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Antonini A.,IRCCS San Camillo | Martinez-Martin P.,CIBER ISCIII | Chaudhuri R.K.,King's College | Merello M.,Movement Disorders Section. FLENI. Buenos Aires | And 11 more authors.
Movement Disorders | Year: 2011

Wearing-off occurs in the majority of patients with Parkinson's disease after a few years of dopaminergic therapy. Because a variety of scales have been used to estimate wearing-off, the Movement Disorder Society commissioned a task force to assess their clinimetric properties. A systematic review was conducted to identify wearing-off scales that have either been validated or used in Parkinson's patients. A scale was designated "Recommended" if it had been used in clinical studies beyond the group that developed it, if it had been specifically used in Parkinson's disease reports, and if clinimetric studies had established that it is valid, reliable, and sensitive. "Suggested" scales met 2 of the above criteria, and those meeting 1 were "Listed." We identified 3 diagnostic and 4 severity rating scales for wearing-off quantification. Two questionnaires met the criteria to be Recommended for diagnostic screening (questionnaires for 19 and 9 items), and 1 was Suggested (questionnaire for 32 items). Only the patient diaries were Recommended to assess wearing-off severity, with the caveat of relatively limited knowledge of validity. Among the other severity assessment tools, the Unified Parkinson Disease Rating Scale version 3 and the version revised from the Movement Disorders Society were classified as Suggested, whereas the Treatment Response Scale was Listed. © 2011 Movement Disorder Society.


Martinez-Martin P.,Carlos III Institute of Health | Martinez-Martin P.,CIBER ISCIII | Lyons K.E.,University of Kansas Medical Center | Rodriguez-Blazquez C.,CIBER ISCIII | And 9 more authors.
Movement Disorders | Year: 2011

Health-related quality of life is an important patient-reported outcome used in intervention trials and for monitoring the consequences of health status on physical, mental, and social domains. Parkinson's disease is a complex disorder that strongly affects patients' quality of life. Several health-related quality of life tools have been used in Parkinson's disease. A Movement Disorder Society Task Force was commissioned to rate the psychometric quality of available health-related quality of life scales as applied to Parkinson's disease. Following the methodology adopted by previous work of the Movement Disorder Society Task Force, a review of generic and specific health-related quality of life scales applied in studies on Parkinson's disease was completed. Considering the scales from 3 perspectives-use in Parkinson's disease, use by multiple research groups, and clinimetric properties-a final classification as "recommended," "suggested," or "listed" was applied to each reviewed instrument. Four generic scales (EuroQoL, Nottingham Health Profile, 36-Item Short-Form Health Survey, and Sickness Impact Profile) and 5 specific scales (39-Item Parkinson's Disease Questionnaire, Parkinson's Disease Questionnaire Short Form, Parkinson's Disease Quality of Life Questionnaire, Parkinson's Impact Scale, and Scales for Outcomes in Parkinson's Disease-Psychosocial) reached the level of "recommended." The 39-item Parkinson's Disease Questionnaire is the most thoroughly tested and applied questionnaire. Three other generic measures (Quality of Life Questionnaire 15D, Schedule for the Evaluation of Individual Quality of Life-Direct Weighting, and World Health Organization Quality of Life Assessment Short Version) and the specific Parkinson's Disease Quality of Life Scale are "suggested." With a little additional effort in completing the stipulated requirements, they could reach the "recommended" level. At present there is a wide variety of health-related quality of life measures for application in the Parkinson's disease setting, and the task force does not recommend the development of a new scale. Selection of the most appropriate instrument for a particular objective requires consideration of the characteristics of each scale and the goals of the assessment. © 2011 Movement Disorder Society.


Dodel R.,University of Marburg | Jonsson B.,Stockholm School of Economics | Reese J.P.,University of Marburg | Winter Y.,University of Marburg | And 11 more authors.
Movement Disorders | Year: 2014

Health economic studies in Parkinson's disease (PD) have become increasingly common in recent years. Because several methodologies and instruments have been used to assess cost and outcomes in PD, the Movement Disorder Society (MDS) commissioned a Task Force to assess their properties and make recommendations regarding their use. A systematic literature review was conducted to explore the use of those instruments in PD and to determine which should be selected for this review. We assessed approaches to evaluate cost of illness (COI), cost effectiveness, and cost utilities, which include the use of direct (standard gamble, time trade-off. and visual analogue scales) and indirect instruments to measure health status and utilities. No validated instruments/models were identified for the evaluation of COI or cost-effectiveness in patients with PD; therefore, no instruments in this group are recommended. Among utility instruments, only a few of these outcome instruments have been used in the PD population, and only limited psychometric data are available for these instruments with respect to PD. Because psychometric data for further utility instruments in conditions other than PD already exist, the standard gamble and time trade-off methods and the EQ-5D (a European quality-of-life health states instrument) and Health Utility Index instruments met the criteria for scales that are "recommended (with limitations)," but only the EQ-5D has been assessed in detail in PD patients. The MDS Task Force recommends further study of these instruments in the PD population to establish core psychometric properties. For the assessment of COI, the Task Force considers the development of a COI instrument specifically for PD, like that available for Alzheimer's disease. © 2013 Movement Disorder Society.


