According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" ... more According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" acting drugs. Conversely, most of these compounds were shown to easily cross the blood-brain barrier, and hence partly produce their effects by a central mechanism. The relative contribution of each site of action may vary from one drug to another. Aspirin-like drugs may act by inhibiting arachidonate cyclooxygenase in both the damaged tissues and the central nervous system. Finally, these drugs appear to be either selective, or dose-dependent, or nonspecific inhibitors of prostaglandin-synthetases.
PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 co... more PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 community-dwelling individuals, aged 65 and over, was randomly selected from electoral lists of 37 parishes of Gironde after stratification by age, sex, and size of urban unit; 68.9 percent agreed to participate. Baseline information was obtained from a one-hour home interview. Health measures included ADL, IADL, mobility, Rosow scale, and two subjective health assessments. Depressive symptomatology was assessed by the CES-D scale and cognitive functioning by Folstein's MMS. Dependence rates vary from 9.7 percent to 71.9 percent according to the indicator under consideration. Cross-sectional correlations with dependence are significant for age, sex, education, rural setting, joint pain, dyspnea, hearing and visual impairment, MMS score, and depression. In logistic regressions, only dyspnea, MMS score, and depression are always significantly correlated with dependence, whichever the indicator.
e15157Background: Immunotherapy is a new paradigm with EMA approval in melanoma and lung cancer. ... more e15157Background: Immunotherapy is a new paradigm with EMA approval in melanoma and lung cancer. However, recent study has underlined potential drug interactions between immunotherapy and antibiotics or corticoids with decrease of overall survival. The Observatory of Drugs, Medical Devices and Therapeutic Innovations (OMEDIT) Bretagne/ Pays de la Loire (B-PL), in collaboration with the Medical Department of the French Regional Health Insurance, wanted to carry out a study about the impact of these treatments on the efficacy of immunotherapy. Methods: French Regional Health Insurance System (PL) has made an extract in its database for patients who initiated treatment with Nivolumab/Opdivo® and Pembrolizumab/Keytruda® between 02/01/2016 and 30/06/2017. Dispensing of antibiotics, corticoids and antifungals 60 days before initiation of immunotherapy and after the beginning of treatment (within 30 days after). The patient‘s clinical data (age, sex; diagnosis, indication, grade III/IV side-effects, response rat...
Issue Well known drug-drug interaction with some antidepressants, especially selective serotonin ... more Issue Well known drug-drug interaction with some antidepressants, especially selective serotonin reuptake inhibitors which reduce tamoxifen’s effectiveness and associated with an increased risk of death from breast cancer. Description of the problem To identify and characterize the exposure to antidepressants in women with breast cancer treated with tamofixen in a west french area. Retrospective population based cohort study; claims from the French Health insurance database. Women living in Pays de la Loire area, aged 20 years or older treated with tamoxifen for breast cancer in 2018 who had concomitant treatment with antidepressants. Call phone to general practitioner’s and meeting with pharmacist when a high or moderate level drug-drug interaction’s was identified. Results Of 4138 women treated with tamoxifen, 497 (12%) received an antidepressant treatment in 2018, corresponding to 571 co-prescriptions. Of them, 74 (13%) was moderate level drug-drug interaction, 66 (11.6%) high le...
