J Clin Med

We aimed to describe the burden represented by potentially inappropriate medications (PIMs) in chronic polypharmacy in France. We conducted a nationwide cross-sectional study using data from the French National Insurance databases. The study period was from 1 January 2016 to 31 December 2016. Chronic drug use was defined as uninterrupted daily use lasting ?6 months. Chronic polypharmacy was defined as the chronic use of ?5 medications, and chronic hyperpolypharmacy as the chronic use of ?10 medications. For individuals aged ?65 (older adults), PIMs were defined according to the Beers and Laroche lists, and for individuals aged 45-64 years (middle-aged) PIMs were defined according to the PROMPT (Prescribing Optimally in Middle-aged People's Treatments) list. Among individuals with chronic polypharmacy, 4009 (46.2%) middle-aged and 18,036 (64.8%) older adults had at least one chronic PIM. Among individuals with chronic hyperpolypharmacy, these figures were, respectively, 570 (75.0%) and 2544 (88.7%). The most frequent chronic PIM were proton pump inhibitors (43.4% of older adults with chronic polypharmacy), short-acting benzodiazepines (older adults: 13.7%; middle-aged: 16.1%), hypnotics (6.1%; 7.4%), and long-acting sulfonylureas (3.9%; 12.3%). The burden of chronic PIM appeared to be very high in our study, concerning almost half of middle-aged adults and two-thirds of older adults with chronic polypharmacy. Deprescribing interventions in polypharmacy should primarily target proton pump inhibitors and hypnotics

Targeted Therapy for Older Patients with Non-Small Cell Lung Cancer: Systematic Review and Guidelines from the French Society of Geriatric Oncology (SoFOG) and the French-Language Society of Pulmonology (SPLF)/ French-Language Oncology Group (GOLF)

Systematic molecular profiling and targeted therapy (TKI) have changed the face of Non-Small Cell Lung Cancer (NSCLC) treatment. However, there are no specific recommendations to address the prescription of TKI for older patients. A multidisciplinary task force from the French Society of Geriatric Oncology (SoFOG) and the French Society of Pulmonology/Oncology Group (SPLF/GOLF) conducted a systematic review from May 2010 to May 2021. Protocol registered in Prospero under number CRD42021224103. Three key questions were selected for older patients with NSCLC: (1) to whom TKI can be proposed, (2) for whom monotherapy should be favored, and (3) to whom a combination of TKI can be proposed. Among the 534 references isolated, 52 were included for the guidelines. The expert panel analysis concluded: (1) osimertinib 80 mg/day is recommended as a first-line treatment for older patients with the EGFR mutation; (2) full-dose first generation TKI, such as erlotinib or gefitinib, is feasible; (3) ALK and ROS1 rearrangement studies including older patients were too scarce to conclude on any definitive recommendations; and (4) given the actual data, TKI should be prescribed as monotherapy. Malnutrition, functional decline, and the number of comorbidities should be assessed primarily before TKI initiation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Assessment of drug exposure in pharmacoepidemiology : comparison of interview data and reimbursement claims data from the French national healthcare insurance system

