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Caussé C, Pépin JL, Dauvilliers Y, Attali V, Lehert P. Pitolisant efficacy in excessive daytime sleepiness for patients with obstructive sleep apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lehert P, Arvis P, Avril C, Massin N, Parinaud J, Porcu G, Rongières C, Sagot P, Wainer R, D'Hooghe T. A large observational data study supporting the PROsPeR score classification in poor ovarian responders according to live birth outcome. Hum Reprod 2021; 36:1600-1610. [PMID: 33860313 DOI: 10.1093/humrep/deab050] [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: 09/23/2019] [Revised: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can the Poor Responder Outcome Prediction (PROsPeR) score identify live birth outcomes in subpopulations of patients with poor ovarian response (POR) defined according to the ESHRE Bologna criteria (female age, anti-Müllerian hormone (AMH), number of oocytes retrieved during the previous cycle (PNO) after treatment with originator recombinant human follitropin alfa? SUMMARY ANSWER The PROsPeR score discriminated the probability of live birth in patients with POR using observational data with fair discrimination (AUC ≅ 70%) and calibration, and the AUC losing less than 5% precision compared with a model developed using the observational data. WHAT IS KNOWN ALREADY Although scoring systems for the likelihood of live birth after ART have been developed, their accuracy may be insufficient, as they have generally been developed in the general population with infertility and were not validated for patients with POR. The PROsPeR score was developed using data from the follitropin alfa (GONAL-f; Merck KGaA, Darmstadt, Germany) arm of the Efficacy and Safety of Pergoveris in Assisted Reproductive Technology (ESPART) randomized controlled trial (RCT) and classifies women with POR as mild, moderate or severe, based upon three variables: female age, serum AMH level and number of oocytes retrieved during the previous cycle (PNO). STUDY DESIGN, SIZE, DURATION The external validation of the PROsPeR score was completed using data derived from eight different centres in France. In addition, the follitropin alfa data from the ESPART RCT, originally used to develop the PROsPeR score, were used as reference cohort. The external validation of the PROsPeR score l was assessed using AUC. A predetermined non-inferiority limit of 0.10 compared with a reference sample and calibration (Hosmer-Lemeshow test) were the two conditions required for evaluation. PARTICIPANTS/MATERIALS, SETTING, METHODS The observational cohort included data from 8085 ART treatment cycles performed with follitropin alfa in patients with POR defined according to the ESHRE Bologna criteria (17.6% of the initial data set). The ESPART cohort included 477 ART treatment cycles with ovarian stimulation performed with follitropin alfa in patients with POR. MAIN RESULTS AND THE ROLE OF CHANCE The external validation of the PROsPeR score to identify subpopulations of women with POR with different live birth outcomes was shown in the observational cohort (AUC = 0.688; 95% CI: 0.662, 0.714) compared with the ESPART cohort (AUC = 0.695; 95% CI: 0.623, 0.767). The AUC difference was -0.0074 (95% CI: -0.083, 0.0689). This provided evidence, with 97.5% one-sided confidence, that there was a maximum estimated loss of 8.4% in discrimination between the observational cohort and the ESPART cohort, which was below the predetermined margin of 10%. The Hosmer-Lemeshow test did not reject the calibration when comparing observed and predicted data (Hosmer-Lemeshow test = 1.266688; P = 0.260). LIMITATIONS, REASONS FOR CAUTION The study was based on secondary use of data that had not been collected specifically for the analysis reported here and the number of characteristics used to classify women with POR was limited to the available data. The data were from a limited number of ART centres in a single country, which may present a bias risk; however, baseline patient data were similar to other POR studies. WIDER IMPLICATIONS OF THE FINDINGS This evaluation of the PROsPeR score using observational data supports the notion that the likelihood of live birth may be calculated with reasonable precision using three readily available pieces of data (female age, serum AMH and PNO). The PROsPeR score has potential to be used to discriminate expected probability of live birth according to the degree of POR (mild, moderate, severe) after treatment with follitropin alfa, enabling comparison of performance at one centre over time and the comparison between centres. STUDY FUNDING/COMPETING INTEREST(S) This analysis was funded by Merck KGaA, Darmstadt, Germany. P.L. received grants from Merck KGaA, outside of the submitted work. N.M. reports grants, personal fees and non-financial support from Merck KGaA outside the submitted work. T.D.H. is Vice President and Head of Global Medical Affairs Fertility, Research and Development at Merck KGaA, Darmstadt, Germany. P.A. has received personal fees from Merck KGaA, Darmstadt, Germany, outside the submitted work. C.R. has received grants and personal fees from Gedeon Richter and Merck Serono S.A.S., France, an affiliate of Merck KGaA, Darmstadt, Germany, outside the submitted work. P.S. reports congress support from Merck Serono S.A.S., France (an affiliate of Merck KGaA, Darmstadt, Germany), Gedeon Richter, TEVA and MDS outside the submitted work. C.A., J.P., G.P. and R.W. declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- P Lehert
- Faculty of Medicine, Melbourne University, Melbourne, Australia.,Faculty of Economics, Louvain University, Louvain, Belgium
| | | | - C Avril
- Clinique Mathilde, 76100 Rouen, France
| | - N Massin
- Centre Hospitalier Intercommunal de Creteil, 94000 Créteil, France
| | - J Parinaud
- Hôpital Paule de Viguier, 31000 Toulouse, France
| | - G Porcu
- IMR, 13008 Marseille, France
| | | | - P Sagot
- CHU Dijon, 21079 Dijon Cedex, France
| | - R Wainer
- Centre Hospitalier de Poissy, 78303 Poissy, France
| | - T D'Hooghe
- Global Medical Affairs Fertility, R&D Biopharma, Merck Healthcare KGaA, Darmstadt, Germany.,Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven (University of Leuven), Belgium.,Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
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Arvis P, Lesourd F, Parneix I, Paillet S, Pirrello O, Lehert P. Long-term outcome of patients undergoing in-vitro fertilisation in France: The outcome study. J Gynecol Obstet Hum Reprod 2020; 50:101968. [PMID: 33152544 DOI: 10.1016/j.jogoh.2020.101968] [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: 07/17/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
The Outcome study examines the fate of 4083 patients beginning IVF in 41 IVF centres, between January 2010 and December 2013. Cumulative live birth rate per patient (CLBR), the best reflection of IVF efficacy, is rarely presented in publications as it requires long-term follow-up, including all successive cycles, and pregnancies outcome. Analysis of international publications shows an average CLBR of 41.6 % and a drop-out rate of 49.5 %, both greatly varying by country and IVF centres. Because of the frequency with which patients change centre (8%), the Outcome study distinguishes patients with a past history of IVF in another centre (CLBR=47.2 %) and patients undergoing their first true cycle (CLBR=56.4 %). Survival techniques by Competing Risk, intended to take account of drop-out and lost to follow-up, assessed the overall CLBR as being 65.4 %. Differences in performance between centres are considerable for both CLBR (32-64%) and Performance Index, taking account of the number of cycles required to achieve a pregnancy (2-5). Multiple variance logistic regression analysis shows that the indicators influencing performance are age, parity, number of oocytes, smoking habit and overweight. These indicators are independent each other and are influencing performance in a high significant way. After adjusting for these indicators, the differences between centres are reduced but remain large and very significant. No centre appears to have specific expertise in the management of patients with adverse indicators. The Outcome study therefore confirms that the large differences in performance between centres are not explained by a difference in the treated population.
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Affiliation(s)
- P Arvis
- Clinique Mutualiste la Sagesse, Rennes, France.
