Télécardiologie en France (organisation et financement)

PARIS-BIUP (751062107) / SudocSudocFranceF

Survival and treatment patterns of patients with relapsed or refractory multiple myeloma in France — a cohort study using the French National Healthcare database (SNDS)

International audienceAbstract Over the past decade, several drugs have been approved for the treatment of relapsed or refractory multiple myeloma (RRMM). This retrospective study, using the French National Healthcare database (SNDS), describes the treatment patterns and outcomes of patients with RRMM treated in real-world clinical practice in France. Patients were adults, with a diagnosis of multiple myeloma, who initiated second-line (2L) treatment approved for use in France between 2014 and 2018; this included bortezomib, carfilzomib, daratumumab, ixazomib, lenalidomide, or pomalidomide. Data were analyzed overall, by first-line (1L) autologous stem cell transplant (ASCT) status and by lenalidomide treatment status at 2L. In total, 12987 patients with RRMM were included in the study (mean age 69.5 years); 27% received an ASCT at 1L, and 30% received a lenalidomide-sparing regimen at 2L. Overall, and among the ASCT and non-ASCT subgroups, most patients received a bortezomib-based regimen at 1L, whereas lenalidomide-based regimens were most common at 2L. Among patients who received a lenalidomide-sparing regimen at 2L, this was most often a proteasome inhibitor-based regimen. Mortality rate was 26.1/100 person-years, and median (95% confidence interval) survival from 2L initiation was 32.4 (31.2–33.6) months. Survival differed by various factors, shorter survival was reported in the non-ASCT group, those receiving a lenalidomide-sparing regimen at 2L, older patients (≥ 70 years), and those with multiple comorbidities. This analysis provides insight into the real-world use of approved novel MM treatments and highlights an ongoing unmet need to improve outcomes, particularly for selected patient groups

Can precision medicine be integrated into routine therapeutic decisions at the bedside of patients?

International audienceTherapeutic strategies are shifting from a "one-size-fits-all" population-based approach to a stratified approach targeting groups with similar characteristics, or even individuals, tailoring treatments to the unique characteristics of each patient. Since such strategies rely on increasingly complex knowledge and healthcare technologies, along with an understanding of the tools of precision medicine, the appropriate dissemination and use of these strategies involves a number of challenges for the medical community. Having evaluation methodologies that have been jointly designed with the institutional, industrial, academic stakeholders, and also patients, like streamlining the processes and externally validating performances, could enhance the relevance of the "evaluation" aspect of precision medicine. Creating a network of expert precision-medicine centers and ensuring that precision-medicine procedures are reimbursed by social security would guarantee fair and sustainable access. Finally, training healthcare professionals, creating interfaces between precision-medicine expert centers and primary care professionals as well as patients, and integrating individual patient data into medical records are all key drivers that will enable information from precision-medicine to be made available and guarantee the proper use of these approaches

Comment faire entrer la médecine de précision dans la décision thérapeutique de routine au lit du malade?

National audienceLes stratégies thérapeutiques évoluent d’une approche populationnelle « one size fits all » vers une stratifiée, où des groupes présentant caractéristiques homogènes sont ciblés, voire à l’échelle de l’individu la thérapeutique est adaptée aux uniques du patient. Ces reposent sur connaissances et technologies santé toujours plus complexes maîtrise outils cette médecine dite précision, sa diffusion son usage manière posent un certain nombre challenges pour communauté médicale. Une co-construction méthodologies d’évaluations avec les différents acteurs institutionnels, industriels, académiques ainsi que patients fluidification ces process validation externe performance approches pourraient renforcer pertinence volet évaluation précision. La création structuration centres experts précision véritables actes pris en charge par sécurité sociale propositions assurer l’accès équitable pérenne stratégies. Enfin, former professionnels santé, créer interfaces entre premiers recours patients, intégrer données individuelles patient dans dossier médical leviers permettant mise disposition informations relatives le bon approches