En pharmaco-épidémiologie, la mesure de l’exposition médicamenteuse est fondamentale. Des données déclaratives recueillies par interrogatoire des sujets ou des données extraites des bases de remboursement de l’Assurance Maladie peuvent être utilisées. Les objectifs de ce travail étaient de comparer l’exposition mesurée à partir de ces deux sources de données et d’évaluer l’impact du choix de l’une ou l’autre source sur les mesures de risque dans les études étiologiques. Les travaux ont été conduits au sein de l’étude des Trois-Cités, cohorte de sujets âgés pour laquelle étaient disponibles des données déclaratives et de remboursement. La concordance entre les expositions issues des deux sources ou la validité de l’exposition issue de l’une par rapport à celle issue de l’autre ont été évaluées dans différents contextes. La survenue d’événements a été simulée dans la population et des études cas-témoins nichées ont été conduites pour évaluer l’association entre l’exposition issue de chaque source et chaque événement. Pour les médicaments cardiovasculaires, les mesures d’exposition étaient peu différentes entre les deux sources. L’impact du choix de l’une ou l’autre source sur les mesures d’association entre l’exposition et un événement était faible. Pour les benzodiazépines ou les anti-inflammatoires non stéroïdiens, des différences étaient observées entre les expositions issues des deux sources. Pour ces médicaments, l’association avec un événement pouvait varier selon la source utilisée. Pour des médicaments pris de manière irrégulière ou intermittente, le choix de la source de données pour la mesure de l’exposition peut donc être un élément déterminant.In pharmacoepidemiology, assessment of drug exposure is fundamental. It can rely on data collected through patient interviews or extracted from healthcare insurance system databases recording reimbursement claims. This work aimed to compare drug exposure measured from these two data sources and to evaluate the impact of choosing one source or the other on risk estimates in etiological studies. It was conducted as part of the Three-City Study, a cohort of French elderly persons for which both interview and reimbursement data were available. Agreement between exposures measured from both sources or validity of exposure measured from one source with reference to that measured from the other were evaluated in different backgrounds. Simulated outcomes were generated in the study population and nested case-control studies were conducted in order to estimate the association between the drug exposure measured from each source and each simulated outcome. For cardiovascular system drugs, exposure measured from interview data was close to that measured from reimbursement data. The choice of one source or the other had few impact on the estimated associations between the exposure and an outcome. For benzodiazepines or non-steroidal anti-inflammatory drugs, exposure measured from both sources could differ. For these drugs, the association between the exposure measured from each source and an outcome could vary. For drugs that can be used irregularly or intermittently, the choice of the source of data for drug exposure assessment could thus be of great importance

Assessment of drug exposure in pharmacoepidemiology : comparison of interview data and reimbursement claims data from the French national healthcare insurance system

En pharmaco-épidémiologie, la mesure de l’exposition médicamenteuse est fondamentale. Des données déclaratives recueillies par interrogatoire des sujets ou des données extraites des bases de remboursement de l’Assurance Maladie peuvent être utilisées. Les objectifs de ce travail étaient de comparer l’exposition mesurée à partir de ces deux sources de données et d’évaluer l’impact du choix de l’une ou l’autre source sur les mesures de risque dans les études étiologiques. Les travaux ont été conduits au sein de l’étude des Trois-Cités, cohorte de sujets âgés pour laquelle étaient disponibles des données déclaratives et de remboursement. La concordance entre les expositions issues des deux sources ou la validité de l’exposition issue de l’une par rapport à celle issue de l’autre ont été évaluées dans différents contextes. La survenue d’événements a été simulée dans la population et des études cas-témoins nichées ont été conduites pour évaluer l’association entre l’exposition issue de chaque source et chaque événement. Pour les médicaments cardiovasculaires, les mesures d’exposition étaient peu différentes entre les deux sources. L’impact du choix de l’une ou l’autre source sur les mesures d’association entre l’exposition et un événement était faible. Pour les benzodiazépines ou les anti-inflammatoires non stéroïdiens, des différences étaient observées entre les expositions issues des deux sources. Pour ces médicaments, l’association avec un événement pouvait varier selon la source utilisée. Pour des médicaments pris de manière irrégulière ou intermittente, le choix de la source de données pour la mesure de l’exposition peut donc être un élément déterminant.In pharmacoepidemiology, assessment of drug exposure is fundamental. It can rely on data collected through patient interviews or extracted from healthcare insurance system databases recording reimbursement claims. This work aimed to compare drug exposure measured from these two data sources and to evaluate the impact of choosing one source or the other on risk estimates in etiological studies. It was conducted as part of the Three-City Study, a cohort of French elderly persons for which both interview and reimbursement data were available. Agreement between exposures measured from both sources or validity of exposure measured from one source with reference to that measured from the other were evaluated in different backgrounds. Simulated outcomes were generated in the study population and nested case-control studies were conducted in order to estimate the association between the drug exposure measured from each source and each simulated outcome. For cardiovascular system drugs, exposure measured from interview data was close to that measured from reimbursement data. The choice of one source or the other had few impact on the estimated associations between the exposure and an outcome. For benzodiazepines or non-steroidal anti-inflammatory drugs, exposure measured from both sources could differ. For these drugs, the association between the exposure measured from each source and an outcome could vary. For drugs that can be used irregularly or intermittently, the choice of the source of data for drug exposure assessment could thus be of great importance