| | - F Lesourd
- Hôpital Paule de Viguier, Toulouse, France
| | - I Parneix
- Polyclinique Jean Villar, Bruges, France
| | - S Paillet
- Département Affaires Médicales, Merck Santé S.A.S., Lyon, France(1)
| | | | - P Lehert
- Faculty of Medicine, University of Melbourne, Australia; Faculté d'Économie, Louvain, Belgium
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Le C, Duong T, Lehert P, Do D, Le T, Vo T. Clinical pregnancy following GnRH agonist administration in luteal phase of fresh or frozen assisted reproductive technology (ART) cycles: systematic review and meta analysis. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.582] [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: 10/28/2022]
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Plazzi G, Lehert P. Narcolepsy treatments: comparison of pitolisant, modafinil and sodium oxybate via a network meta-analysis. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.772] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Arvis P, Guivarc'h-Leveque A, Jaffre F, Bidet M, Lehert P. Predicting pregnancy after intra-uterine insemination (IUI): a new model incorporating prior evidence. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.1023] [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: 10/18/2022]
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Arvis P, Guivarc'h-Leveque A, Jaffre F, Bidet M, Lehert P. Predictive models for intra-uterine insemination (IUI):recent meta-analytical developments needed for synthesizing prior evidence. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.1024] [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: 10/18/2022]
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Lehert P, Villaseca P, Hogervorst E, Maki PM, Henderson VW. Individually modifiable risk factors to ameliorate cognitive aging: a systematic review and meta-analysis. Climacteric 2015; 18:678-89. [PMID: 26361790 PMCID: PMC5199766 DOI: 10.3109/13697137.2015.1078106] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A number of health and lifestyle factors are thought to contribute to cognitive decline associated with age but cannot be easily modified by the individual patient. We identified 12 individually modifiable interventions that can be implemented during midlife or later with the potential to ameliorate cognitive aging. For ten of these, we used PubMed databases for a systematic review of long-duration (at least 6 months), randomized, controlled trials in midlife and older adults without dementia or mild cognitive impairment with objective measures of neuropsychological performance. Using network meta-analysis, we performed a quantitative synthesis for global cognition (primary outcome) and episodic memory (secondary outcome). Of 1038 publications identified by our search strategy, 24 eligible trials were included in the network meta-analysis. Results suggested that the Mediterranean diet supplemented by olive oil and tai chi exercise may improve global cognition, and the Mediterranean diet plus olive oil and soy isoflavone supplements may improve memory. Effect sizes were no more than small (standardized mean differences 0.11-0.22). Cognitive training may have cognitive benefit as well. Most individually modifiable risk factors have not yet been adequately studied. We conclude that some interventions that can be self-initiated by healthy midlife and older adults may ameliorate cognitive aging.
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Affiliation(s)
- P Lehert
- a Faculty of Economics, Université Catholique de Louvain (UCL Mons) , Mons , Belgium and Department of Psychiatry , Faculty of Medicine, The University of Melbourne , Australia
| | - P Villaseca
- b * Department of Endocrinology , Faculty of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - E Hogervorst
- c Applied Cognitive Research, School of Sport, Exercise and Health Sciences, Loughborough University , Loughborough, Leicestershire, UK
| | - P M Maki
- d Departments of Psychiatry and Psychology , University of Illinois at Chicago , Chicago , Illinois ; USA
| | - V W Henderson
- e Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences , Stanford University , Stanford , California , USA
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de Jager J, Kooy A, Schalkwijk C, van der Kolk J, Lehert P, Bets D, Wulffelé MG, Donker AJ, Stehouwer CDA. Long-term effects of metformin on endothelial function in type 2 diabetes: a randomized controlled trial. J Intern Med 2014; 275:59-70. [PMID: 23981104 DOI: 10.1111/joim.12128] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We investigated whether metformin can improve endothelial function and decrease inflammatory activity, and thereby decrease the risk of atherothrombotic disease. SUBJECTS AND DESIGN A randomized, placebo-controlled trial with a follow-up period of 4.3 years set in the outpatient clinics of three nonacademic hospitals (Hoogeveen, Meppel and Coevorden Hospitals, the Netherlands). A total of 390 patients with type 2 diabetes treated with insulin were included. Either metformin 850 mg or placebo (one to three times daily) was added to insulin therapy. Urinary albumin excretion and plasma levels of von Willebrand factor (vWf), soluble vascular adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured at baseline and after 4, 17, 30, 43 and 52 months. RESULTS Metformin significantly reduced levels of vWF, sVCAM-1, t-PA, PAI-1, CRP and sICAM-1, which, except for CRP, remained significant after adjustment for baseline differences in age, sex, smoking and severity of previous cardiovascular (CV) disease. No effects on urinary albumin excretion or sE-selectin were observed. The improvements in vWf and sVCAM-1 statistically explained about 34% of the reduction in the risk of CV morbidity and mortality associated with metformin treatment in this study. CONCLUSIONS Metformin is associated with improvement in some (vWF and sVCAM-1) but not all markers of endothelial function, which may explain why it is associated with a decreased risk of CV disease in type 2 diabetes.
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Affiliation(s)
- J de Jager
- Bethesda Diabetes Research Center, Hoogeveen, The Netherlands; Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
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Lehert P, Rosner S, Lehert P, Rosner S, Higuchi S, Schwejda C, Krahl W, Fomino J, Ridinger M, Muller C, Beck A, Pelz P, Lorenz R, Charlet K, Kruger J, Friedel E, Geisel O, Ivens S, Banas R, Heinz A. O2 * FREE ORAL COMMUNICATIONS 2: PHARMACOLOGICAL TREATMENT OF ALCOHOL DEPENDENCE. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt098] [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: 11/13/2022] Open
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Freour T, Dessolle L, Lehert P, Barriere P. Building performing centre-specific predictive models of live birth in in vitro fertilization based on the revisited templeton model. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.611] [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: 11/29/2022]
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Walczak J, Jarosz J, Miernik K, Wachal M, Krumpl G, Gual A, Sorensen P, Gual A, van den Brink W, Sorensen P, Torup L, Mann K, Aubin HJ, van den Brink W, Bladstrom A, Torup L, Mann K, Gual A, Aubin HJ, van den Brink W, Sorensen P, Usieto EG, Carmen M, Higuera P, Veiga AR, Roblego F, Perney P, Lehert P, Haass-Koffler C, Kenna G, Simms J, Bartlett S, Cacciaglia R, Lesch OM, Vivet P, Guerri C, Orrico A, Marti-Prats L, Sinclair J, Chick J, Bineau S, LeReun C, Daeppen JB, Bineau S, LeReun C, Daeppen JB, Peuskens H, Dierckx E, Santens E, Basinska-Szafranska A, Silczuk A, Habrat B, Pirog-Balcerzak A, Cieslak U, Basinska-Szafranska A, Silczuk A, Habrat B, Pirog-Balcerzak A, Cieslak U. TREATMENT. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt114] [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: 11/14/2022] Open
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Dervaux A, Bourdel MC, Krebs M, Laqueille X, Lehert P, Hugon N, Velasquez N, Hugon N, Velasquez N, Lehert P, Egorov A, Kutcher E, Chernikova N, Filatova E. O7 * FREE ORAL COMMUNICATIONS 7: COMORBIDITY AND DETOXIFICATION. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt111] [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: 11/13/2022] Open
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Arvis P, Guivarc'h-Leveque A, Colella C, Lehert P. A life birth predictive model after in vitro fertilization (IVF) may have a fair discrimination: results of a multicenter external validation based on 15039 IVF cycles. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.349] [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: 11/30/2022]
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Rongieres C, Lehert P, Pirrello O, Bettahar K, Koscinski I, Colella C. Predicting poor ovarian response in IVF/ICSI: is bologna consensus a valid tool in routine practice? Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1508] [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: 11/29/2022]
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Porcu-Buisson G, Collela C, Chabert-Orsini V, Terriou P, Lehert P. Is addition of recombinant lutenizing hormone (rLH) beneficial during controlled ovarian hyperstimulation (COS). a matched pair controlled naturalistic study. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1688] [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]
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Devy R, Lehert P, Varlan E, Genty M, Edan G. A short and validated multiple sclerosis-specific health-related quality of life measurement for routine medical practice. Eur J Neurol 2013; 20:935-41. [DOI: 10.1111/ene.12107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/19/2012] [Indexed: 11/27/2022]
Affiliation(s)
- R. Devy
- Association DNS; Saumur; France
| | | | - E. Varlan
- Merck Serono s.a.s.; Merck Santé s.a.s.; Lyon cedex 08; France
| | - M. Genty
- Centre thermal; Yverdon-les-Bains; Switzerland
| | - G. Edan
- Department of Neurology; CIC-P0203 INSERM; Pontchaillou University Hospital; Rennes; France
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Arvis P, Lehert P, Guivarc'h-Levêque A. Simple adaptations to the Templeton model for IVF outcome prediction make it current and clinically useful. Hum Reprod 2012; 27:2971-8. [PMID: 22851717 DOI: 10.1093/humrep/des283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION What is the validity of the Templeton model (TM) in predicting live birth (LB) for a couple starting an IVF/ICSI cycle? SUMMARY ANSWER A centre-specific model based on the original predictors of the TM may reach a sufficient level of accuracy to be used in every day practice, with a few simple adaptations. WHAT IS KNOWN AND WHAT THIS PAPER ADDS The TM seems the best predictive model of LB in IVF. However, previous validations of the TM suggest a lack of discrimination and calibration which means that it is not used in regular practice. We confirm this finding, and argue that such results are predictable, and essentially due to a strong centre effect. We provide evidence that the TM constitutes a useful reference reflecting a high proportion of the patient-mix effect since the parameters of the model remain invariant among centres, but also across various cultures, countries and types of hospitals. The only difference was the intercept value, interpreted as the measurement of the global performance of one centre, in particular, for a population of reference. STUDY DESIGN The validity of the TM was tested by a retrospective analysis all IVF/ICSI cycles (n = 12 901) in our centre since 2000. PARTICIPANTS, SETTING AND METHODS All IVF/ICSI cycles were included in the analysis. The model discrimination was evaluated by C-statistics, calculated as the area under the curve of an ROC curve. The TM was then adjusted for our data and additional variables were assessed. MAIN RESULTS AND THE ROLE OF CHANCE Poor calibration and discrimination (C = 0.64) was observed in conformity with previous external validations. Fitting the TM to our centre constituted the first substantial improvement in prediction accuracy of discrimination (C = 0.69) and calibration. We identified an important linear time trend effect and the added value of three other predictors (FSH, smoking habits and BMI) that significantly improved the model (C = 0.71). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION Bias due to missing data handling was assessed through sensitivity analyses. GENERALIZABILITY TO OTHER POPULATIONS Neither the TM nor any other models based on some centres are directly applicable to other centres. However, the TM constitutes a useful basis to build an accurate centre-specific model. STUDY FUNDING/COMPETING INTEREST(S) There were no commercial relationships (i.e. consultancies, patent-licensing agreements) that might pose a conflict of interest in connection with the submitted manuscript. The objective of this research was not directed toward any treatment effects.