Guilhaumou R.,Aix - Marseille University | Guilhaumou R.,Laboratoire Of Pharmacocinetique Et Toxicologie | Guilhaumou R.,Laboratoire Of Pharmacologie Medicale Et Clinique | Solas C.,Aix - Marseille University | And 8 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2011

Purpose: The aim of this study was to investigate the impact of plasma and intracellular exposure and CYP3A4, CYP3A5, and ABCB1 polymorphisms on vincristine neurotoxicity. We subsequently assessed the impact of ABCB1 polymorphisms on intracellular vincristine accumulation. Methods: Children treated for solid tumors were enrolled in the study (n = 26) and received 1.5 mg/m2 of vincristine per course. Individual pharmacokinetic parameters and CYP3A4, CYP3A5, and ABCB1 genotypes were available from a previous analysis. A global toxicity score (pain, peripheral neurotoxicity, and gastrointestinal toxicity) was collected at each course. Vincristine in plasma and PBMCs were quantified by LC-MS/MS. Results: Vincristine plasma and intracellular concentrations ranged from 0.40 to 89.6 ng/ml and from 0.00225 to 1.85 ng/10 6 cells over a 24-h interval, respectively. The global toxicity score ranged from 0 to 6 and was not correlated with individual pharmacokinetics parameters. Neurotoxicity events (global score ≥3) were observed in 8 patients but the incidence was not influenced by the different studied polymorphisms. The global toxicity score was correlated with age, body surface area, and dose in mg. A trend to higher intracellular/plasma ratio of vincristine was found for patients with heterozygous diplotype (CGC-TTT) of ABCB1. Conclusions: None of the different genetic covariates nor plasma and intracellular exposure was predictive of the observed neurotoxicity in our pediatric population. Nevertheless, the heterozygote diplotype of ABCB1 appears to influence the intracellular accumulation of vincristine. Owing to the small sample size, further evaluations are needed in a larger patient cohort. © 2011 Springer-Verlag.


Semmar N.,Laboratoire Of Pharmacologie Medicale Et Clinique | Semmar N.,Institute Superieur Des Science Biologiques Appliquees Of Tunis Issbat
Chemical Biology and Drug Design | Year: 2010

The flexibility of metabolic systems implies a high variability of metabolic profiles linked to different regulation ratios between metabolites. Such regulations are controlled by several interactive metabolic pathways resulting in multidirectional continuums of metabolic profiles. This article presents a new metabolomic approach helping to graphically analyse the flexibility of metabolic regulation systems. Its principle consists in extracting a metabolic backbone from iterative combinations of metabolic profiles representing different metabolic trends. The iterated combinations were performed on the basis of Scheffe matrix then averaged to calculate a response matrix of smoothed metabolic profiles. From such a smoothed matrix, a graphical analysis of relationships between metabolites highlighted different scale-dependent variation paths responsible for the observed metabolic trends. Such a flexibility favouring some metabolites at the expense of others was indirectly checked by a single kinetic approach by considering both the variation of maximal concentrations and the metabolic trends in time. This kinetic approach highlighted a succession of metabolic trends linked to the variation of maximal concentrations in time. Finally, a delayed regulation of a metabolite was highlighted both by the kinetic approach and by a dynamic application of the metabolomic approach. This new approach was illustrated on a dataset of blood concentrations of levodopa and its metabolites analysed in 34 patients at different times. © 2009 John Wiley & Sons A/S.


Guilhaumou R.,French Institute of Health and Medical Research | Guilhaumou R.,Laboratoire Of Pharmacocinetique Et Toxicologie | Guilhaumou R.,Laboratoire Of Pharmacologie Medicale Et Clinique | Simon N.,Laboratoire Of Pharmacologie Medicale Et Clinique | And 7 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2011