ABSTRACT Cancer patients receiving chemotherapy are at increased risk of venous thromboembolism (... more ABSTRACT Cancer patients receiving chemotherapy are at increased risk of venous thromboembolism (VTE). The presence of cancer and anticoagulant use are risk factors for bleeding, yet data on bleeding risk are limited in these patients. This analysis evaluated the risk of major bleeding in cancer patients receiving chemotherapy using a US claims database. This retrospective cohort study used the MarketScan® databases, a nationwide database containing data from about 100 payers and covering > 30 million patients annually. Adult cancer patients receiving chemotherapy within 6 months of cancer diagnosis between January 2004 and December 2010 were included. Cancers of interest were: lung, colon/rectum, pancreas, bladder, stomach, and ovary. The index date was the first date of chemotherapy. Patients were followed until the earliest of: 1) first diagnosis of major bleeding; 2) termination of enrolment in the health plan; 3) end of study. The primary outcome was the first occurrence of major bleeding, based on selected ICD-9-CM/CPT codes, following chemotherapy initiation. Of 74,575 patients identified, exclusion of those with prior history of bleeding at baseline (∼5%) resulted in 70,822 patients included in the analysis. Mean age was 62 years, 37% were ≥ 65 years, and 52% were male. Average time of follow up and chemotherapy were 14.3 and 8.6 months, respectively; 6% had a history of VTE within 6 months prior to the index date. Major bleeding occurred in 5.8% of patients and the incidence rate for all cancers combined was 4.9 per 100 person-year (PY) and 10.5, 9.3, 6.2, 4.3, 3.6, and 3.3/100 PY for pancreatic, stomach, lung, bladder, colon/rectum, and ovarian cancer, respectively. Approximately 14% of patients (N = 10,456) developed VTE after chemotherapy initiation (> half in the first 3 months of chemotherapy treatment). Of these, 7.8% experienced major bleeding with incidence rates ranging from 5.9-17.7/100 PY after VTE. Major bleeding incidence in cancer patients receiving chemotherapy varies by cancer type with the highest rates in patients with upper gastrointestinal cancer. Compared to the overall cohort, major bleeding risk was higher in cancer patients who developed VTE. Disclosure J.H. Zong: Employee of Sanofi. L. Eckert: Employee of Sanofi. L. Zhang: Employee of Sanofi. W.S. Dai: Employee of Sanofi. A.T. Cohen: Consult: Astellas, AZ, Bayer, BI, BMS, Daiichi, GSK, JJ ResFund: AZ, Bayer, BI, BMS, Daiichi, GSK, JJ BoardSpeakerAdvis comm: Bayer, BI, BMS, Daiichi, GSK, J&J, Mitsubishi, Pfizer, Sanofi. All other authors have declared no conflicts of interest.
Objectives Monitoring the appropriateness of antibiotic prescriptions with indicators based on re... more Objectives Monitoring the appropriateness of antibiotic prescriptions with indicators based on reimbursement data is required to guide antibiotic stewardship (AMS) interventions in nursing homes (NHs). Quantity metrics (QMs) monitor the volume of prescriptions while proxy indicators (PIs) reflect the appropriateness of antibiotic use. Our objectives were: (i) to provide a relevant consensual set of indicators to be used in French NHs; and (ii) to assess the feasibility of their implementation at the national and local scale. Methods Nine French professional organizations implicated in AMS in NHs were asked to nominate at least one member to create a national expert panel of 20 physicians. Twenty-one recently published QMs and 11 PIs were assessed by the expert panel. Indicators were evaluated using a RAND-modified Delphi procedure comprising two online surveys and a videoconference meeting. Indicators were kept in the final list if >70% of stakeholders validated their relevance f...
Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in th... more Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. Methods This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were includ...
TOTHEEDITOR: Cyproterone acetate (CPA) generally is used as an antiandrogen for the treatment of ... more TOTHEEDITOR: Cyproterone acetate (CPA) generally is used as an antiandrogen for the treatment of hirsutism and severe acne in women and for prostatic cancer in men. Since being placed on the market, CPA has been thought to be well tolerated, but few reports of hepatocellular dysfunctions have been published.!" We describe 2 elderly men who died of severe fulminant hepatitis after taking CPA for prostatic cancer. An87-year-old manwasadmitted inDecember 1991 forfatigue anddysphagia. Fourmonths before admission, hestarted taking CPA200mg/d forprostatic cercinoma;othertreatments takenfor 3 yearswereaspirin 250 mg/dand amiodarone 200mg/dforsupraventricular