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Affiliation(s)
- P Arvis
- Clinique la Sagesse, Place St Guénolé, Rennes 35000, France.
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Sunkara SK, Seshadri S, El-Toukhy T, Khalaf Y, Schuh-Huerta SM, Johnson NA, Rosen MP, Sternfeld B, Cedars MI, Reijo Pera RA, Groendahl M, Vikesa J, Borup R, Yding Andersen C, Ernst E, Lykke-Hartmann K, Liu W, Zhong Y, Zou X, Xi WY, Gong F, Fan LQ, Lu GX, Lehert P, Rongieres C, Pirrello O, Ohl J, Bettahar K, Nisand I, Smit JG, Kasius JC, Eijkemans MJC, Campo R, Broekmans FJM. SESSION 03: FEMALE INFERTILITY 1. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.3] [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: 11/14/2022] Open
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Karasu Y, Dilbaz B, Demir B, Dilbaz S, Secilmis Kerimoglu O, Ercan CM, Keskin U, Korkmaz C, Duru NK, Ergun A, de Zuniga I, Horton M, Oubina A, Scotti L, Abramovich D, Pascuali N, Tesone M, Parborell F, Bouzas N, Yang XH, Chen SL, Chen X, Ye DS, Zheng HY, Nyboe Andersen A, Lauritsen MP, Thuesen LL, Khodadadi M, Shivabasavaiah S, Mozafari R, Ansari Z, Hamdine O, Broekmans F, Eijkemans MJC, Cohlen BJ, Verhoeff A, van Dop PA, Bernardus RE, Lambalk CB, Oosterhuis GJE, Holleboom C, van den Dool-Maasland GC, Verburg HJ, van der Heijden PFM, Blankhart A, Fauser BCJM, Laven JSE, Macklon NS, Agudo D, Lopez C, Alonso M, Huguet E, Bronet F, Garcia-Velasco JA, Requena A, Gonzalez Comadran M, Checa MA, Duran M, Fabregues F, Carreras R, Ersahin A, Kahraman S, Kavrut M, Gorgen B, Acet M, Dokuzeylul N, Aybar F, Lim SY, Park JC, Bae JG, Kim JI, Rhee JH, Mahran A, Abdelmeged A, El-Adawy A, Eissa M, Darne J, Shaw RW, Amer SA, Dai A, Yan G, He Q, Hu Y, Sun H, Ferrero H, Gomez R, Garcia-Pascual CM, Simon C, Gaytan F, Pellicer A, Garcia Pascual CM, Zimmermann RC, Ferrero H, Simon C, Pellicer A, Gomez R, Madani T, Mohammadi Yeganeh L, Khodabakhshi SH, Akhoond MR, Hasani F, Monzo C, Haouzi D, Assou S, Dechaud H, Hamamah S, Amer S, Mahran M, Eissa M, Darne J, Shaw R, Lan V, Nhu G, Tuong H, Mahmoud Youssef MA, Aboulfoutouh I, Al-inany H, Van Der Veen F, Van Wely M, Zhang Q, Fang T, Wu S, Zhang L, Wang B, Li X, Yan G, Sun H, Hu Y, He Q, Ding L, Day A, Wang B, Yan G, Hu Y, Sun H, Zhang L, Fang T, Zhang Q, Wu S, Yan G, Sun H, Hu Y, Fulford B, Boivin J, Alanbay I, Ercan CM, Sakinci M, Coksuer H, Ozturk M, Tapan S, Chung CK, Chung Y, Seo S, Aksoy S, Yakin K, Caliskan S, Salar Z, Ata B, Urman B, Devroey P, Pellicer A, Nyboe Andersen A, Arce JC, Harrison K, Irving J, Osborn J, Harrison M, Fusi F, Arnoldi M, Cappato M, Galbignani E, Galimberti A, Zanga L, Frigerio L, Taghavi SA, Ashrafi M, Karimian L, Mehdizadeh M, Joghataie M, Aflatoonian R, Xu B, Cui YG, Gao LL, Diao FY, Li M, Liu XQ, Liu JY, Jiang F, Li M, Cui YG, Diao FY, Liu JY, Jee BC, Yi G, Kim JY, Suh CS, Kim SH, Liu S, Cui YG, Liu JY, Cai LB, Liu JJ, Ma X, Geenen E, Bots RSGM, Smeenk JMJ, Chang E, Lee W, Seok H, Kim Y, Han J, Yoon T, Lazaros L, Xita N, Zikopoulos K, Makrydimas G, Kaponis A, Sofikitis N, Stefos T, Hatzi E, Georgiou I, Atilgan R, Kumbak B, Sahin L, Ozkan ZS, Simsek M, Sapmaz E, Karacan M, Alwaeely FA, Cebi Z, Berberoglugil M, Ulug M, Camlibel T, Kavrut M, Kahraman S, Ersahin A, Acet M, Yelke H, Kamalak Z, Carlioglu A, Akdeniz D, Uysal S, Inegol Gumus I, Ozturk Turhan N, Regan S, Yovich J, Stanger J, Almahbobi G, Kara M, Aydin T, Turktekin N, Youssef M, Aboulfoutouh I, Al-Inany H, van der Veen F, van Wely M, Hart R, Doherty D, Frederiksen H, Keelan J, Pennell C, Newnham J, Skakkebaek N, Main K, Salem HT, Ismail AA, Viola M, Siebert TI, Steyn DW, Kruger TF, Robin G, Dewailly D, Thomas P, Leroy M, Lefebvre C, soudan B, Pigny P, Decanter C, ElPrince M, Wang F, Zhu Y, Huang H, Valdez Morales F, Vital Reyes V, Mendoza Rodriguez A, Gamboa Dominguez A, Cerbon M, Aizpurua J, Ramos B, Luehr B, Moragues I, Rogel S, Cil AP, Guler ZB, Kisa U, Albu A, Radian S, Grigorescu F, Albu D, Fica S, Al Boghdady L, Ghanem ME, Hassan M, Helal AS, Ozdogan S, Ozdegirmenci O, Dilbaz S, Demir B, Cinar O, Dilbaz B, Goktolga U, Seeber B, Tsybulyak I, Bottcher B, Grubinger T, Czech T, Wildt L, Wojcik J, Howles CM, Destenaves B, Arriagada P, Tavmergen E, Sahin G, Akdogan A, Levi R, Goker ENT, Thuesen LL, Loft A, Smitz J, Nyboe Andersen A, Ricciardi L, Di Florio C, Busacca M, Gagliano D, Immediata V, Selvaggi L, Romualdi D, Guido M, Bouhanna P, Salama S, Kamoud Z, Torre A, Paillusson B, Fuchs F, Bailly M, Wainer R, Tagliaferri V, Busacca M, Gagliano D, Di Florio C, Tartaglia C, Cirella E, Romualdi D, Guido M, Aflatoonian A, Eftekhar M, Mohammadian F, Yousefnejad F, De Cicco S, Gagliano D, Busacca M, Di Florio C, Immediata V, Campagna G, Romualdi D, Guido M, Depalo R, Lippolis C, Vacca M, Nardelli C, Selvaggi L, Cavallini A, Panic T, Mitulovic G, Franz M, Sator K, Tschugguel W, Pietrowski D, Hildebrandt T, Cupisti S, Giltay EJ, Gooren LJ, Oppelt PG, Hackl J, Reissmann C, Schulze C, Heusinger K, Attig M, Hoffmann I, Beckmann MW, Dittrich R, Mueller A, Sharma S, Singh S, Chakravarty A, Sarkar A, Rajani S, Chakravarty BN, Dilbaz S, Ozturk E, Ozdegirmenci O, Demir B, Isikoglu S, Kul S, Dilbaz B, Cinar O, Goktolga U, Eftekhar M, Aflatoonian A, Mohammadian F, Broekmans F, Hillensjo T, Witjes H, Elbers J, Mannaerts B, Gordon K, Krasnopolskaya K, Galaktionova A, Gorskaya O, Kabanova D, Venturella R, Morelli M, Mocciaro R, Capasso S, Cappiello F, Zullo F, Monterde M, Gomez R, Marzal A, Vega O, Rubio-Rubio JM, Diaz-Garcia C, Pellicer A, Gordon K, Kolibianakis E, Griesinger G, Yding Andersen C, Witjes H, Mannaerts B, Ocal P, Guralp O, Aydogan B, Irez T, Cetin M, Senol H, Erol N, Yding Andersen C, Kolibianakis E, Devroey P, Witjes H, Mannaerts B, Gordon K, Griesinger G, Rombauts L, Van Kuijk J, Mannaerts B, Montagut J, Nogueira D, Porcu G, Chomier M, Giorgetti C, Nicollet B, Degoy J, Lehert P, Alviggi C, De Rosa P, Vallone R, Picarelli S, Coppola M, Conforti A, Strina I, Di Carlo C, De Placido G, Hackl J, Cupisti S, Haeberle L, Schulze C, Hildebrandt T, Oppelt PG, Reissmann C, Heusinger K, Attig M, Hoffmann I, Dittrich R, Beckmann MW, Mueller A, Akdogan A, Demirtas O, Sahin G, Tavmergen E, Goker ENT, Fatemi H, Shapiro BS, Griesinger G, Witjes H, Gordon K, Mannaerts BM, Chimote MN, Mehta BN, Chimote NN, Nath NM, Chimote NM, Karia S, Bonifacio M, Bowman M, McArthur S, Jung J, Cho S, Choi Y, Lee B, Seo S, Lee KH, Kim CH, Kwon SK, Kim SH, Kang BM, Jung KS, Basios G, Trakakis E, Hatziagelaki E, Vaggopoulos V, Tsiavou A, Panagopoulos P, Chrelias C, Kassanos D, Sarhan A, Elsamanoudy A, Harira M, Dogan S, Bozdag G, Esinler I, Polat M, Yarali H. REPRODUCTIVE ENDOCRINOLOGY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.88] [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: 11/13/2022] Open
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Devy R, Jolibois M, Lehert P, Genty M, Edan G. Validation of a short and specific quality of life scale in multiple sclerosis: Two Life Scale (TLS_QoL10). Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.348] [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: 11/16/2022]
