinfolds (biceps, triceps, subscapular, suprailiac), waist and hip girths, were measured. Sum of skinfolds (SSF), body mass index (BMI), and relative weight (RW) were calculated. Energy intake (EI), percentage of energy intake ascribed to carbohydrates (%EIC), complex carbohydrates (%EICC), fats (%EIF), saturated fats (%EISF) and proteins (%EIP) were assessed by a single 24 h record. Basal metabolic rate (BMRI was estimated according to Schofield's equations. Obese (RW > or = 120%), and underreporting children according to Goldberg's and Black's equations were excluded. RESULTS In multiple linear regressions analyses performed with hierarchical mixed models, adiposity indices were significantly and inversely associated in girls with %EIC (all P-values < 0.02), and positively with %EIF (all P-values < 0.05, waist girth and BMI excepted). Similar but non-significant trends were observed in boys. The relationships were not linear, and thresholds close to current dietary recommendations were highlighted. When %EIF was low, a lower percentage of energy intake ascribed to %EISF was associated with thinness. These associations remained after the exclusion of children who had an EI/BMR > or = 1.50. CONCLUSIONS In nonobese prepubertal children aged 5-11 y, a high %EIC, close to dietary recommendations (> or = 55%), was associated with thinness. A high %EIF, over the upper dietary recommendation (< or = 35%), was associated with a greater adiposity thickness. There was no further increase in adiposity beyond this threshold. Reasons for the absence of a linear relationship pattern between adiposity and macronutrient intake remain to be determined.
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Affiliation(s)
- G Maillard
- Institut National de la Santé Et de la Recherche Médicale, INSERM, Unité 258, Villejuif, France
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Lafay L, Vray M, Boute D, Basdevant A. Food and nutritional data for a population from northern France: the Fleurbaix Laventie Ville Santé (FLVS) Study. Rev Epidemiol Sante Publique 1998; 46:263-75. [PMID: 9805731] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND This paper describes nutritional characteristics and eating habits of the participants of the Fleurbaix Laventie Ville Santé study. METHODS One-day dietary records for children (under 14 years of age) and three-day records for adolescents and adults provided nutritional data for 2,364 people between the ages of 2 and 70. RESULTS Daily energy intake increased up to the age of 18 (9038 +/- 2620 kJ in women and 11,659 +/- 2146 kJ in men) and decreased thereafter. In parallel, the contribution of fat and protein to energy intake increased with age (respectively 42% and 18% in people older than 40) whereas the contribution of carbohydrates decreased (40% in people older than 40). The daily distribution of energy intake indicated increased contributions of lunch and dinner with age, and decreased contributions of breakfast and of afternoon snacks. Consumption of potatoes and processed meat far exceeded that of fruit, bread and fish. In comparison to recommended intakes and to other French nutritional studies, total energy intake in our study was similar, whatever the sex and age range. In contrast, the contribution of fat and protein to energy intake was always higher while that of carbohydrates was lower. This was especially true for the adults. CONCLUSIONS These differences cannot be entirely explained by the differences in methodologies used and are undoubtedly due to the regional eating habits in the area studied.
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Affiliation(s)
- L Lafay
- Unit of Epidemiologic and Clinical Research, INSERM Unit 21, Villejuif, France
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Lafay L, Basdevant A, Charles MA, Vray M, Balkau B, Borys JM, Eschwège E, Romon M. Determinants and nature of dietary underreporting in a free-living population: the Fleurbaix Laventie Ville Santé (FLVS) Study. Int J Obes (Lond) 1997; 21:567-73. [PMID: 9226487 DOI: 10.1038/sj.ijo.0800443] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To study the determinants and nature of dietary underreporting in a free-living population. DESIGN Cross-sectional study of nutritional and behavioural characteristics. SUBJECTS 1030 weight-stable subjects, 501 women and 529 men older than 15 y, included in the Fleurbaix Laventie Ville Santé study. MEASUREMENTS Dietary intake was assessed using a 3 dy dietary record. Self assessed body weight and height were also recorded. Behavioural and socio-economic data were obtained from a questionnaire. Underreporters were defined as people with a reported ratio of energy intake to estimated basal metabolic rate lower than 1.05. RESULTS Underreporting concerned 16% of the population and was significantly more frequent in obese than in non obese subjects (P < 0.001). Underreporting was significantly associated with a high socio-professional class (P < 0.05), having dieted at least once (P < 0.01) and to be in dietary restraint (P < 0.05). Furthermore, the contribution of protein to energy intake was significantly higher in underreporters than in non underreporters, independently of weight status. CONCLUSIONS These data underline that underreporting may bias the assessment of energy and macronutrient intake, particularly in studies on obesity and dietary restraint. Questions about weight concern, dieting and dietary restraint may be useful to identify subjects who underestimate their food intake.
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Affiliation(s)
- L Lafay
- Institut National de la Santé Et de la Recherche Médicale, Faculté de Médecine Paris Sud, Villejuif, France
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Boissel JP, Perret L, Bouvenot G, Castaigne A, Gérard-Coué MJ, Maillère P, Mismetti P, Vray M. [Clinical evaluation: from intermediate to surrogate criteria]. Therapie 1997; 52:281-5. [PMID: 9437878] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The development and evaluation of new drugs often rely on surrogacy. An intermediate outcome becomes a surrogate outcome if it fulfils certain criteria, it should be easier to measure compared with the clinical outcome, a statistical relationship should exist between the clinical outcome and the surrogate outcome, a relation should exist allowing prediction of the degree of clinical effect based on the measured effect on the surrogate outcome. Development and authorization of drugs today often rely on so-called surrogate outcomes. Is this use sound? The validity of such outcomes has been reviewed in different therapeutic areas: hypertension, venous thromboembolism, AIDS, osteoporosis, hepatitis C. Based on this review, a pragmatic strategy is proposed which allows for the validation and proper use of surrogate outcomes.