premature contractions. Physical examination was normal. Routine laboratory tests,including liverfunction tests, wereperformed; serumaspartate aminotransferase was208 UIL, serumalanine aminotransferase was 100UlL, andgamma-glutamyttransferase was584UIL. Totalbilirubin was 841!molIL, prothrombin timewasnormal (12s), andsedimentation ratewasnormal. Abdominal ultrasonography showed normal liverandbiliary tract. Serologic tests for infection by hepatitis A, B,and C viruses (hepatitis B surfaceantigen [HBs-AgI, antibody to HBs[anti-Hfss], and antibody to hepatitis C virus[antiHCY))werenegative. Serologic hepatitis B virus-DNA (HBY-DNA) and hepatitisC virus-RNA (HCY-RNA) testswerenegative. Results of assays alsowere negative fora recent infection withcytomegalovirus, Epstein-Barr virus, andherpessimplex virus. Antinuclear, antismooth-muscle, antimitochondrial, andantibody to liver-kidney microsomel (anti-LKM I) antibody tests were negative. Therewasno history of excess alcohol consumption. CPA-induced hepatotoxicity wassuspected; therefore, all drugs were withdrawn. Threeweeksafteradmission hepaticencephalopathy developed, liverfunction enzymesincreased, and prothrombin time decreased (41 s),Thepatient died4 dayslater. Postmortem liverexamination revealed markedly hepatocellular andcholestatic lobular hepatitis and diffuse fibrosis. A 78-year-old manbegan toexperience fatigue in December 1992 andwasadmitted; further symptoms werediarrhea anddiffuse abdominal pain.The patient hadbeengiven CPA 150mg/d forprostatic carcinoma for I year. Healsopresented with Parkinson'sdisease,whichwas treatedwith levodopa, selegiline, and bromocriptine. Physical examination wasnegative except formild diffuse abdominal tenderness. Theserumalanine aminotransferase was86 UIL, serumaspartate aminotransferase was99 UIL, andgamma-glutamyltransferase was252 UIL. Alkaline phosphatases, total bilirubin, andprothrombin timewere normal. Theclinical diagnosis was hepatocellular and cholestatic hepatitis, and an etiologicprocedurewasperformed. Serologic tests forhepatitis virusA, B (HBY-DNA), andC (HCY-RNA) were negative, as were tests fora recent infection withcytomegalovirus, Epstein-Barr virus, andherpes simplex virus. Antinuclear, antismooth-muscle, anti-LKM I, andantimitochondrial antibodies werenegative. Abdominal ultrasonographic examination showed a normal liverandbiliary tract. The patient had usedalcohol sparingly. Despite thefactthatalldrugtherapy hadbeenstopped on admission, thecondition of the patientcontinued to deteriorate and hepaticencephalopathy developed. The patientdied3 weeksafteradmission. Postmortem liverbiopsy revealed hepatocellular andcholestatic hepatitis withsevere predominantcentrilobular necrosis. The clinical features, laboratory results, and time course of these 2 patients are similar to those of the prior reports of CPA-induced hepatotoxicity. Results of a liver biopsy revealing centrilobular necrosis and fibrosis suggest a mechanism of drug-induced hepatitis. In these 2 patients other drug-induced hepatotoxicity cannot be excluded, but usually with amiodarone-induced liver disorders the histologic changes are similar to those induced by alcohol and include steatosis. No acute or fulminant hepatitis has been reported with low dosages of aspirin, levodopa,selegiline, or bromocriptine. The mechanism by which CPA induces hepatotoxicity is not fully understood, but I of the hypotheses is an idiosyncratic reaction induced by I of its merabolites.-' CPA-induced hepatotoxicity is sometimes reversible on cessation of therapy, but it may be severe and potentially fatal. These 2 cases reinforce the importance of monitoring liver function test results in patients receiving CPA.
Issue Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guide... more Issue Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guidelines as a prophylaxis of febrile neutropenia are expensive drugs. Despite biosimilars marketing since 2008, G-CSF spending represents a major and growing expense for health insurance. Description of the problem Between 2010 and 2013 an unsustainable increase of G-CSF spending by 20% occurred in a French area: Pays-la-Loire. An intervention based on guidelines was carried out to the oncologists involved in ambulatory cancer care to reduce G-CSF spending by improving prescription and promoting biosimilars. Hospital oncologists have been the main target. A partnership between physicians and pharmacists of the Brittany - Pays-de-la-Loire Cancer Dedicated Observatory network and the Pays de la Loire Medical Department of Health insurance composed the operational team involved in the work. Interrupted time series analysis based on the French national health data system database were chosen to...