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Hutchison K, Claus E, Harlaar N, Bryan A, Grilo CM, Jenkov VP, Toteva S, Jenkov V, Lehert P, VandenBrink W, Preuss UW, Ridinger M, Fehr C, Koller G, Bondy B, Wodarz N, Soyka M, Zill P, Zimmermann US, Mick I, Lachnit A, Kabus M, Gahr M. FREE ORAL COMMUNICATIONS 7: SUBGROUPS OF ALCOHOL DEPENDENCE AND THEIR SPECIAL TREATMENT * O7.1 * ALCOHOL DEPENDENCE: LINKING GENES WITH INTERMEDIATE NEUROBIOLOGICAL PHENOTYPES. Alcohol Alcohol 2011. [DOI: 10.1093/alcalc/agr123] [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: 11/12/2022] Open
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Rossignol P, Cridlig J, Lehert P, Zannad F, Kessler M. La variabilité inter-visite de la pression artérielle est un prédicteur majeur des évènements cardiovasculaires en insuffisance rénale terminale. Données de l’étude FOSIDIAL (Fosinopril in dialysis). Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.043] [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: 11/28/2022]
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Infante MA, Humber CC, Mattson SN, Riley EP, Bryan AD, Ewing SF, Brock A, Magnan R, Hutchison K, Berglund KJ, Fahlke C, Berggren U, Zetterberg H, Blennow K, Engel J, Balldin J, Ulmer A, Lehert P, Mason B, Beaunieux H, Cauvin C, Lannuzel C, Duval C, Le Berre A, Vabret F, Pitel A, Allain P, Desgranges B, Eustache F. FREE ORAL COMMUNICATIONS 4: ALCOHOL DEPENDENCE: TREATMENT APPROACHES * O4.1 * EFFECTIVENESS OF STIMULANT MEDICATION IN FETAL ALCOHOL SPECTRUM DISORDERS. Alcohol Alcohol 2011. [DOI: 10.1093/alcalc/agr096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mialon O, Delotte J, Lehert P, Donzeau M, Drici M, Isnard V, Bongain A. [Comparison between two analgesic protocols on IVF success rates]. J Gynecol Obstet Hum Reprod 2011; 40:137-143. [PMID: 20934819 DOI: 10.1016/j.jgyn.2010.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/04/2010] [Accepted: 08/17/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Analgesic protocols administered before a follicular puncture under local anesthesia are well tolerated when using NSAIDs, but we still do not know their possible impacts on in vitro fertilization (IVF) outcomes. MATERIAL AND METHODS A retrospective monocentric study using two consecutive temporal cohorts of patients was conducted to compare two analgesic protocols: paracetamol/alprazolam (P/A), then nefopam/ketoprofen (N/K). RESULTS We demonstrated that biochemical pregnancy rate and the others outcomes of IVF are not significantly influenced by the type of analgesic protocol used. CONCLUSION The protocol N/K enhances patient comfort without jeopardizing the IVF success rates.
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Affiliation(s)
- O Mialon
- Service de gynécologie-obstétrique-reproduction et de médecine fœtale, hôpital de l'Archet, CHU de Nice, 2, route Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Lejoyeux M, Lehert P. Alcohol-Use Disorders and Depression: Results from Individual Patient Data Meta-Analysis of the Acamprosate-Controlled Studies. Alcohol Alcohol 2011; 46:61-67. [DOI: 10.1093/alcalc/agq077] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Silva V, Pita Barros P, Lourenco O, Batel Marques F, Martinez-Salazar J, Palumbo A, De La Fuente P, Rodriguez M, Sanchez F, Lizan C, Marqueta J, Espallardo O, Lizan L, Polanco C, Paz S, Haagen EC, Nelen WLDM, Hermens RPMG, Adang EM, Grol RPTM, Kremer JAM, Pinborg A, Hougaard CO, Nyboe Andersen A, Kragh Andersen P, Boivin J, Schmidt L, Moolenaar L, Broekmans FB, van de Veen F, Fauser BCJM, Hompes P, Mol BW, Porcu - Buisson G, Lehert P, Chabert - Orsini V, Giorgetti C, Shirkavand A, Sedigh Sarvestani R, Ezabadi Z, Omani Samani R, Silva Carvalho JL, Santos A, Tabuas I, Braga DPAF, Setti AS, Figueira RCS, Queiroz P, Iaconelli A, Borges E, Fuldeore M, Wu N, Boulanger L, Chwalisz K, Marx S, Scaravelli G, De luca R, D'Aloja P, Vigiliano V, Mayorga JM, Bolli S, Spoletini R, Fiaccavento S, Monzo A, Flores R, Aniorte S, Rubio JM, Peinado I, Pellicer A, Woodward BJ, Sohan K, Dahl E, Ziegler A, Horlbeck S, Strowitzki T, Eggert-Kruse W, Padhy N, Mahla A, Balasubramanyam S, Varma TR, Yellamareddygari S, Willett MJ, Batra S, Farquhar C, Wang YA, Sullivan AE. Posters * Demography, Epidemiology, Registries, and Health Economy. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.100] [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: 11/13/2022] Open
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Maldonado L, Azjen SA, Aoki T, Busato W, Pasqualotto FF, Iaconelli A, Borges E, Aflatoonian A, Oskouian H, Ahmadi S, Oskouian L, Kolibianakis EM, Venetis CA, Diedrich K, Tarlatzis BC, Griesinger G, Lehert P, Ezcurra D, Guzeloglu Kayisli O, Lalioti M, Sasson I, Sakkas D, Aydiner F, Seli E, Almeida H, Ribeiro A, Pinto A, Gomes F, Silva-Carvalho JL, Porrati L, Vilela M, Viglierchio MI, Valcarcel A, Lombardi E, Marconi G. Session 64: Clinical Art 2. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG. The menopausal transition: a 9-year prospective population-based study. The Melbourne Women's Midlife Health Project. Climacteric 2010; 7:375-89. [PMID: 15799609 DOI: 10.1080/13697130400012163] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [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: 10/26/2022]
Abstract
OBJECTIVES To describe the natural history of the menopause in Australian-born women. To determine the hormonal changes relating to the menopausal transition (MT) and how these affect quality of life, bone mineral density, body composition, cardiovascular disease (CVD) risk and memory. DESIGN A 9-year prospective, observational study of a population-based sample of 438 Australian-born women aged 45-55 years at baseline. By the 9th year, the retention rate was 88%. Interviews, blood sampling, menstrual calendars, quality of life and physical measures were taken annually, and bone mineral density was measured bi-annually. RESULTS The late MT coincides with changes in estradiol, follicle stimulating hormone, and free testosterone index, decreases in bone density and mastalgia, and increases in central adiposity, vasomotor symptoms, insomnia and vaginal dryness. Levels of total testosterone and dehydroepiandrosterone sulfate are unchanged by the MT. An increase in CVD risk was associated with increases in weight and free testosterone index and a decrease in estradiol. Depressed mood is increased by symptoms and by stressors occurring in the MT. Sexual functioning significantly deteriorates with the MT and aging, but relational factors have major effects. Menstrual cycles became more variable and longer closer to the final menstrual period. CONCLUSIONS As hormonal changes during the MT directly or indirectly adversely affect quality of life, body composition and CVD risk, maintenance of health parameters in the premenopausal years is crucial for a healthy postmenopause.
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Affiliation(s)
- J R Guthrie
- Office for Gender and Health, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.
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Abstract
OBJECTIVE To assess the efficacy of naftidrofuryl compared with placebo in treating the symptoms of intermittent claudication. DESIGN Meta-analysis based on individual patient data. DATA SOURCES Medline, International Pharmaceutical Abstracts, Embase, Science Citation Index, and the Cochrane trial registers. Reference lists of retrieved articles were checked. Authors and companies were approached for additional information and individual patient data. INCLUSION CRITERIA Double blind, randomised controlled trials in patients with intermittent claudication receiving oral naftidrofuryl or placebo and with pain-free walking distance as primary outcome. DATA COLLECTION Individual patient data were collected from electronic data or from case report forms and checked for integrity. ANALYSIS All randomised patients were analysed following the intention to treat principle. Efficacy was assessed by the ratio of geometric mean of the relative improvement in pain-free walking distance after use of naftidrofuryl compared with placebo. In the analysis of responders, therapeutic success was defined as an improvement of walking distance at baseline by at least 50%. RESULTS In total, 1266 patients were randomised (1083 in the main analysis). The ratio of relative improvement in pain-free walking distance after use of naftidrofuryl compared with placebo was 1.37 (95% confidence interval 1.27 to 1.49). The difference in response rate was 22.3% (95% confidence interval 17.1% to 27.6%) and the number needed to treat for relief of symptoms during six months of treatment was 4.48 (95% confidence interval 3.62 to 5.85). CONCLUSION This meta-analysis of individual patient data provides evidence that naftidrofuryl has a clinically meaningful effect compared with placebo in improving walking distance in patients with intermittent claudication.
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Affiliation(s)
- T De Backer
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
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Abstract
BACKGROUND Lifestyle changes and cardiovascular prevention measures are a primary treatment for intermittent claudication (IC). Symptomatic treatment with vasoactive agents (Anatomic Therapeutic Chemical Classification (ATC) for medicines from the World Health Organisation class CO4A) is controversial. OBJECTIVES To evaluate evidence on the efficacy and safety of oral naftidrofuryl (ATC CO4 21) versus placebo on the pain-free walking distance (PFWD) of people with IC by using a meta-analysis based on individual patient data (IPD). SEARCH STRATEGY The Cochrane Peripheral Vascular Diseases Group searched their Trials Register (last searched December 2007) and CENTRAL (last searched 2007, Issue 4). We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, the Science Citation Index and contacted the authors and checked the reference lists of retrieved articles. We asked the manufacturing company for IPD. SELECTION CRITERIA We included only randomized controlled trials (RCTs) with low or moderate risk of bias for which the IPD were available. DATA COLLECTION AND ANALYSIS We collected data from the electronic data file or from the case report form and checked the data by a statistical quality control procedure. All randomized patients were analyzed following the intention-to-treat (ITT) principle. The geometric mean of the relative improvement in PFWD was calculated for both treatment groups in all identified studies. The effect of the drug was assessed compared with placebo on final walking distance (WDf) using multilevel and random-effect models and adjusting for baseline walking distance (WD0). For the responder analysis, therapeutic success was defined as an improvement of walking distance of at least 50%. MAIN RESULTS We included seven studies in the IPD (n = 1266 patients). One of these studies (n = 183) was only used in the sensitivity analysis so that the main analysis included 1083 patients. The ratio of the relative improvement in PFWD (naftidrofuryl compared with placebo) was 1.37 (95% confidence interval (CI) 1.32 to 1.51, P < 0.001). The absolute difference in responder rate, or proportion successfully treated, was 22.3% (95% CI 17.1% to 27.6%). The calculated number needed to treat was 4.5 (95% CI 3.6 to 5.8). AUTHORS' CONCLUSIONS Naftidrofuryl has a statistically significant and clinically meaningful effect of improving walking distance in the six months after initiation of therapy for people with intermittent claudication. Access by researchers to data from RCTs that is suitable for IPD analysis should be possible through repositories of data from pharmacological trials. Regular formal appraisal of the balance of risk and benefit is needed for older pharmaceutical products.
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Affiliation(s)
- T L M De Backer
- Ghent University, Heymans Institute of Pharmacology, De Pintelaan 185, Gent, Belgium, B-9000.
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Lehert P, Poirier-Littre MF, Pringuey D, Galinowski A. New statistical proposals to evaluate the benefit/risk ratio of long-term treatment of depression: application to a one-year double-blind study comparing medifoxamine with fluoxetine. Clin Drug Investig 2008; 15:285-95. [PMID: 18370483 DOI: 10.2165/00044011-199815040-00004] [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: 11/02/2022]
Abstract
The aim of this study was to determine the benefit/risk ratio of long-term treatment with medifoxamine, a non-tricyclic, non-monoamine oxidase inhibitor agent, and fluoxetine in patients with acute depressive episode and at high risk of relapse and/or recurrence. The study involved a 12-month double-blind, randomised, parallel-group design with a multicentric trial setting conducted by 64 participating physicians. 155 and 158 patients of either gender, aged between 18 and 70 years, were allocated to fluoxetine and medifoxamine, respectively. All patients had an acute depressive episode defined by the presence of at least five of the DSM III-R criteria with a minimal score of 25 on the Montgomery and Asberg Depression Rating Scale (MADRS). All subjects had at least one previous documented depressive episode in their medical history. The main outcome criterion consisted of good therapeutic response defined by a sustained 50% reduction of the Clinical Global Impression (CGI) score combined with the absence of any serious or troublesome (i.e. intensity motivating study discontinuation) events. In the fluoxetine and medifoxamine groups, respectively, 45.2% and 43% of the randomised patients completed the 12-month follow-up period with no major differences between groups regarding the reasons for treatment withdrawal. With each treatment 58% of the patients reached at least a 50% decrease in their CGI score, with no differences on the evolution of the MADRS, Hamilton Anxiety Rating Scale (HARS), the Self Rating Depression Scale of Zung (Zung scale) and Scott depression visual analogue scale (VAS) scores on average. According to the main efficacy criterion, 26% of the patients in the fluoxetine group were considered as responders compared with 36% in the medifoxamine group (p = 0.047). When only serious adverse effects were considered in combination with CGI scores to define response rates, the respective percentages were in favour of medifoxamine but the difference (45 vs 53%) was not significant. Results with medifoxamine were better in the elderly whereas, with fluoxetine, best responses were observed in younger patients. In conclusion, medifoxamine was an active and well tolerated drug in the continuation and maintenance treatment of depression. Its benefit/risk ratio appeared to be superior to fluoxetine, but this difference was mainly based on the occurrence of less minor adverse effects, a potential advantage not sufficient to favour better compliance with long-term therapy. Nevertheless, efficacy and tolerance of medifoxamine merits further evaluation in specific elderly populations.
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Affiliation(s)
- P Lehert
- Statistical Department, Catholic University of Mons, Mons, Belgium
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Zannad F, Kessler M, Lehert P, Grünfeld JP, Thuilliez C, Leizorovicz A, Lechat P. Prevention of cardiovascular events in end-stage renal disease: results of a randomized trial of fosinopril and implications for future studies. Kidney Int 2006; 70:1318-24. [PMID: 16871247 DOI: 10.1038/sj.ki.5001657] [Citation(s) in RCA: 224] [Impact Index Per Article: 12.4] [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: 01/10/2023]
Abstract
Cardiovascular events (CVEs) are the leading cause of death in chronic hemodialysis patients. Results of trials in non-end-stage renal disease (ESRD) patients cannot be extrapolated to patients with ESRD. It is critical to test cardiovascular therapies in these high-risk patients who are usually excluded from major cardiovascular trials. The study objective was to evaluate the effect of fosinopril on CVEs in patients with ESRD. Eligible patients were randomized to fosinopril 5 mg titrated to 20 mg daily (n=196) or placebo (n=201) plus conventional therapy for 24 months. The primary end point was combined fatal and nonfatal first major CVEs (cardiovascular death, resuscitated death, nonfatal stroke, heart failure, myocardial infarction, or revascularization). No significant benefit for fosinopril was observed in the intent to treat analysis (n=397) after adjusting for independent predictors of CVEs (RR=0.93, 95% confidence interval (CI) 0.68-1.26, P=0.35). The per protocol secondary supportive analysis (n=380) found a trend towards benefit for fosinopril (adjusted RR=0.79 (95% CI 0.59-1.1, P=0.099)). In the patients who were hypertensive at baseline, systolic and diastolic blood pressures were significantly decreased in the fosinopril as compared to the placebo group. After adjustment for risk factors, trends were observed suggesting fosinopril may be associated with a lower risk of CVEs. These trends may have become statistically significant had the sample size been larger, and these findings warrant further study.
