Journal of Generic Medicines: The Business Journal for the Generic Medicines Sector
Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-... more Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-name drugs for generic drugs. They are expected to understand the principles and practices of generic drug substitution for high-quality patient care. Some key areas of knowledge include bioequivalence and therapeutic equivalence, regulatory requirements, drug interchangeability, and adequate patient counseling. Objectives This study aims to assess the knowledge, perception, and practice of generic drug substitution among pharmacists in Lebanon following the crises and the factors affecting the prescription and selection of generic drugs. Methods A pilot descriptive cross-sectional study targeting 80 Lebanese pharmacists was conducted over 2 months (September-October 2022), in which data were collected using a uniform survey. Results Overall, pharmacists had a good knowledge of generic drugs in terms of active ingredients (97.5%), pharmaceutical form (85.0%), lower cost (88.7%), bioequiv...
Alopecia has become a growing concern since it directly affects the quality of life of the patien... more Alopecia has become a growing concern since it directly affects the quality of life of the patients. It can be stimulated by various factors including stress, lifestyle changes, genetic predisposition, and aging. The objectives of this study were to evaluate the lifestyle patterns of alopecia patients, to understand alopecia´s characteristics and treatment options, and finally to assess the factors affecting the willingness to undergo treatment. An observational crosssectional study was conducted targeting 171 alopecia patients in the Lebanese adult population in 2020. A survey was administered during face-to-face interviews to collect the study data. Almost half of the participants in this study were smokers and alcohol consumers. For the majority of participants, alopecia initiated between 20 and 40 years and was associated with family history. Moreover, the willingness to use hair loss treatment is higher with age and university graduates had 5.05 higher odds to use them compared...
La prise en charge contemporaine du cancer repose de plus en plus sur le concept de medecine dite... more La prise en charge contemporaine du cancer repose de plus en plus sur le concept de medecine dite personnalisee qui permet, apres identification des caracteristiques propres de la tumeur, d'envisager une therapeutique adaptee a chaque patient. La meilleure connaissance de la biologie des cancers et la mise en evidence de nouvelles cibles therapeutiques ont ainsi abouti au developpement des therapies ciblees qui vont agir sur une cible cellulaire, generalement surexprimee au niveau d'une tumeur, leur conferant une plus grande specificite d'action tumorale et un profil d'effets indesirables moins marque par rapport a la therapie cytotoxique conventionnelle. Malgre les donnees d'efficacite clinique, rapportees sur les strategies therapeutiques integrant des therapies ciblees, on ne dispose pas, malheureusement, des etudes pharmaco-economiques en cancerologie surtout que ces medicaments se caracterisent par leurs couts tres eleves (exemple: bevacizumab 1000 euros/400...
Supplemental material, Hospital_pharmacy_survey._11.26.18 for Current Trends in Hospital Pharmacy... more Supplemental material, Hospital_pharmacy_survey._11.26.18 for Current Trends in Hospital Pharmacy Practice in Lebanon by Nibal Chamoun, Ulfat Usta, Lamis R. Karaoui, Pascale Salameh, Souheil Hallit, Patricia Shuhaiber, Anna-Maria Henaine, Youssef Akiki, Rony M. Zeenny and Katia Iskandar in Hospital Pharmacy
Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating phar... more Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating pharmacy practice worldwide. Recently, the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP), the European Association of Hospital Pharmacists (EAHP), and the American Society of Health-System Pharmacists (ASHP) updated their statements about the future role and responsibilities of the pharmacy executive in hospitals and health systems. A series of surveys were conducted around the globe to better understand the current state of hospital pharmacy practice. The purpose of these surveys was to identify challenges in hospital pharmacy practice and to develop improvement strategies. The objective of this national survey is to evaluate hospital pharmacy practice in Lebanon. Methods: A cross-sectional observational study was performed among pharmacists working in hospital settings in Lebanon, from January through June 2016. Based on a literature review, a questionnaire...