According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" ... more According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" acting drugs. Conversely, most of these compounds were shown to easily cross the blood-brain barrier, and hence partly produce their effects by a central mechanism. The relative contribution of each site of action may vary from one drug to another. Aspirin-like drugs may act by inhibiting arachidonate cyclooxygenase in both the damaged tissues and the central nervous system. Finally, these drugs appear to be either selective, or dose-dependent, or nonspecific inhibitors of prostaglandin-synthetases.
PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 co... more PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 community-dwelling individuals, aged 65 and over, was randomly selected from electoral lists of 37 parishes of Gironde after stratification by age, sex, and size of urban unit; 68.9 percent agreed to participate. Baseline information was obtained from a one-hour home interview. Health measures included ADL, IADL, mobility, Rosow scale, and two subjective health assessments. Depressive symptomatology was assessed by the CES-D scale and cognitive functioning by Folstein's MMS. Dependence rates vary from 9.7 percent to 71.9 percent according to the indicator under consideration. Cross-sectional correlations with dependence are significant for age, sex, education, rural setting, joint pain, dyspnea, hearing and visual impairment, MMS score, and depression. In logistic regressions, only dyspnea, MMS score, and depression are always significantly correlated with dependence, whichever the indicator.
e15157Background: Immunotherapy is a new paradigm with EMA approval in melanoma and lung cancer. ... more e15157Background: Immunotherapy is a new paradigm with EMA approval in melanoma and lung cancer. However, recent study has underlined potential drug interactions between immunotherapy and antibiotics or corticoids with decrease of overall survival. The Observatory of Drugs, Medical Devices and Therapeutic Innovations (OMEDIT) Bretagne/ Pays de la Loire (B-PL), in collaboration with the Medical Department of the French Regional Health Insurance, wanted to carry out a study about the impact of these treatments on the efficacy of immunotherapy. Methods: French Regional Health Insurance System (PL) has made an extract in its database for patients who initiated treatment with Nivolumab/Opdivo® and Pembrolizumab/Keytruda® between 02/01/2016 and 30/06/2017. Dispensing of antibiotics, corticoids and antifungals 60 days before initiation of immunotherapy and after the beginning of treatment (within 30 days after). The patient‘s clinical data (age, sex; diagnosis, indication, grade III/IV side-effects, response rat...
Issue Well known drug-drug interaction with some antidepressants, especially selective serotonin ... more Issue Well known drug-drug interaction with some antidepressants, especially selective serotonin reuptake inhibitors which reduce tamoxifen’s effectiveness and associated with an increased risk of death from breast cancer. Description of the problem To identify and characterize the exposure to antidepressants in women with breast cancer treated with tamofixen in a west french area. Retrospective population based cohort study; claims from the French Health insurance database. Women living in Pays de la Loire area, aged 20 years or older treated with tamoxifen for breast cancer in 2018 who had concomitant treatment with antidepressants. Call phone to general practitioner’s and meeting with pharmacist when a high or moderate level drug-drug interaction’s was identified. Results Of 4138 women treated with tamoxifen, 497 (12%) received an antidepressant treatment in 2018, corresponding to 571 co-prescriptions. Of them, 74 (13%) was moderate level drug-drug interaction, 66 (11.6%) high le...