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Affiliation(s)
- F Zannad
- Hypertension and Preventive Cardiology Division, Department of Cardiovascular Disease, Centre d'Investigations Cliniques INSERM-CHU, INSERM U684, Nancy, France.
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Abstract
AIMS We investigated in a double-blind study whether metformin reduces blood pressure (BP) in patients with Type 2 diabetes intensively treated with insulin. METHODS A total of 220 patients with Type 2 diabetes were asked to undergo 24-h ambulatory BP monitoring (24-h ABPM). One hundred and eighty-two gave informed consent. Eighty-nine were randomized to metformin and 93 to placebo. Thirty-five subjects dropped out (13 placebo, 22 metformin users); 147 patients underwent a second 24-h ABPM, 16 weeks after randomization. RESULTS Systolic BP (SBP), diastolic BP (DBP), pulse BP (PP), mean BP (MP) and heart rate (HR) were measured as office BP measurements and as 24-h ABPM for 24-h, day and night. Office BP measurements did not differ significantly between the placebo- and metformin-treated groups for any BP measure, but showed a non-significant trend for SBP reduction with metformin use (mean baseline-adjusted difference, metformin minus placebo: -4.2 mmHg, 95% CI, -9.9 to +1.5; P = 0.15). The baseline-adjusted differences of the ambulatory measurements were -0.2 mmHg (95% CI, -2.9 to +2.6) for the 24-h SBP, and +1.1 mmHg (95% CI, -0.7 to +2.8) for the 24-h DBP. On the whole, BP differences between metformin- and placebo-treated groups were not statistically significant. The only significant difference was for night-time PP (baseline-adjusted difference: -2.2 mmHg; 95% CI, -4.2 to -0.2). These results were not different after adjustment for age and diabetes duration, or for (changes in) body mass index, glycated haemoglobin, insulin dose or plasma homocysteine. CONCLUSION Metformin does not significantly affect BP in patients with Type 2 diabetes intensively treated with insulin.
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Affiliation(s)
- M G Wulffelé
- Department of Internal Medicine, Bethesda General Hospital, Hoogeveen, The Netherlands
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Pelc I, Hanak C, Baert I, Houtain C, Lehert P, Landron F, Verbanck P. EFFECT OF COMMUNITY NURSE FOLLOW-UP WHEN TREATING ALCOHOL DEPENDENCE WITH ACAMPROSATE. Alcohol Alcohol 2005; 40:302-7. [PMID: 15870092 DOI: 10.1093/alcalc/agh136] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To measure the effect of community nurse follow-up on abstinence and retention rates in the outpatient treatment of alcohol-dependent patients treated with acamprosate. METHODS Recently detoxified alcohol-dependent patients were prescribed acamprosate for 26 weeks and randomized to either physician-only follow-up, or physician plus regular visits from a community nurse. Drinking behaviour in the next 26 weeks was assessed at monthly visits to non-blind clinicians. RESULTS The cumulative abstinence duration proportion (CADP) was significantly longer in (P=0.03) the subjects who had received community nurse support (0.57) than in those who had not (0.39). This might, in part, be an artefact of the higher retention rate among those followed up by the nurse, in that, the method of calculating CADP allocates 100% days of drinking for the month before a failed attendance. Differences favouring nurse in the follow-up were seen for time to first drink, and clinical global impression. CONCLUSIONS For recently detoxified alcohol-dependent patients treated with acamprosate, follow-up by a community nurse improves patient retention and probably also improves the 6-month drinking outcome.
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Affiliation(s)
- I Pelc
- Psychiatry Department, Hôpital Universitaire Brugmann, Universite Libre de Bruxelles, Place A.van Gehuchten 4, 1020 Bruxelles, Belgium.
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Wulffelé MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger van der Burg B, Donker AJM, Stehouwer CDA. Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial. J Intern Med 2003; 254:455-63. [PMID: 14535967 DOI: 10.1046/j.1365-2796.2003.01213.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [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: 11/20/2022]
Abstract
OBJECTIVE Metformin is a key treatment option in type 2 diabetes. However, metformin may decrease vitamin B12 levels and increase levels of homocysteine, a cardiovascular risk factor. We investigated whether 16 weeks of treatment with metformin affects serum concentrations of homocysteine, folate and vitamin B12 in subjects with type 2 diabetes treated with insulin. DESIGN Placebo-controlled, randomized trial. MEASUREMENTS at baseline and 16 weeks later. SETTING This trial was conducted in the outpatient clinics of three general hospitals in The Netherlands. SUBJECTS A total of 745 patients with type 2 diabetes, treated with insulin and not known with a contraindication for the use of metformin, were approached; 390 gave informed consent and entered the study. Thirty-seven subjects dropped out (12 placebo and 25 metformin users). INTERVENTION Addition of metformin or placebo to insulin therapy. PRIMARY OUTCOME PARAMETERS: Serum homocysteine, folate, vitamin B12, indices of glycaemic control and body weight. RESULTS Amongst those who completed 16 weeks of treatment, metformin use, as compared with placebo, was associated with an increase in homocysteine of 4% (0.2 to 8; P=0.039) and with decreases in folate [-7% (-1.4 to -13); P=0.024] and vitamin B12 [-14% (-4.2 to -24); P<0.0001]. In addition, the increase in homocysteine could be explained by the decreases in folate and vitamin B12. CONCLUSION In patients with type 2 diabetes, 16 weeks of treatment with metformin reduces levels of folate and vitamin B12, which results in a modest increase in homocysteine. The clinical significance of these findings remains to be investigated.
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Affiliation(s)
- M G Wulffelé
- Department of Internal Medicine, Bethesda General Hospital, Hoogeveen, The Netherlands
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Garber A, Marre M, Blonde L, Allavoine T, Howlett H, Lehert P, Cornes M. Influence of initial hyperglycaemia, weight and age on the blood glucose lowering efficacy and incidence of hypoglycaemic symptoms with a single-tablet metformin-glibenclamide therapy (Glucovance) in type 2 diabetes. Diabetes Obes Metab 2003; 5:171-9. [PMID: 12681024 DOI: 10.1046/j.1463-1326.2003.00259.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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: 11/20/2022]
Abstract
AIM To evaluate the efficacy and incidence of hypoglycaemic symptoms associated with fixed combinations of metformin and glibenclamide (glyburide in the USA) formulated within a single tablet (tablet strengths 250 mg/1.25 mg, 500 mg/2.5 mg and 500 mg/5 mg), in comparison with metformin 500 mg and glibenclamide 2.5-5 mg monotherapy, in clinically important patient subgroups within the type 2 diabetic population. METHODS A total of 1856 patients from three randomized, double-blind, multicentre, parallel-group clinical trials were stratified at baseline according to HbA1C (< 8% or > or = 8%), age (< 65 years or > or = 65 years) and body mass index (BMI; < 28 kg/m2 or > or = 28 kg/m2). The effects of study treatments on HbA1C and the incidence of hypoglycaemic symptoms were determined in each subgroup. RESULTS The combination treatments were more effective than either monotherapy irrespective of baseline HbA1C, age or BMI in each trial. Antihyperglycaemic effects were greater in patients with HbA1C > or = 8% at baseline, especially with the combinations. The majority of hypoglycaemic symptoms with glibenclamide-containing treatments occurred in patients with HbA1C < 8% at baseline. Neither age nor BMI had a marked effect on the efficacy of the combination treatments, and there was no increase in hypoglycaemic symptoms in older patients. CONCLUSIONS Single-tablet metformin-glibenclamide combination treatment is more effective than metformin or glibenclamide monotherapy, and is well tolerated in patients with hyperglycaemia inadequately controlled by diet and exercise or antidiabetic monotherapy, irrespective of their severity of hyperglycaemia at baseline, age or weight.
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Affiliation(s)
- A Garber
- Baylor College of Medicine and The Methodist Hospital, Houston, Texas 77030, USA.