Hyperkaliémies sévères médicamenteuses (études rétrospective en Midi-Pyrénées)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Mesure de l'exposition médicamenteuse en pharmaco-épidémiologie (étude comparative de données issues des bases de remboursement de l'Assurance Maladie française et de données déclaratives)

En pharmaco-épidémiologie, la mesure de l exposition médicamenteuse est fondamentale. Des données déclaratives recueillies par interrogatoire des sujets ou des données extraites des bases de remboursement de l Assurance Maladie peuvent être utilisées. Les objectifs de ce travail étaient de comparer l exposition mesurée à partir de ces deux sources de données et d évaluer l impact du choix de l une ou l autre source sur les mesures de risque dans les études étiologiques. Les travaux ont été conduits au sein de l étude des Trois-Cités, cohorte de sujets âgés pour laquelle étaient disponibles des données déclaratives et de remboursement. La concordance entre les expositions issues des deux sources ou la validité de l exposition issue de l une par rapport à celle issue de l autre ont été évaluées dans différents contextes. La survenue d événements a été simulée dans la population et des études cas-témoins nichées ont été conduites pour évaluer l association entre l exposition issue de chaque source et chaque événement. Pour les médicaments cardiovasculaires, les mesures d exposition étaient peu différentes entre les deux sources. L impact du choix de l une ou l autre source sur les mesures d association entre l exposition et un événement était faible. Pour les benzodiazépines ou les anti-inflammatoires non stéroïdiens, des différences étaient observées entre les expositions issues des deux sources. Pour ces médicaments, l association avec un événement pouvait varier selon la source utilisée. Pour des médicaments pris de manière irrégulière ou intermittente, le choix de la source de données pour la mesure de l exposition peut donc être un élément déterminant.In pharmacoepidemiology, assessment of drug exposure is fundamental. It can rely on data collected through patient interviews or extracted from healthcare insurance system databases recording reimbursement claims. This work aimed to compare drug exposure measured from these two data sources and to evaluate the impact of choosing one source or the other on risk estimates in etiological studies. It was conducted as part of the Three-City Study, a cohort of French elderly persons for which both interview and reimbursement data were available. Agreement between exposures measured from both sources or validity of exposure measured from one source with reference to that measured from the other were evaluated in different backgrounds. Simulated outcomes were generated in the study population and nested case-control studies were conducted in order to estimate the association between the drug exposure measured from each source and each simulated outcome. For cardiovascular system drugs, exposure measured from interview data was close to that measured from reimbursement data. The choice of one source or the other had few impact on the estimated associations between the exposure and an outcome. For benzodiazepines or non-steroidal anti-inflammatory drugs, exposure measured from both sources could differ. For these drugs, the association between the exposure measured from each source and an outcome could vary. For drugs that can be used irregularly or intermittently, the choice of the source of data for drug exposure assessment could thus be of great importance.BORDEAUX2-Bib. électronique (335229905) / SudocSudocFranceF

Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives

Since the early 2000s, the arrival of the so-called targeted therapies and immunotherapies have prolonged survival rates in many cancers. In parallel, post-marketing surveillance of anticancer drugs through pharmacoepidemiology has gradually developed. This paper provides (i) a detailed argumentation of the foundations for pharmacoepidemiology of anticancer drugs, (ii) an overview of pharmacoepidemiological studies currently available in this field, and (iii) some perspectives to improve pharmacoepidemiology for oncology practice. First of all, according to the existing literature, the development of pharmacoepidemiological studies for the clinical evaluation of anticancer drugs appears particularly justified based on common limitations of clinical trials in oncology regarding essential methodological principles such as adequate control groups, randomisation or double blinding. Many descriptive field cohort studies have investigated together treatment patterns, effectiveness, and safety to compare results from clinical trials with those of everyday practice. The utilisation of anticancer drugs has also been extensively described through cross-sectional or cohort studies by often using medico-administrative or medical databases. Such studies are useful to quantify and characterise use over time in the population, including clinically unvalidated use, and to evaluate adherence and persistence to increasingly available oral anticancer drugs. Despite their importance to increase knowledge, comparative effectiveness or safety studies remain uncommon. In a context of rapidly emerging therapies and personalised treatments, this may be due to methodological challenges especially related to the choice of a comparator or the consideration of confounding by indication. In the future, efforts must be pursued to provide real-time access to high-quality, large-scale clinical, biological and treatment data, and to improve record-linkage between hospital and outpatient databases. More research is also needed to better evaluate all medications, not only anticancer, as part of an overall cancer care pathway and to bring the evaluation of anticancer drugs closer to patients and society (social pharmacology)