ABSTRACT Cancer patients receiving chemotherapy are at increased risk of venous thromboembolism (... more ABSTRACT Cancer patients receiving chemotherapy are at increased risk of venous thromboembolism (VTE). The presence of cancer and anticoagulant use are risk factors for bleeding, yet data on bleeding risk are limited in these patients. This analysis evaluated the risk of major bleeding in cancer patients receiving chemotherapy using a US claims database. This retrospective cohort study used the MarketScan® databases, a nationwide database containing data from about 100 payers and covering > 30 million patients annually. Adult cancer patients receiving chemotherapy within 6 months of cancer diagnosis between January 2004 and December 2010 were included. Cancers of interest were: lung, colon/rectum, pancreas, bladder, stomach, and ovary. The index date was the first date of chemotherapy. Patients were followed until the earliest of: 1) first diagnosis of major bleeding; 2) termination of enrolment in the health plan; 3) end of study. The primary outcome was the first occurrence of major bleeding, based on selected ICD-9-CM/CPT codes, following chemotherapy initiation. Of 74,575 patients identified, exclusion of those with prior history of bleeding at baseline (∼5%) resulted in 70,822 patients included in the analysis. Mean age was 62 years, 37% were ≥ 65 years, and 52% were male. Average time of follow up and chemotherapy were 14.3 and 8.6 months, respectively; 6% had a history of VTE within 6 months prior to the index date. Major bleeding occurred in 5.8% of patients and the incidence rate for all cancers combined was 4.9 per 100 person-year (PY) and 10.5, 9.3, 6.2, 4.3, 3.6, and 3.3/100 PY for pancreatic, stomach, lung, bladder, colon/rectum, and ovarian cancer, respectively. Approximately 14% of patients (N = 10,456) developed VTE after chemotherapy initiation (> half in the first 3 months of chemotherapy treatment). Of these, 7.8% experienced major bleeding with incidence rates ranging from 5.9-17.7/100 PY after VTE. Major bleeding incidence in cancer patients receiving chemotherapy varies by cancer type with the highest rates in patients with upper gastrointestinal cancer. Compared to the overall cohort, major bleeding risk was higher in cancer patients who developed VTE. Disclosure J.H. Zong: Employee of Sanofi. L. Eckert: Employee of Sanofi. L. Zhang: Employee of Sanofi. W.S. Dai: Employee of Sanofi. A.T. Cohen: Consult: Astellas, AZ, Bayer, BI, BMS, Daiichi, GSK, JJ ResFund: AZ, Bayer, BI, BMS, Daiichi, GSK, JJ BoardSpeakerAdvis comm: Bayer, BI, BMS, Daiichi, GSK, J&J, Mitsubishi, Pfizer, Sanofi. All other authors have declared no conflicts of interest.
Objectives Monitoring the appropriateness of antibiotic prescriptions with indicators based on re... more Objectives Monitoring the appropriateness of antibiotic prescriptions with indicators based on reimbursement data is required to guide antibiotic stewardship (AMS) interventions in nursing homes (NHs). Quantity metrics (QMs) monitor the volume of prescriptions while proxy indicators (PIs) reflect the appropriateness of antibiotic use. Our objectives were: (i) to provide a relevant consensual set of indicators to be used in French NHs; and (ii) to assess the feasibility of their implementation at the national and local scale. Methods Nine French professional organizations implicated in AMS in NHs were asked to nominate at least one member to create a national expert panel of 20 physicians. Twenty-one recently published QMs and 11 PIs were assessed by the expert panel. Indicators were evaluated using a RAND-modified Delphi procedure comprising two online surveys and a videoconference meeting. Indicators were kept in the final list if >70% of stakeholders validated their relevance f...
Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in th... more Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. Methods This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were includ...
TOTHEEDITOR: Cyproterone acetate (CPA) generally is used as an antiandrogen for the treatment of ... more TOTHEEDITOR: Cyproterone acetate (CPA) generally is used as an antiandrogen for the treatment of hirsutism and severe acne in women and for prostatic cancer in men. Since being placed on the market, CPA has been thought to be well tolerated, but few reports of hepatocellular dysfunctions have been published.!" We describe 2 elderly men who died of severe fulminant hepatitis after taking CPA for prostatic cancer. An87-year-old manwasadmitted inDecember 1991 forfatigue anddysphagia. Fourmonths before admission, hestarted taking CPA200mg/d forprostatic cercinoma;othertreatments takenfor 3 yearswereaspirin 250 mg/dand amiodarone 200mg/dforsupraventricular premature contractions. Physical examination was normal. Routine laboratory tests,including liverfunction tests, wereperformed; serumaspartate aminotransferase was208 UIL, serumalanine aminotransferase was 100UlL, andgamma-glutamyttransferase was584UIL. Totalbilirubin was 841!molIL, prothrombin timewasnormal (12s), andsedimentation ratewasnormal. Abdominal ultrasonography showed normal liverandbiliary tract. Serologic tests for infection by hepatitis A, B,and C viruses (hepatitis B surfaceantigen [HBs-AgI, antibody to HBs[anti-Hfss], and antibody to hepatitis C virus[antiHCY))werenegative. Serologic hepatitis B virus-DNA (HBY-DNA) and hepatitisC virus-RNA (HCY-RNA) testswerenegative. Results of assays alsowere negative fora recent infection withcytomegalovirus, Epstein-Barr virus, andherpessimplex virus. Antinuclear, antismooth-muscle, antimitochondrial, andantibody to liver-kidney microsomel (anti-LKM I) antibody tests were negative. Therewasno history of excess alcohol consumption. CPA-induced hepatotoxicity wassuspected; therefore, all drugs were withdrawn. Threeweeksafteradmission hepaticencephalopathy developed, liverfunction enzymesincreased, and prothrombin time decreased (41 s),Thepatient died4 dayslater. Postmortem liverexamination revealed markedly hepatocellular andcholestatic lobular hepatitis and diffuse fibrosis. A 78-year-old manbegan toexperience fatigue in December 1992 andwasadmitted; further symptoms werediarrhea anddiffuse abdominal pain.The patient hadbeengiven CPA 150mg/d forprostatic carcinoma for I year. Healsopresented with Parkinson'sdisease,whichwas treatedwith levodopa, selegiline, and bromocriptine. Physical examination wasnegative except formild diffuse abdominal tenderness. Theserumalanine aminotransferase was86 UIL, serumaspartate aminotransferase was99 UIL, andgamma-glutamyltransferase was252 UIL. Alkaline phosphatases, total bilirubin, andprothrombin timewere normal. Theclinical diagnosis was hepatocellular and cholestatic hepatitis, and an etiologicprocedurewasperformed. Serologic tests forhepatitis virusA, B (HBY-DNA), andC (HCY-RNA) were negative, as were tests fora recent infection withcytomegalovirus, Epstein-Barr virus, andherpes simplex virus. Antinuclear, antismooth-muscle, anti-LKM I, andantimitochondrial antibodies werenegative. Abdominal ultrasonographic examination showed a normal liverandbiliary tract. The patient had usedalcohol sparingly. Despite thefactthatalldrugtherapy hadbeenstopped on admission, thecondition of the patientcontinued to deteriorate and hepaticencephalopathy developed. The patientdied3 weeksafteradmission. Postmortem liverbiopsy revealed hepatocellular andcholestatic hepatitis withsevere predominantcentrilobular necrosis. The clinical features, laboratory results, and time course of these 2 patients are similar to those of the prior reports of CPA-induced hepatotoxicity. Results of a liver biopsy revealing centrilobular necrosis and fibrosis suggest a mechanism of drug-induced hepatitis. In these 2 patients other drug-induced hepatotoxicity cannot be excluded, but usually with amiodarone-induced liver disorders the histologic changes are similar to those induced by alcohol and include steatosis. No acute or fulminant hepatitis has been reported with low dosages of aspirin, levodopa,selegiline, or bromocriptine. The mechanism by which CPA induces hepatotoxicity is not fully understood, but I of the hypotheses is an idiosyncratic reaction induced by I of its merabolites.-' CPA-induced hepatotoxicity is sometimes reversible on cessation of therapy, but it may be severe and potentially fatal. These 2 cases reinforce the importance of monitoring liver function test results in patients receiving CPA.
Issue Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guide... more Issue Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guidelines as a prophylaxis of febrile neutropenia are expensive drugs. Despite biosimilars marketing since 2008, G-CSF spending represents a major and growing expense for health insurance. Description of the problem Between 2010 and 2013 an unsustainable increase of G-CSF spending by 20% occurred in a French area: Pays-la-Loire. An intervention based on guidelines was carried out to the oncologists involved in ambulatory cancer care to reduce G-CSF spending by improving prescription and promoting biosimilars. Hospital oncologists have been the main target. A partnership between physicians and pharmacists of the Brittany - Pays-de-la-Loire Cancer Dedicated Observatory network and the Pays de la Loire Medical Department of Health insurance composed the operational team involved in the work. Interrupted time series analysis based on the French national health data system database were chosen to...
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