Journal of Clinical Pharmacy and Therapeutics, 2014
Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last d... more Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last decade with the emergence of new regimens combining radiotherapy plus temozolomide and the use of bevacizumab at recurrence. Our aim was to assess the clinical and economic impacts of those novel strategies in our center. A single-center retrospective chart review was conducted on patients newly diagnosed with a GBM over two periods (year 2004, group 1 or year 2008, group 2) with limitations to those eligible to radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total costs from diagnosis to death or the last follow-up date. Cost analysis was performed under the French Sickness Fund perspective using tariffs from 2012. One hundred twenty-two patients were selected (49 in group 1 and 73 in group 2) with similar baseline characteristics within the two groups. Patients from group 2 received more frequently temozolomide radiochemotherapy (71% vs. 39%, P < 0·05) as first-line treatment as well as bevacizumab regimen at recurrence (48% vs. 6%, P < 0·05); the median overall survival was increased between the two periods (respectively 17 vs. 10 months, P < 0·05). The mean total cost per patient was 54,388 € in group 1 and 71,148 € in group 2 (P < 0·05). Hospital care represented the largest expenditure (76% and 58% in groups 1 and 2 respectively) followed by chemotherapy drugs costs (11% and 30% respectively). The total cost difference between the two groups was explained by the increasing use of temozolomide and bevacizumab. The incremental cost-effectiveness ratio was estimated at 54,355 € per life-year gained. As far as we know, this is the first study reporting the total cost of GBM management based on the French perspective, as well as the cost-effectiveness of clinical practices in term of cost per life-year gained. Those novel strategies have contributed to improve overall survival while inducing a substantial, but acceptable, increase of total costs.
Introduction Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. F... more Introduction Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. Following appraisal by health technology assessment (HTA) bodies, this medicine has not been widely covered across European countries. We have compared the HTA process in England and France. Area covered We undertook an analysis of relevant documents that were published by the two HTA bodies. We analyzed patients’ availability of Ocrelizumab at the different stages of the process. Expert opinion We identified differences in the assessment, one being the use of a different population of the pivotal trial, which has resulted in the consideration of distinct clinical effectiveness estimates. Ocrelizumab became available earlier in France as part of an early access program. However, rapid access was discontinued for newly eligible patients following an opinion concluding that Ocrelizumab yielded no additional benefit over placebo. This opinion was not compatible with the criteria allowing rei...
Journal of Clinical Pharmacy and Therapeutics, 2016
Trends in the care of glioblastoma in actual practice settings are poorly described. In a previou... more Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma (GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade.
Le Journal médical libanais. The Lebanese medical journal
Medication prescribing errors are made all over the world. However, exact data about them are lac... more Medication prescribing errors are made all over the world. However, exact data about them are lacking in Lebanon. Our objective was to describe medication errors, including drug-drug interactions in medication orders given to patients admitted to Lebanese hospitals. A prospective study was carried out on 313 patients taken from seven Lebanese hospitals; 1826 medication orders were assessed for errors and 456 drug-drug interactions were found. Data was entered and analyzed on SPSS. Around 40% of medication orders were judged to comprise at least one prescribing error, mainly no ordering of parameters monitoring (20%), unnecessary medication (9%), and no indication (7%). Errors occurred mainly in the pediatrics (50%) and internal medicine wards (40%). Having an infectious or gastrointestinal problem almost doubled the risk of medication prescribing error. Antiulcer agents, NSAIDs, antibiotics and steroidal agents were the medications mainly involved. Meanwhile, 12 adverse medication e...
Objectives: To evaluate the association between sociodemographic characteristics and antibiotic k... more Objectives: To evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population. Methods: A questionnaire-based survey was conducted in community pharmacies from all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January 1 until March 31, 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes, and a linear regression model was performed to assess factors associated with knowledge. Results: An antibiotic knowledge index was computed for 623 participants, with a minimum score of 3 and a maximum score of 19 (average of 12.5 ± 3.2). Higher knowledge score was inversely correlated with age (r = -0.118; P = 0.003), but no gender differences were reported (12.6 for females vs. 12.3 for males) (P >0.05). However, differences were statistically significant for residence type, ed...
Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Managem... more Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Management of meta-static colorectal cancer: Current treatments and new therapies. J Med Liban 2015 ; 63 (4) : 218-227. Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Prise en charge du cancer colorectal métastatique : Traitements standards et nouveau-tés thérapeutiques. J Med Liban 2015 ; 63 (4) : 218-227. RÉSUMÉ • Le cancer colorectal représente 8% des cas de cancers métastatiques. Pendant des décennies, la chimio-thérapie associant le 5-Fluorouracil (5-FU) et l'acide folinique a constitué le traitement conventionnel de référence. L'arri-vée de l'irinotécan, de l'oxaliplatine et des formes orales de 5-FU au cours des années 90 a été considérée comme une grande avancée thérapeutique. À partir de 2004, la thérapie ciblée, avec les anticorps monoclonaux visant les récepteurs EGF et l'angiogenèse (VEGF), a permis un bénéfice en termes de survie même si le cancer colorectal métastatique reste, à ce jour, incurable. Nous présentons la prise en charge ac-tuelle du cancer colorectal métastatique, le développement clinique de ces traitements émergents et leur positionnement dans le système de santé libanais. ABSTRACT • Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil (5-FU) associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system.
Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thr... more Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thromebomlic complications. Periodic laboratory testing of international normalized ratio (INR) and a subsequent dose adjustment are therefore mandatory. The use of home testing devices to measure INR has been suggested as a potential way to improve the comfort and compliance of the patients and their families, the frequency of monitoring and, finally, the management and safety of long-term oral anticoagulation. In pediatric patients, increased doses to obtain and maintain the therapeutic target INR, more frequent adjustments and INR testing, multiple medication, inconstant nutritional intake, difficult venepunctures, and the need to go to the laboratory for testing (interruption of school and parents' work attendance) highlight those difficulties. After reviewing the most relevant published studies of self-testing and self-management of INR for adult patients and children on oral anticoagulation, it seems that these are valuable and effective strategies of INR control. Despite an unclear relationship between INR control and clinical effects, these self-strategies provide a better control of the anticoagulant effect, improve patients and their family quality of life, and are an appealing solution in term of cost-effectiveness. Structured education and knowledge evaluation by trained health care professionals is required for children, to be able to adjust their dose treatment safely and accurately. However, further data are necessary in order to best define those patients who might better benefit from this multidisciplinary approach.
Le Journal médical libanais. The Lebanese medical journal
Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has... more Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil (5-FU) associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system.
SUMMARY What is known and objective: Therapeutic options for the management of glioblastoma (GBM)... more SUMMARY What is known and objective: Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last decade with the emergence of new regimens combining radiotherapy plus temozolomide and the use of bevacizumab at recurrence. Our aim was to assess the clinical and economic impacts of those novel strategies in our center. Methods: A single-center retrospective chart review was conducted on patients newly diagnosed with a GBM over two periods (year 2004, group 1 or year 2008, group 2) with limitations to those eligible to radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total costs from diagnosis to death or the last follow-up date. Cost analysis was performed under the French Sickness Fund perspective using tariffs from 2012. Results: One hundred twenty-two patients were selected (49 in group 1 and 73 in group 2) with similar baseline characteristics within the two groups. Patients from group 2 received more frequently temozolomide radiochemotherapy (71% vs. 39%, P < 0Á05) as first-line treatment as well as bevacizumab regimen at recurrence (48% vs. 6%, P < 0Á05); the median overall survival was increased between the two periods (respectively 17 vs. 10 months, P < 0Á05). The mean total cost per patient was 54 388 € in group 1 and 71 148 € in group 2 (P < 0Á05). Hospital care represented the largest expenditure (76% and 58% in groups 1 and 2 respectively) followed by chemotherapy drugs costs (11% and 30% respectively). The total cost difference between the two groups was explained by the increasing use of temozolomide and bevacizumab. The incremental cost-effectiveness ratio was estimated at 54 355 € per life-year gained. What is new and conclusion: As far as we know, this is the first study reporting the total cost of GBM management based on the French perspective, as well as the cost-effectiveness of clinical practices in term of cost per life-year gained. Those novel strategies have contributed to improve overall survival while inducing a substantial, but acceptable, increase of total costs.
Journal of Generic Medicines: The Business Journal for the Generic Medicines Sector
Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-... more Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-name drugs for generic drugs. They are expected to understand the principles and practices of generic drug substitution for high-quality patient care. Some key areas of knowledge include bioequivalence and therapeutic equivalence, regulatory requirements, drug interchangeability, and adequate patient counseling. Objectives This study aims to assess the knowledge, perception, and practice of generic drug substitution among pharmacists in Lebanon following the crises and the factors affecting the prescription and selection of generic drugs. Methods A pilot descriptive cross-sectional study targeting 80 Lebanese pharmacists was conducted over 2 months (September-October 2022), in which data were collected using a uniform survey. Results Overall, pharmacists had a good knowledge of generic drugs in terms of active ingredients (97.5%), pharmaceutical form (85.0%), lower cost (88.7%), bioequiv...
Alopecia has become a growing concern since it directly affects the quality of life of the patien... more Alopecia has become a growing concern since it directly affects the quality of life of the patients. It can be stimulated by various factors including stress, lifestyle changes, genetic predisposition, and aging. The objectives of this study were to evaluate the lifestyle patterns of alopecia patients, to understand alopecia´s characteristics and treatment options, and finally to assess the factors affecting the willingness to undergo treatment. An observational crosssectional study was conducted targeting 171 alopecia patients in the Lebanese adult population in 2020. A survey was administered during face-to-face interviews to collect the study data. Almost half of the participants in this study were smokers and alcohol consumers. For the majority of participants, alopecia initiated between 20 and 40 years and was associated with family history. Moreover, the willingness to use hair loss treatment is higher with age and university graduates had 5.05 higher odds to use them compared...
La prise en charge contemporaine du cancer repose de plus en plus sur le concept de medecine dite... more La prise en charge contemporaine du cancer repose de plus en plus sur le concept de medecine dite personnalisee qui permet, apres identification des caracteristiques propres de la tumeur, d'envisager une therapeutique adaptee a chaque patient. La meilleure connaissance de la biologie des cancers et la mise en evidence de nouvelles cibles therapeutiques ont ainsi abouti au developpement des therapies ciblees qui vont agir sur une cible cellulaire, generalement surexprimee au niveau d'une tumeur, leur conferant une plus grande specificite d'action tumorale et un profil d'effets indesirables moins marque par rapport a la therapie cytotoxique conventionnelle. Malgre les donnees d'efficacite clinique, rapportees sur les strategies therapeutiques integrant des therapies ciblees, on ne dispose pas, malheureusement, des etudes pharmaco-economiques en cancerologie surtout que ces medicaments se caracterisent par leurs couts tres eleves (exemple: bevacizumab 1000 euros/400...
Supplemental material, Hospital_pharmacy_survey._11.26.18 for Current Trends in Hospital Pharmacy... more Supplemental material, Hospital_pharmacy_survey._11.26.18 for Current Trends in Hospital Pharmacy Practice in Lebanon by Nibal Chamoun, Ulfat Usta, Lamis R. Karaoui, Pascale Salameh, Souheil Hallit, Patricia Shuhaiber, Anna-Maria Henaine, Youssef Akiki, Rony M. Zeenny and Katia Iskandar in Hospital Pharmacy
Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating phar... more Objectives: For decades, the role of hospital pharmacists has been instrumental in elevating pharmacy practice worldwide. Recently, the Hospital Pharmacy Section of the International Pharmaceutical Federation (FIP), the European Association of Hospital Pharmacists (EAHP), and the American Society of Health-System Pharmacists (ASHP) updated their statements about the future role and responsibilities of the pharmacy executive in hospitals and health systems. A series of surveys were conducted around the globe to better understand the current state of hospital pharmacy practice. The purpose of these surveys was to identify challenges in hospital pharmacy practice and to develop improvement strategies. The objective of this national survey is to evaluate hospital pharmacy practice in Lebanon. Methods: A cross-sectional observational study was performed among pharmacists working in hospital settings in Lebanon, from January through June 2016. Based on a literature review, a questionnaire...
