Multiple Myeloma Treatment in Real-world Clinical Practice : Results of a Prospective, Multinational, Noninterventional Study

Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: M.M. has received personal fees from Janssen, Celgene, Amgen, Bristol-Myers Squibb, Sanofi, Novartis, and Takeda and grants from Janssen and Sanofi during the conduct of the study. E.T. has received grants from Janssen and personal fees from Janssen and Takeda during the conduct of the study, and grants from Amgen, Celgene/Genesis, personal fees from Amgen, Celgene/Genesis, Bristol-Myers Squibb, Novartis, and Glaxo-Smith Kline outside the submitted work. M.V.M. has received personal fees from Janssen, Celgene, Amgen, and Takeda outside the submitted work. M.C. reports honoraria from Janssen, outside the submitted work. M. B. reports grants from Janssen Cilag during the conduct of the study. M.D. has received honoraria for participation on advisory boards for Janssen, Celgene, Takeda, Amgen, and Novartis. H.S. has received honoraria from Janssen-Cilag, Celgene, Amgen, Bristol-Myers Squibb, Novartis, and Takeda outside the submitted work. V.P. reports personal fees from Janssen during the conduct of the study and grants, personal fees, and nonfinancial support from Amgen, grants and personal fees from Sanofi, and personal fees from Takeda outside the submitted work. W.W. has received personal fees and grants from Amgen, Celgene, Novartis, Roche, Takeda, Gilead, and Janssen and nonfinancial support from Roche outside the submitted work. J.S. reports grants and nonfinancial support from Janssen Pharmaceutical during the conduct of the study. V.L. reports funding from Janssen Global Services LLC during the conduct of the study and study support from Janssen-Cilag and Pharmion outside the submitted work. A.P. reports employment and shareholding of Janssen (Johnson & Johnson) during the conduct of the study. C.C. reports employment at Janssen-Cilag during the conduct of the study. C.F. reports employment at Janssen Research and Development during the conduct of the study. F.T.B. reports employment at Janssen-Cilag during the conduct of the study. The remaining authors have stated that they have no conflicts of interest. Publisher Copyright: © 2018 The AuthorsMultiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits.publishersversionPeer reviewe

Les psychotropes et la grossesse (comptes rendus d'études portées sur les anxiolytiques, hypnotiques et antidépresseurs)

La grossesse est une période primordiale dans la vie d une femme. Elle est aussi synonyme de nombreux changements physiologiques pouvant influencer sur la pharmacocinétique des médicaments. Pour mettre en évidence l impact des médicaments sur le devenir d un foetus nous disposons des données résultantes des expérimentations animales et des études cliniques réalisées chez l homme. Malheureusement, ces études ne sont pas toujours suffisamment nombreuses, fiables et unanimes pour établir des conclusions certaines sur l usage d un médicament durant la grossesse. De nombreuses femmes ont recours aux psychotropes pendant leur grossesse et notamment, des anxiolytiques et des antidépresseurs. Nous rassemblons ici un panel d études afin de faire le point sur les recommandations actuelles concernant la prescription de ces psychotropes au cours de la grossesse.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

La mésothérapie

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Les inhibiteurs de tyrosines kinases (médicaments et essais cliniques)

Dans la guerre menée contre le cancer, la nécessitée de nouveaux traitements est devenue une priorité. Avec l avènement du projet génome humain une nouvelle approche a été découverte. La meilleur compréhension de la physiopathologie de cette maladie, l étude des communications intra et intercellulaire, ainsi que des altérations survenant dans le contrôle du cycle, ont mis sur le devant de la scène les protéines tyrosines kinases. Ces protéines récepteurs cellulaire ou intracytoplasmiques sont intéressantes à bloquer. Leurs dysfonctionnements a une implication dans la prolifération, la croissance, la mobilité des cellules ainsi que dans l angiogenèse. Deux classes de médicaments ont été développées dans le but d inhiber leurs complexes voies de signalisations. Il s agit des inhibiteurs de tyrosines kinases (ITK) qui vont bloquer ces protéines par une action intracellulaire, et des anticorps monoclonaux qui auront une action extracellulaire. L étude et l analyse des ITK et de leurs essais cliniques montrent une famille de médicaments cytostatiques dont l utilisation clinique ne cesse d augmenter. Leur efficacité est contrastée selon les indications, mais ils sont faciles d utilisation et permettent le maintient d une qualité de vie acceptable. Ils ont des avantages indéniables tant pour les patients que pour les soignants. Néanmoins, l émergence de résistances, d un certain manque d efficacité et l apparition d effets indésirables gênants pour une partie des patients posent quelques problèmes. Cependant la poursuite des essais cliniques évaluant de nouvelles questions intéressantes dans la prédiction de l efficacité, ainsi que les différentes associations possibles avec les traitements conventionnels continuent. Ces médicaments sont certes innovants mais ils risquent d alourdir encore le coût des traitements anticancéreux. De nouvelles molécules très prometteuses sont attendues pour confirmer une réelle amélioration de la prise en charge de ces pathologies très évolutives.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

La constipation, ses traitements et les risques de l'automédication

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Observance des traitements antidiabétiques oraux dans le diabète de type 2

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

LES MEDICAMENTS CHEZ LA FEMME ALLAITANTE

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Les troubles thyroïdiens (quelles options thérapeutiques)

La thyroïde est une glande endocrine située à la base du cou. Les hormones thyroïdiennes secrétées par celle-ci agissent sur le métabolisme de la plupart des cellules de l organisme. Les troubles thyroïdiens sont très répandus. L étiologie conditionne la prise en charge thérapeutique, le pronostic et la surveillance. Le traitement de l hypothyroïdie repose sur l administration d hormones thyroïdiennes et celui de l hyperthyroidie sur l utilisation d antithyroïdien de synthèse, d iode radioactif ou au recours à la chirurgie. Leur prise en charge ne fait pas appel à des schémas standards. L essentiel est de respecter une démarche thérapeutique cohérente et adaptée au patient. Le dosage actuel de la TSH est extrêmement sensible et amène à reconnaitre des anomalies mineures de la fonction thyroïdienne ne s exprimant pas cliniquement. Ces situations illustrent la continuité qu il existe entre le normal et le pathologique . La difficulté étant de définir dans ces cas-là l indication de la thérapeutique.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF