DHEA (une molécule miracle en officine? : enquête auprès de patients dans les officines de Côte d'Or)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Interactions avec télaprévir ou bocéprévir chez des patients greffés hépatiques : à propos de 4 cas cliniques

Le bocéprévir et le télaprévir sont deux antiviraux à action directe indiqués, en association avec la bithérapie, dans le traitement de l’hépatite C chronique due au virus de l’hépatite C (VHC) de génotype 1. Les patients greffés traités par anticalcineurines (tacrolimus et ciclosporine) sont confrontés à des risques d’interactions majeures. En effet, ces antiviraux sont de forts inhibiteurs des cytochromes 3A4/A5, responsables du métabolisme de la ciclosporine et du tacrolimus. La littérature atteste de la dangerosité de cette interaction. Nous rapportons quatre cas cliniques illustrant les adaptations posologiques nécessaires chez des patients greffés hépatiques et traités par télaprévir ou bocéprévir. Afin de garantir l’efficacité immunosuppressive, une prise en charge pluridisciplinaire et une surveillance étroite de l’interaction entre immunosuppresseur et inhibiteur de protéase ont été nécessaires

Traitement par erlotinib après une toxicité hépatique induite par le géfitinib : revue de la littérature à propos d’une observation

Le géfitinib et l’erlotinib sont des inhibiteurs de la tyrosine kinase du récepteur du facteur de croissance épidermique (EGFR-TK). Ils sont indiqués chez les adultes dans le traitement du cancer bronchique non à petites cellules localement avancé ou métastatique avec mutations activatrices de l’EGFR-TK. Nous rapportons le cas d’une hépatotoxicité cytolytique survenue chez un patient traité par géfitinib ayant présenté une récidive lors de la réintroduction de la molécule. Un relais par erlotinib a été initié par la suite et n’a pas entraîné la réapparition d’une toxicité hépatique. À partir de cette observation et d’une revue de la littérature, des arguments ont été avancés pour proposer l’erlotinib comme une option efficace et bien tolérée chez les patients chez qui le géfitinib a été stoppé du fait de la survenue d’une hépatotoxicité sévère

Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring

International audienc

Peer-driven intervention to help patients resume CPAP therapy following discontinuation: a multicentre, randomised clinical trial with patient involvement

International audienceIntroduction Obstructive sleep apnoea syndrome (OSAS) is one of the most common chronic diseases. It may be associated with symptoms of excessive daytime sleepiness and neurocognitive and cardiovascular complications. First line therapy for OSAS involves home continuous positive airway pressure (CPAP), however, nearly half of patients do not adhere with this treatment over the long term. Cognitive-behavioural interventions that include health professionals and patient and public involvement are increasingly advocated in the fields of education and research. We hypothesise that a peer-driven intervention could help patients with OSAS to resume CPAP use after discontinuation. Methods and analysis We have designed a prospective, multicentre randomised, controlled trial that will be coconducted by health professionals, a home provider of CPAP and patients as experts or peers or participants. The primary aim is to evaluate the impact of a 6-month, peer-driven intervention to promote the resumption of CPAP after discontinuation. We anticipate that 20% of patients in the intervention group will reuse CPAP as compared with 6% in control group, thus, 104 patients must be included in each group. The secondary aims are (1) to evaluate the impact of the peer-driven intervention on adherence to CPAP compared with the control group (mean adherence and percentage of nights with at least 4 hours’ use/night for 70% of nights); (2) to determine factors associated with resumption of CPAP; (3) to assess patient satisfaction with the peer-driven intervention at 6 months; (4) to evaluate the feasibility and the execution of the peer-driven intervention and peer satisfaction. Adult outpatients with an established diagnosis of severe OSA (Apnoea-Hypopnoea Index >30 events/hour) that have stopped using CPAP within 4–12 months after initiation will be recruited. The peers who will perform the intervention will be patients with OSAS treated with CPAP with good adherence (at least 4 hours/night, 70% of nights) and trained in motivational enhancement and cognitive-behavioural therapies. Trained peers will conduct three interviews within 6 months with participants. Ethics and dissemination Ethical approval has been obtained from the French Regional Ethics Committee CPP Ouest II-Angers, (IRB 21.02.25.68606 (2021/2025)). All participants will sign written informed consent. The results will be presented at conferences and published in peer-reviewed journals as well as public media. Trial registration number NCT0453827

Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring

Objective: The earliest possible detection of individuals with COVID-19 has been essential to curb the spread of infection. Existing digital tools have been scaled up to address this issue. Every night telemonitoring data on continuous positive airway pressure (CPAP) device use, the first-line therapy for obstructive sleep apnoea (OSA), is collected worldwide. We asked whether the changes in CPAP adherence patterns of might constitute an alert for COVID-19. Methods: We analysed preliminary results of telemonitoring data, recorded between February 1 and April 30, 2020, on OSA patients followed by our sleep clinics and diagnosed with COVID-19. Results: CPAP telemonitoring data from the first 19 patients diagnosed with COVID-19 showed a clear decrease or halt in adherence in the 20 days immediately preceding COVID-19 diagnosis compared to an earlier period (p<0.01). Conclusion: Patterns of continuous positive airway pressure device use by obstructive sleep apnoea patients collected through telemonitoring can indicate the onset of COVID-19 symptoms. Existing telemonitoring platforms could be immediately used to screen for COVID-19, and for other respiratory infections, in this large at-risk population

IL-7-adjuvanted vaginal vaccine elicits strong mucosal immune responses in non-human primates

Mucosal immune responses are crucial in protecting against pathogens entering through mucosal surfaces. However, due to difficulties in disrupting the tolerogenic environment associated with mucosa, mucosal immunity remains difficult to stimulate through vaccines and requires appropriate adjuvants. We previously demonstrated that either administered systemically to healthy macaques or locally expressed in the intestinal mucosa of acutely SIV-infected macaques, interleukin-7 (IL-7) triggers chemokine expression and immune cell homing into mucosae, suggesting its important role in the development of mucosal immune responses. We therefore examined whether local delivery of recombinant glycosylated simian IL-7 (rs-IL-7gly) to the vaginal mucosa of rhesus macaques could prepare the lower female genital tract (FGT) for subsequent immunization and act as an efficient mucosal adjuvant. First, we showed that local administration of rs-IL-7gly triggers vaginal overexpression of chemokines and infiltration of mDCs, macrophages, NKs, B- and T-cells in the chorion while MamuLa-DR+ APCs accumulated in the epithelium. Subsequent mucosal anti-DT immunization in macaques resulted in a faster, stronger, and more persistent mucosal antibody response compared to DT-immunization alone. Indeed, we detected robust productions of DT-specific IgAs and IgGs in their vaginal secretions and identified cells secreting DT-specific IgAs in their vaginal mucosa and IgGs in draining lymph nodes. Finally, the expression of chemokines involved in the organization of tertiary lymphoid structures (TLS) was only increased in the vaginal mucosa of IL-7-adjuvanted immunized macaques. Interestingly, TLSs developed around PNAd+ high endothelial venules in their lower FGT sampled 2 weeks after the last immunization. Non-traumatic vaginal administration of rs-IL-7gly prepares the mucosa to respond to subsequent local immunization and allows the development of a strong mucosal immune response in macaques, through the chemokine-dependent recruitment of immune cells, the activation of mDCs and the formation of TLSs. The localization of DT-specific IgA plasma cells in the mucosa argues for their contribution to the production of specific immunoglobulins in the vaginal secretions. Our results highlight the potential of IL-7 as a potent mucosal adjuvant to stimulate the FGT immune system and elicit vaginal antibody responses to local immunization, which is the most promising way to confer protection against many sexually transmitted diseases