ADL-dependent older adults were identified in medico-administrative databases

OBJECTIVE: . We aimed to develop an algorithm for the identification of basic Activities of Daily Living (ADL)-dependency in health insurance databases. STUDY DESIGN AND SETTING: . We used the AMI (Aging Multidisciplinary Investigation) population-based cohort including both individual face-to-face assessment of ADL-dependency and merged health insurance data. The health insurance factors associated with ADL-dependency were identified using a LASSO logistic regression model in 1000 bootstrap samples. An external validation on a 1/97(th) representative sample of the French Health Insurance general population of Affiliates has been performed. RESULTS: . Among 995 participants of the AMI cohort aged ≥ 65y, 114 (11.5%) were ADL-dependent according to neuropsychologists individual assessments. The final algorithm developed included: age, sex, four drug classes (dopaminergic antiparkinson drugs, antidepressants, antidiabetic agents, lipid modifying agents), three type of medical devices (medical bed, patient lifter, incontinence equipment), four medical acts (GP's consultations at home, daily and non-daily nursing at home, transport by ambulance) and four long-term diseases (stroke, heart failure, coronary heart disease, Alzheimer and other dementia). Applying this algorithm, the estimated prevalence of ADL-dependency was 12.3% in AMI and 9.5% in the validation sample. CONCLUSION: . This study proposes a useful algorithm to identify ADL-dependency in the health insurance data

Prevalence and direct costs of potentially inappropriate prescriptions in France: a population-based study

BACKGROUND: Potentially inappropriate prescriptions (PIPs) in the older population remain a growing public health concern due to the many associated adverse events increasing healthcare service use and health costs. This study aimed to assess the prevalence and direct costs of PIPs in older adults aged ≥65 years in France. METHODS: A population-based cross-sectional study was conducted in 2017 using a representative sample of the French national healthcare reimbursement system database. PIPs were defined using the French REMEDI[e]S tool. Overall reimbursed direct costs and by PIP category were extrapolated to the French older population. RESULTS: The overall PIP prevalence was estimated at 56.7% (95% CI: 56.4-57.0). Medications with an unfavorable benefit/risk ratio had the highest prevalence (34.0%, 95% CI: 33.7-34.3). Direct costs associated with PIPs represented 6.3% of the total reimbursed medication costs in 2017 (€507 million). Drug duplications were the main contributors to these costs (39.2% of the total reimbursed PIP costs, €199 million) and among all PIPs, proton pump inhibitors (>8 weeks) were the most expensive PIPs (€152 million). CONCLUSIONS: PIP prevalence is still high among French older adults, with substantial direct costs. Large-scale interventions targeting the most prevalent and/or costly PIPs are needed to reduce their clinical and economic impacts

Use of Lipid-Lowering Drugs and the Risk of Cataract: A Population-Based Nested Case-Control Study

Eye lens membrane cells require high cholesterol concentrations that might be counteracted by lipid-lowering drugs. Using a nationwide database, we conducted a nested case-control study to evaluate the risk of cataract development associated with the use of lipid-lowering drugs. Patients aged 45 years and over with first cataract surgery in 2014 (cases) and up to four controls matched on age, gender, diabetes, hypothyroidism, glucocorticoid use, cardiovascular risk and area of residence were included in the study. Among the 2,811 cases and 11,106 matched controls included, analyses showed a significantly increased risk of cataract surgery for a cumulative exposure to fibrates exceeding five years (adjusted odds ratio (aOR) 1.58, 95% confidence interval 1.17-2.15), unlike cumulative exposure to statins whatever the dose or duration of treatment (aORs from 1.00 to 1.08, none being significant). This study highlighted an increased risk of cataract surgery with prolonged use of fibrates, but not of statins. This article is protected by copyright. All rights reserved