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Affiliation(s)
- J P Boissel
- Hôpital Neuro-Cardiologique, Université Claude Bernard, Service de Pharmacologie Clinique, Lyon, France
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Abstract
The role of modelling in economic evaluation is explored by discussing, with examples, the uses of models. The expanded use of pragmatic clinical trials as an alternative to models is discussed. Some suggestions for good modelling practice are made.
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Vray M, Attali JR. Randomized study of glibenclamide versus traditional Chinese treatment in type 2 diabetic patients. Chinese-French Scientific Committee for the Study of Diabetes. Diabete Metab 1995; 21:433-9. [PMID: 8593925] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to evaluate the efficacy of a traditional Chinese treatment (TCT) based on three plants in association with a sulfonylurea, glibenclamide (2.5 mg X 3/d). A 2 X 2 factorial design was adopted for this multicentre randomized double-blind trial involving 4 groups [A = placebo (P) TCT + P glibenclamide; B = P TCT + verum glibenclamide; C = verum TCT + P glibenclamide; D = verum TCT + verum glibenclamide]. Patients included were type 2 diabetic outpatients, 40-70 years of age, treated by diet alone or oral anti-diabetic drugs. Endpoint criteria evaluated were HbA1, blood glucose and plasma insulin (at fasting, and 1 and 2 h after a test meal). At each visit, a clinical examination was performed, and a questionnaire on side effects and associated symptoms was completed. The dose was reduced by half in the case of hypoglycaemia. The 216 patients were recruited in 5 centres [Shanghai (1) = 48, Shanghai (2) = 40, Beijing = 40, Canton = 42, Chengdu = 46 and randomized into treatment groups A, B, C, D (56, 56, 50 and 54 respectively). Eleven patients were withdrawn for administrative reasons. In patients treated with glibenclamide, a significant increase in weight and insulinaemia was observed, together with a significant decrease in blood glucose values; in those receiving TCT, blood glucose values were significantly decreased only 2 h after the test meal. A synergistic effect on blood glucose was observed when both treatments were given. Hypoglycaemia occurred in 19 patients (all in the two verum glibenclamide groups). This first multicentre controlled trial showed that the 3 Chinese plants tested were well-tolerated and effective in Type 2 diabetes as indicated by a significant synergistic effect in association with a sulfonylurea.
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Affiliation(s)
- M Vray
- Université Paris-Nord, Hôpital Jean Verdier, Bondy, France
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Vray M, Chwalow J, Charansonney O, Vasmant D, Capron L, Boccalon H, Eschwege E. National study of obliterative arterial disease of the lower limbs involving general practitioners in France: Artemio study. J Cardiovasc Pharmacol 1995; 25 Suppl 2:S51-7. [PMID: 8699862 DOI: 10.1097/00005344-199500252-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.
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Affiliation(s)
- M Vray
- INSERM U21, Villejuif, France
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25
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Bouvenot G, Vray M. [Internal validity and impact of the results of clinical trials]. Rev Med Interne 1994; 15:9-12. [PMID: 8052759 DOI: 10.1016/s0248-8663(05)82123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Bouvenot G, Vray M. [Clinical trials: find the bias!]. Rev Rhum Ed Fr 1993; 60:412-5. [PMID: 8124273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Rampal P, Raillat A, Viteau JM, Slama JL, Lavignolle A, Bedenne L, Veyres B, Toulet J, Vray M, Prunieras F. Rioprostil and ranitidine in the prevention of duodenal ulcer relapse. Scand J Gastroenterol Suppl 1989; 164:146-50; discussion 150-1. [PMID: 2510259 DOI: 10.3109/00365528909091204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
One hundred and ninety duodenal ulcer patients who had relief of pain and endoscopically proven ulcer healing after a short treatment period are allocated at random to double-blind maintenance treatment with a synthetic dehydroprostaglandin-E1, rioprostil, 300 micrograms, or ranitidine, 150 mg, at bedtime for 6 months. Patients are monitored every two months and examined by endoscopy after six months of treatment, or more often if warranted. The cumulative relapse rate in the rioprostil group at six months is 32% (25/78) vs. 28% (20/72) in the ranitidine group. This difference is not significant. The percentage of side effects observed is 17% in the rioprostil group vs. 5% in the ranitidine group, but discontinuation of treatment is observed with the same frequency in the two groups.
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Affiliation(s)
- P Rampal
- Hôpital de L'Anchet, Nice, France
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Lavignolle A, Raillat A, Slama JL, Viteau JM, Veyres B, Lebourgeois P, Audigier JC, Abgrall J, Parlier H, Vray M. Rioprostil vs. ranitidine in duodenal ulcer healing: a double-blind multicentre trial. Scand J Gastroenterol Suppl 1989; 164:194-7. [PMID: 2510267 DOI: 10.3109/00365528909091212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A total of 156 patients with endoscopically proven duodenal ulcers are randomized in a double-blind, multicentre trial comparing rioprostil, 300 micrograms b.d., with ranitidine, 150 mg b.d. With rioprostil, the cumulative healing rate by endoscopy is 73% at 4 weeks, and 87% at 6 weeks. With ranitidine it is 79% and 92%, respectively. There is no difference in the occurrence of pain after the two types of treatment, and the side effects are comparable in the two groups. These results show that rioprostil is probably as effective and safe as ranitidine in the treatment of duodenal ulcer.
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