Purpose: The interindividual variability of vincristine pharmacokinetics is quite large, but the origins of this variability are not properly understood. The aim of this study was to develop a population pharmacokinetic model of vincristine in a paediatric population treated for solid tumour disease and evaluate the impact of different ABCB1, CYP3A4 and CYP3A5 polymorphisms on the different pharmacokinetic parameters. Methods: We assessed vincristine pharmacokinetics in 26 children treated for various solid tumour diseases. Genotypes were determined by real-time PCR with a LightCycler™ and ABCB1 haplotypes calculated using the software program Phase 2.1. Vincristine plasma concentrations were determined by LC-MS/MS, and a population approach was performed on 184 samples by the NONMEM computer program. Demographic, therapeutic and genotypic covariables were evaluated on vincristine pharmacokinetic parameters. Results: The frequency of CYP3A4*1A/*1A and*1A/*1B genotypes were 87.5 and 12.5%, respectively. CYP3A5*1/*3 and*3/*3 were observed in 20.8 and 79.2% of the patients, respectively. The three major haplotypes were (allelic frequencies) CGC (50%), CGT (14.6%) and TTT (23.2%). Vincristine pharmacokinetics was well described by a two-compartment model. Large interindividual and interoccasion variability were observed. The different polymorphisms studied did not improve the model prediction. Conclusions: CYP3A4, CYP3A5 and ABCB1 polymorphisms did not significantly affect in vivo vincristine pharmacokinetics. Our results demonstrate that vincristine pharmacokinetic variability cannot be explained by these genetic polymorphisms. © 2010 Springer-Verlag.


Boyadjiev I.,Aix - Marseille University | Boulamery A.,Laboratoire Of Pharmacologie Medicale Et Clinique | Simon N.,Laboratoire Of Pharmacologie Medicale Et Clinique | Martin C.,Aix - Marseille University | And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2011

Ertapenem at 1 g once daily has been suggested to be underdosed in intensive care unit (ICU) patients to attain optimal concentrations in target tissues. Therefore, our study aimed to assess the kinetics of ertapenem in plasma and skeletal muscle in ICU patients using microdialysis. Average muscle free-ertapenem concentrations were above the MIC values of targeted pathogens. In a few patients, the concentrations were below the MIC values. The clinical efficiency of ertapenem at 1 g once daily should be evaluated in a large population of ICU patients. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Durrieu G.,Laboratoire Of Pharmacologie Medicale Et Clinique | Durrieu G.,Toulouse University Midi-Pyrénées | Hurault C.,Laboratoire Of Pharmacologie Medicale Et Clinique | Damase-Michel C.,Laboratoire Of Pharmacologie Medicale Et Clinique | And 3 more authors.
Fundamental and Clinical Pharmacology | Year: 2010

Previous studies have pointed out the question of effective training and information to health professionals on pharmacovigilance. The lack of training is known to induce inadequate use of drugs and noncompliance of patients. Pharmacology teaching is performed in the third year of medical studies at the Toulouse Faculty of Medicine. The aim of the study was to investigate the perception of risk of adverse drug reactions (ADRs) by medical students at the end of the one year pharmacology course and two years later, after clinical training period. Sixty-seven students were interviewed in May 2005 and in October 2007. Visual analogue scales were used to define a score of perceived risk of ADRs associated with each drug class (ranking from 0 to 10) before and after pharmacology training. The drug classes evaluated were antibiotics, anticoagulants, antidepressants, aspirin, contraceptive pill, corticosteroids, drugs for arterial hypertension, drugs for diabetes (other than insulin), hypnotics, hypocholesterolaemic drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), postmenopausal hormone replacement therapy and tranquilisers. After pharmacology courses (May 2005), antidepressants were ranked as the most dangerous drugs by medical students [median score (25th-75th centiles): 7.7 (6.3-8.6)], followed by anticoagulants [7.6 (6.6-8.4)] and hypnotics [7.4 (6.1-8.1)]. Contraceptive pills was listed in the last position [median score [4.7 (2.2-6.7)]. Two years later (October 2007), anticoagulants moved into the first position [8.3 (7.3-9.2)], followed by NSAIDs [6.9 (5.0-8.4)] and aspirin [6.8 (5.8-8.4)]. Contraceptive pills remained in the last position. No change was observed for NSAIDs and aspirin, still ranked as dangerous drugs by medical students after clinical training. Values of perceived risk were significantly increased for anticoagulant (+9.2%, P < 0.01) and hypoglycemiant drugs (+27.7%, P < 0.0001). The perceived risk significantly decreased for hypocholesterolaemic (-14.3%, P < 0.0001) and antidepressant drugs (-19.5%, P < 0.0001), but not for hypnotics. The study shows that the perception of risk of ADRs by medical students was modified after clinical training. They were still aware of potentially serious ADRs associated with anticoagulants, aspirin or NSAIDs, but they remained less cautious for drugs such as antidepressants. Additional pharmacology training at the end of medical studies will be useful. © 2009 Société Française de Pharmacologie et de Thérapeutique.

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