Journal of Clinical Pharmacy and Therapeutics, 2014
Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last d... more Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last decade with the emergence of new regimens combining radiotherapy plus temozolomide and the use of bevacizumab at recurrence. Our aim was to assess the clinical and economic impacts of those novel strategies in our center. A single-center retrospective chart review was conducted on patients newly diagnosed with a GBM over two periods (year 2004, group 1 or year 2008, group 2) with limitations to those eligible to radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total costs from diagnosis to death or the last follow-up date. Cost analysis was performed under the French Sickness Fund perspective using tariffs from 2012. One hundred twenty-two patients were selected (49 in group 1 and 73 in group 2) with similar baseline characteristics within the two groups. Patients from group 2 received more frequently temozolomide radiochemotherapy (71% vs. 39%, P &lt; 0·05) as first-line treatment as well as bevacizumab regimen at recurrence (48% vs. 6%, P &lt; 0·05); the median overall survival was increased between the two periods (respectively 17 vs. 10 months, P &lt; 0·05). The mean total cost per patient was 54,388 € in group 1 and 71,148 € in group 2 (P &lt; 0·05). Hospital care represented the largest expenditure (76% and 58% in groups 1 and 2 respectively) followed by chemotherapy drugs costs (11% and 30% respectively). The total cost difference between the two groups was explained by the increasing use of temozolomide and bevacizumab. The incremental cost-effectiveness ratio was estimated at 54,355 € per life-year gained. As far as we know, this is the first study reporting the total cost of GBM management based on the French perspective, as well as the cost-effectiveness of clinical practices in term of cost per life-year gained. Those novel strategies have contributed to improve overall survival while inducing a substantial, but acceptable, increase of total costs.
Introduction Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. F... more Introduction Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. Following appraisal by health technology assessment (HTA) bodies, this medicine has not been widely covered across European countries. We have compared the HTA process in England and France. Area covered We undertook an analysis of relevant documents that were published by the two HTA bodies. We analyzed patients’ availability of Ocrelizumab at the different stages of the process. Expert opinion We identified differences in the assessment, one being the use of a different population of the pivotal trial, which has resulted in the consideration of distinct clinical effectiveness estimates. Ocrelizumab became available earlier in France as part of an early access program. However, rapid access was discontinued for newly eligible patients following an opinion concluding that Ocrelizumab yielded no additional benefit over placebo. This opinion was not compatible with the criteria allowing rei...
Journal of Clinical Pharmacy and Therapeutics, 2016
Trends in the care of glioblastoma in actual practice settings are poorly described. In a previou... more Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma (GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade.
Le Journal médical libanais. The Lebanese medical journal
Medication prescribing errors are made all over the world. However, exact data about them are lac... more Medication prescribing errors are made all over the world. However, exact data about them are lacking in Lebanon. Our objective was to describe medication errors, including drug-drug interactions in medication orders given to patients admitted to Lebanese hospitals. A prospective study was carried out on 313 patients taken from seven Lebanese hospitals; 1826 medication orders were assessed for errors and 456 drug-drug interactions were found. Data was entered and analyzed on SPSS. Around 40% of medication orders were judged to comprise at least one prescribing error, mainly no ordering of parameters monitoring (20%), unnecessary medication (9%), and no indication (7%). Errors occurred mainly in the pediatrics (50%) and internal medicine wards (40%). Having an infectious or gastrointestinal problem almost doubled the risk of medication prescribing error. Antiulcer agents, NSAIDs, antibiotics and steroidal agents were the medications mainly involved. Meanwhile, 12 adverse medication e...
Objectives: To evaluate the association between sociodemographic characteristics and antibiotic k... more Objectives: To evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population. Methods: A questionnaire-based survey was conducted in community pharmacies from all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January 1 until March 31, 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes, and a linear regression model was performed to assess factors associated with knowledge. Results: An antibiotic knowledge index was computed for 623 participants, with a minimum score of 3 and a maximum score of 19 (average of 12.5 ± 3.2). Higher knowledge score was inversely correlated with age (r = -0.118; P = 0.003), but no gender differences were reported (12.6 for females vs. 12.3 for males) (P >0.05). However, differences were statistically significant for residence type, ed...
Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Managem... more Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Management of meta-static colorectal cancer: Current treatments and new therapies. J Med Liban 2015 ; 63 (4) : 218-227. Henaine AM , Chahine G, Salameh P, Élias E, Massoud M, Hartmann D, Aulagner G, Armoiry X. Prise en charge du cancer colorectal métastatique : Traitements standards et nouveau-tés thérapeutiques. J Med Liban 2015 ; 63 (4) : 218-227. RÉSUMÉ • Le cancer colorectal représente 8% des cas de cancers métastatiques. Pendant des décennies, la chimio-thérapie associant le 5-Fluorouracil (5-FU) et l'acide folinique a constitué le traitement conventionnel de référence. L'arri-vée de l'irinotécan, de l'oxaliplatine et des formes orales de 5-FU au cours des années 90 a été considérée comme une grande avancée thérapeutique. À partir de 2004, la thérapie ciblée, avec les anticorps monoclonaux visant les récepteurs EGF et l'angiogenèse (VEGF), a permis un bénéfice en termes de survie même si le cancer colorectal métastatique reste, à ce jour, incurable. Nous présentons la prise en charge ac-tuelle du cancer colorectal métastatique, le développement clinique de ces traitements émergents et leur positionnement dans le système de santé libanais. ABSTRACT • Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil (5-FU) associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system.
Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thr... more Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thromebomlic complications. Periodic laboratory testing of international normalized ratio (INR) and a subsequent dose adjustment are therefore mandatory. The use of home testing devices to measure INR has been suggested as a potential way to improve the comfort and compliance of the patients and their families, the frequency of monitoring and, finally, the management and safety of long-term oral anticoagulation. In pediatric patients, increased doses to obtain and maintain the therapeutic target INR, more frequent adjustments and INR testing, multiple medication, inconstant nutritional intake, difficult venepunctures, and the need to go to the laboratory for testing (interruption of school and parents&amp;amp;amp;amp;#39; work attendance) highlight those difficulties. After reviewing the most relevant published studies of self-testing and self-management of INR for adult patients and children on oral anticoagulation, it seems that these are valuable and effective strategies of INR control. Despite an unclear relationship between INR control and clinical effects, these self-strategies provide a better control of the anticoagulant effect, improve patients and their family quality of life, and are an appealing solution in term of cost-effectiveness. Structured education and knowledge evaluation by trained health care professionals is required for children, to be able to adjust their dose treatment safely and accurately. However, further data are necessary in order to best define those patients who might better benefit from this multidisciplinary approach.
Le Journal médical libanais. The Lebanese medical journal
Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has... more Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil (5-FU) associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system.
SUMMARY What is known and objective: Therapeutic options for the management of glioblastoma (GBM)... more SUMMARY What is known and objective: Therapeutic options for the management of glioblastoma (GBM) have greatly evolved over the last decade with the emergence of new regimens combining radiotherapy plus temozolomide and the use of bevacizumab at recurrence. Our aim was to assess the clinical and economic impacts of those novel strategies in our center. Methods: A single-center retrospective chart review was conducted on patients newly diagnosed with a GBM over two periods (year 2004, group 1 or year 2008, group 2) with limitations to those eligible to radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total costs from diagnosis to death or the last follow-up date. Cost analysis was performed under the French Sickness Fund perspective using tariffs from 2012. Results: One hundred twenty-two patients were selected (49 in group 1 and 73 in group 2) with similar baseline characteristics within the two groups. Patients from group 2 received more frequently temozolomide radiochemotherapy (71% vs. 39%, P < 0Á05) as first-line treatment as well as bevacizumab regimen at recurrence (48% vs. 6%, P < 0Á05); the median overall survival was increased between the two periods (respectively 17 vs. 10 months, P < 0Á05). The mean total cost per patient was 54 388 € in group 1 and 71 148 € in group 2 (P < 0Á05). Hospital care represented the largest expenditure (76% and 58% in groups 1 and 2 respectively) followed by chemotherapy drugs costs (11% and 30% respectively). The total cost difference between the two groups was explained by the increasing use of temozolomide and bevacizumab. The incremental cost-effectiveness ratio was estimated at 54 355 € per life-year gained. What is new and conclusion: As far as we know, this is the first study reporting the total cost of GBM management based on the French perspective, as well as the cost-effectiveness of clinical practices in term of cost per life-year gained. Those novel strategies have contributed to improve overall survival while inducing a substantial, but acceptable, increase of total costs.
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