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Abstract
OBJECTIVE The aim of this study was to determine whether women's well-being changed with the menopausal transition, and the effect on well-being of other biological, psychosocial and lifestyle factors. METHOD A longitudinal observational study was carried out utilising a population-based sample of 438 mid-aged, Australian- born women. A total of 9 assessments were made at annual intervals. Mood was measured using the Affectometer 2. Mood, menopausal status, psychosocial and lifestyle variables and hormone levels were determined annually. 226 subjects who transited the natural menopausal transition were included in the analysis. RESULTS As women pass from early in the menopausal transition to later in the transition, reporting at least 3 months of amenorrhoea, negative mood declines significantly, positive mood does not change and well-being significantly improves. Well-being scores are highly correlated over time, with early scores having a major effect on later scores. Well-being is also significantly affected by changes in marital status, work satisfaction, daily hassles and life events. CONCLUSIONS Well-being improves as women enter the later stages of the menopausal transition and is also influenced significantly by psychosocial factors.
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Affiliation(s)
- L Dennerstein
- Department of Psychiatry, Faculty of Medicine, The University of Melbourne, Australia.
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40
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Marre M, Howlett H, Lehert P, Allavoine T. Improved glycaemic control with metformin-glibenclamide combined tablet therapy (Glucovance) in Type 2 diabetic patients inadequately controlled on metformin. Diabet Med 2002; 19:673-80. [PMID: 12147149 DOI: 10.1046/j.1464-5491.2002.00774.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [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: 11/20/2022]
Abstract
AIMS To evaluate the efficacy and safety of two dosage strengths of a single-tablet metformin-glibenclamide (glyburide) combination, compared with the respective monotherapies, in patients with Type 2 diabetes mellitus (DM) inadequately controlled by metformin monotherapy. METHODS In this 16-week, double-blind, multicentre, parallel-group trial, 411 patients were randomized to receive metformin 500 mg, glibenclamide 5 mg, metformin-glibenclamide 500 mg/2.5 mg or metformin-glibenclamide 500 mg/5 mg, titrated with the intention to achieve fasting plasma glucose (FPG) < or = 7 mmol/l. RESULTS Decreases in glycated haemoglobin (HbA1c) and FPG were greater (P < 0.05) for metformin-glibenclamide 500 mg/2.5 mg (-1.20% and -2.62 mmol/l) and 500 mg/5 mg (-0.91% and -2.34 mmol/l), compared with metformin (-0.19% and -0.57 mmol/l) or glibenclamide (-0.33% and -0.73 mmol/l). HbA1c < 7% was achieved by 75% and 64% of patients receiving metformin-glibenclamide 500 mg/2.5 mg and 500 mg/5 mg, respectively, compared with 42% for glibenclamide and 38% for metformin (P = 0.001). These benefits were achieved at lower mean doses of metformin or glibenclamide with metformin-glibenclamide 500 mg/2.5 mg and 500 mg/5 mg (1225 mg/6.1 mg and 1170 mg/11.7 mg) than with glibenclamide (13.4 mg) or metformin (1660 mg). Treatment-related serious adverse events occurred in two patients receiving glibenclamide. Plasma lipid profiles were unaffected and mean changes in body weight were < or = 1.0 kg. CONCLUSIONS Intensive management of Type 2 DM with a new metformin-glibenclamide combination tablet improved glycaemic control and facilitated the attainment of glycaemic targets at lower doses of metformin or glibenclamide compared with the respective monotherapies, without compromising tolerability.
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Affiliation(s)
- Michel Marre
- Diabetology-Endocrinology-Metabolism Unit, Hospital of Xavier Bichat, 46 Rue Henri Huchard, 75877 Paris Cedex 18, France
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Abstract
OBJECTIVE Critical review of statistical techniques used to analyze data from longitudinal studies. METHOD Literature search and classification of statistical methods and their utilization evaluated against known underlying assumptions. RESULTS One hundred and twenty-three papers found: 1. cross-sectional reduction of data (56%); 2. multifactorial techniques (26%); 3. repeated measurement analysis of variance (14%); 4. other (time series and structural equation modelling) (4%). CONCLUSIONS Cross-sectional reduction violates underlying statistical assumptions. A simple and powerful technique is to mean values prior to and following an event such as the final menstrual period. To allow for the influence of multiple factors, linear regression is preferred to logistic regression where continuous data are available. For more information about evolution in time, more complex techniques are needed. A suitable technique is repeated measurement multivariate analysis of variance using a number of contrasts to estimate various effects. Split plot or randomized block designs cannot be recommended as they violate compound symmetry assumptions. For series involving more than 100 observations for each subject, time series and spectral analysis techniques should be considered. Structural equation modelling is recommended for examination in detail of a range of factors that may influence the studied end-point, the presence of feedback and of latent or non-measurable variables.
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Affiliation(s)
- P Lehert
- Statistical Department, Faculty of Economics, University of Mons, Belgium
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Wulffelé MG, Kooy A, Lehert P, Bets D, Oom JA, Borger van der Burg B, Donker AJM, Stehouwer CDA. Discontinuation of metformin in type 2 diabetes patients treated with insulin. Neth J Med 2002; 60:249-52. [PMID: 12365468] [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: 02/26/2023]
Abstract
BACKGROUND Metformin added to insulin therapy in type 2 diabetic patients improves glycaemic control and decreases the required daily dose of insulin (DDI). Metformin should be discontinued if cardiac, hepatic or renal failure develops. We examined whether glycaemic control can be maintained after metformin cessation. METHODS We included 45 type 2 diabetic patients treated with insulin plus metformin, and 45 matched controls treated with insulin only. After discontinuation of metformin in the first group, we aimed for tight fasting and postprandial blood glucose levels, 4-7 and 4-10 mmol/l, respectively, in both groups. During 12 weeks we assessed glycaemic control every two weeks and, if necessary, adjusted the insulin dosage. RESULTS In the group in which metformin was discontinued, DDI increased from 67.9 +/- 22.9 to 92.2 +/- 29.4 IU (p < 0.001) leaving glycaemic control unchanged. In the controls, glycated haemoglobin (GHb) decreased by 0.93% (p < 0.001), while DDI increased slightly from 62.4 +/- 22.9 to 72.3 +/- 27.3 IU (p < 0.001). The increase in DDI was larger in patients in whom metformin was discontinued than in the controls (p < 0.001). CONCLUSIONS In type 2 diabetic patients treated with insulin plus metformin, glycaemic control can be maintained after discontinuation of metformin by increasing the DDI substantially (20 to 36%) during application of an intensified treatment protocol.
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Affiliation(s)
- M G Wulffelé
- Bethesda Hospital Hoogeveen, Department of Internal Medicine, The Netherlands
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Spengel F, Clément D, Boccalon H, Liard F, Brown T, Lehert P. Findings of the Naftidrofuryl in Quality of Life (NIQOL) European study program. INT ANGIOL 2002; 21:20-7. [PMID: 11941270] [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: 02/24/2023]
Abstract
BACKGROUND We report in this paper the findings of a pooled analysis of 3 previously published studies undertaken in Germany, France and Belgium to assess the effects of naftidrofuryl on the quality of life of patients with intermittent claudication. METHODS A total of 754 patients were randomised in the 3 studies, 709 of whom (358 naftidrofuryl, 351 placebo) were available for the primary intention-to-treat analysis. The primary outcome variable was the change in the disease-related limitation of the quality of life as measured by the CLAU-S questionnaire. This instrument which has been validated in an international study, comprises 47 questions covering 5 dimensions: "daily living", "pain", "social life", "disease specific anxiety" and "mood". RESULTS A multivariate analysis of covariance adjusted for baseline values, study effect and first order study treatment interaction, demonstrated the global superiority of naftidrofuryl over placebo (p<0.001). A separate covariance analysis for the 5 dimensions showed highly significant differences for "daily living", "pain", "social life" and "mood" (all p<0.01). CONCLUSIONS In conclusion, this pooled analysis has shown that naftidrofuryl can significantly improve the quality of life of patients with intermittent claudication. These findings, taken together with evidence from previous studies that it improves treadmill walking distances, suggest that naftidrofuryl can play a useful role in the treatment of this condition.
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Affiliation(s)
- F Spengel
- Klinik Feldafing, Feldafing, Germany.
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D'Hooge D, Lehert P, Clement DL. Naftidrofuryl in quality of life (NIQOL). A Belgian study. INT ANGIOL 2001; 20:288-94. [PMID: 11782694] [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: 02/23/2023]
Abstract
BACKGROUND Using a disease specific questionnaire, the Claudication Scale (CLAU-S), we undertook a double blind, placebo controlled study in patients with intermittent claudication (IC) to determine whether the increase in the pain-free walking distance, previously demonstrated with naftidrofuryl, is reflected as an improvement in the patients' quality of life. METHODS Following an initial one month placebo run-in 235 patients, with stable IC for at least 3 months, were randomized to either naftidrofuryl (Praxilene), at a dosage of 200 mg three times daily, or matching placebo, for 6 months. All patients completed the self-administered CLAU-S questionnaire which is divided into 6 dimensions, before the start of treatment, at 3 and at 6 months. Statistical analysis was undertaken on an intention-to-treat (ITT) basis which included all patients known to have taken at least one dose of the drug and to have provided key data on at least one occasion after baseline. For each of the CLAU-S dimensions the two groups were compared in respect to difference between the initial and final values. RESULTS Two hundred and twenty patients (108 naftidrofuryl, 112 placebo) were eligible for the ITT analysis. Significant improvements, in favour of the active medication, were seen for the dimensions Daily living, Pain and Social life (all p<0.01). For the dimensions complaints, disease specific fears and mood, there were no significant differences between naftidrofuryl and placebo. A multivariate analysis of covariance, which took into account such factors as initial score, age and sex confirmed the global superiority of naftidrofuryl (p=0.047). CONCLUSIONS In this placebo controlled study, using a disease specific questionnaire, naftidrofuryl has been shown to significantly improve several aspects of the quality of life of patients with IC.
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Affiliation(s)
- D D'Hooge
- On behalf of the investigators of the NIQOL study: MERCK nv/sa, Overijse, Belgium.
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Abstract
The design of this study was based on the European guidelines for the treatment of Alzheimer's disease. After a placebo run-in period of 4 weeks, patients with a diagnosis of vascular dementia (VaD) were randomised to receive either 400 mg naftidrofuryl/day, 600 mg naftidrofuryl/day or placebo for 6 months. The patients were assessed using the ADAS-cog, the SCAG, the NOSGER and the CGI item 2 scale. The primary analysis was undertaken on the ITT population. At the end of the study, significantly more patients in the treatment groups showed no deterioration on both ADAS-cog and SCAG scales compared with placebo (400 mg p = 0.005, 600mg p = 0.015). There were also significant differences between the active and placebo groups for the individual scales. This study has demonstrated that treatment with naftidrofuryl can slow the rate of deterioration of patients with vascular dementia.
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Affiliation(s)
- H J Möller
- Psychiatrische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Germany
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Abstract
To test acamprosate's role as an aid in preventing relapse after detoxification, 296 alcohol-dependent patients entered a prospective, multicentre, randomized, double-blind, parallel comparison of acamprosate treatment consisting of two 333 mg tablets given three times daily for 180 days with matching placebo treatment. Unlike previous studies, acamprosate was prescribed from the start of alcohol withdrawal, rather than after the detoxification process. During the treatment period, 110 patients dropped out. The two treatment groups were balanced with regard to baseline values and reasons for discontinuation. There was no difference between the groups in the severity of withdrawal symptoms as measured by the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol scale). Acamprosate given during withdrawal did not cause unwanted effects. The cumulative abstinence duration (CAD, main end-point) was 19 days longer in the acamprosate treatment group than the placebo treatment group (analysis of variance on ranks, P = 0.0006) and the stable recovery duration, defined as the number of abstinent days between the last relapse into any drinking and the end of the trial, was 16 days longer in the acamprosate treatment group (P = 0.021). Continuous abstinence, estimated by survival analysis on time to first relapse, was achieved by 35% of acamprosate-treated patients and 26% of placebo-treated patients (log rank P = 0.068). The geometric mean of the ratio final/baseline values for serum carbohydrate-deficient transferrin was 0.802 (placebo) and 0.733 (acamprosate) (P = 0.059). The geometric mean of the ratio final/baseline values for serum gamma-glutamyltransferase was 0.496 (placebo) and 0.415 (acamprosate) (P = 0.024) which corroborated the greater abstinence reported by the acamprosate group.
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Affiliation(s)
- A Gual
- Unitat d'Alcohologia de la Generalitat, IMD, Hospital Clínic, Villarroel 136, 08036 Barcelona, Spain
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Abstract
This article examines sex-questionnaire data using the Personal Experiences Questionnaire (PEQ; Dennerstein, Hopper, & Burger, 1997). We used data from a population-based sample of 354 Australian mid-aged women and an optimization procedure in order to reduce the length of the PEQ while retaining items measuring the components of female sexual functioning and key determinants. Eight items were selected. We recommend retaining the item related to orgasm (rejected for parsimony only). Eight of the nine items were from the McCoy Female Sexuality Questionnaire, confirming the validity of this source scale. The original wording in the McCoy scale is recommended as considerable data has now become available on reliability and validity.
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Affiliation(s)
- L Dennerstein
- Office for Gender and Health, Department of Psychiatry, 6th Floor, Charles Connibere Building, University of Melbourne, Royal Melbourne Hospital, Victoria 3050, Australia.
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Abstract
PURPOSE To evaluate the physiological walking distance measured with the Peripheral Arterial Disease Holter Control device (PADHOC) after 12 months of treatment with naftidrofuryl in a double blind placebo controlled, parallel group study, in patients presenting with intermittent claudication. MATERIAL AND METHODS The outpatients selected were of both sexes, aged 40 to 80, with a chronic, stable intermittent claudication and an ankle brachial index between 0.60 and 0.90. They received naftidrofuryl 200 mg tid or placebo for 12 months. Outcome measures included physiological painfree and maximal walking distances using the PADHOC device. The principle of this device is the measurement of the intermalleolar distances using ultrasound telemetry. The PADHOC measures the walking distance and the speed profile in an ambulatory subject. RESULTS 182 patients were randomised and 168 entered the intention to treat analysis. The two groups were well matched for demographic variables, risk factors and history of vascular disease. After 12-month treatment, patients who received naftidrofuryl had a 107% improvement of geometric physiological pain-free walking distance versus 12% in the placebo group (P < 0.001) and 74% improvement of geometric maximal physiological walking distance versus 1% in the placebo group (P < 0.001). CONCLUSION This study demonstrates the efficacy of naftidrofuryl versus placebo in patients with intermittent claudication using a new device measuring the walking distances of the patients in a more physiological way than the treadmill test.
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Affiliation(s)
- H Boccalon
- Service de médecine vasculaire, hôpital Rangueil, 1, avenue Jean Poulhes, 31403 Toulouse, France
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Abstract
This study determined which variables affect women's positive mood state during the menopausal transition using nine prospective annual assessments of a population based sample of 267 Australian mid-aged women. Longitudinal data analysis carried out by analysis of covariance on Summary Statistics found that positive mood scores remained stable over time and were not related to natural menopausal transition, age, or education. In the early phase of the menopausal transition, positive mood was adversely influenced by baseline interpersonal stress (p = .009) and negative attitudes to aging (p = .026). The most important predictor of positive mood at the phase of late peri-/ postmenopause was positive mood in the premenopause (p = .000). Other factors affecting positive mood in the late peri-/postmenopause were changes in dysphoric symptoms (p = .000), major life events (p = .041), daily hassles (p = .014), marital status (p = .007), and work satisfaction (p = .001). Structural equation modelling found a goodness of fit index of .821.
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Affiliation(s)
- L Dennerstein
- Royal Melbourne Hospital, Office for Gender and Health, Department of Psychiatry, The University of Melbourne, Vic, Australia
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Lehert P. Quality-of-life assessment in comparative therapeutic trials and causal structure considerations in peripheral occlusive arterial disease. Pharmacoeconomics 2001; 19:121-130. [PMID: 11284379 DOI: 10.2165/00019053-200119020-00002] [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: 05/23/2023]
Abstract
When considering the use of quality of life as a primary end-point in phase III to IV comparative trials, the trial designer generally faces some unresolved questions. These include: How does one explain that some dimensions [quality-of-life (QOL) instruments usually have more than 1 dimension] are directly influenced by the studied treatments whereas others are not? How can one interpret conflicting results between conventional clinical measurements and QOL measurements, when the relationships between conventional clinical measurement and quality of life are not known? In this paper, we consider the use of Structural Equation Modelling (SEM) as a methodological alternative to answer these problems. As an example, we analyse the internal causal structure of the Claudication Scale (CLAU-S), a specific QOL 5-dimensional instrument for peripheral occlusive arterial disease. In applying SEM to different studies and different types of calculation, we suggest that CLAU-S is based on a stable, simple and comprehensive QOL model, is compatible with the general International Classification of Impairments, Disabilities and Handicaps (ICIDH) classification, is coherent and complementary with clinical data measurements and, using differences in a prospective study, considerably improves specificity. We suggest that SEM can help in QOL scale validation, in providing a unified scheme of the inter-relationships between internal dimensions and with external variables, in particular, clinical measurements.
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Affiliation(s)
- P Lehert
- Faculty of Economics, Fucam, Department of Statistics, University of Mons, Belgium
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