Gabapentinoid use in French most precarious populations: Insight from Lyon Permanent Access to Healthcare (PASS) units, 2016-1Q2021.

BACKGROUND: Gabapentinoids (i.e., gabapentin and pregabalin) are medications approved for epilepsy, chronic pain, or generalized anxiety disorder. Recently, there have been regular reports of misuse of pregabalin, and to a lesser extent, gabapentin, in particular among opioid and polydrug users. OBJECTIVES: To longitudinally explore the amounts of gabapentinoids dispensed in Lyon's Permanent Access to Healthcare (PASS) units, which offer permanent and free healthcare to precarious populations with no healthcare insurance coverage. METHODS: We collected the amounts of pregabalin and gabapentin dispensed in the three PASS units of Lyon and calculated the average doses dispensed monthly between 2016 and the first quarter of 2021 (1Q2021), with and without adjustment for the number of dispensing visits. RESULTS: The total doses of gabapentinoid dispensed every month in Lyon's PASS units displayed a 1233% increase for pregabalin, and a 1185% increase for gabapentin, between 2016 and 1Q2021. When adjusted for the number of visits, this increase reached a factor of 8.5 for pregabalin and 8.3 for gabapentin, respectively. However, while the increase in pregabalin dispensing was constant throughout the study period, gabapentin total dispensed doses were more fluctuating over time, and the rise of dispensations was thus less straightforward. CONCLUSION: Our study reveals a local but substantial increase in gabapentinoid use in populations with no social insurance. These findings should be confirmed more widely and plead for the systematic collection of anonymous patient data in free healthcare centers in France.

Universal cancer peptide-based therapeutic vaccine breaks tolerance against telomerase and eradicates established tumor.

PURPOSE: To evaluate CD4(+) helper functions and antitumor effect of promiscuous universal cancer peptides (UCP) derived from telomerase reverse transcriptase (TERT). EXPERIMENTAL DESIGN: To evaluate the widespread immunogenicity of UCPs in humans, spontaneous T-cell responses against UCPs were measured in various types of cancers using T-cell proliferation and ELISPOT assays. The humanized HLA-DRB1*0101/HLA-A*0201 transgenic mice were used to study the CD4(+) helper effects of UCPs on antitumor CTL responses. UCP-based antitumor therapeutic vaccine was evaluated using HLA-A*0201-positive B16 melanoma that express TERT. RESULTS: The presence of a high number of UCP-specific CD4(+) T cells was found in the blood of patients with various types of cancer. These UCP-specific T cells mainly produce IFN-γ and TNF-α. In HLA transgenic mice, UCP vaccinations induced high avidity CD4(+) T(H)1 cells and activated dendritic cells that produced interleukin-12. UCP-based vaccination breaks self-tolerance against TERT and enhances primary and memory CTL responses. Furthermore, the use of UCP strongly improves the efficacy of therapeutic vaccination against established B16-HLA-A*0201 melanoma and promotes tumor infiltration by TERT-specific CD8(+) T cells. CONCLUSIONS: Our results showed that UCP-based vaccinations strongly stimulate antitumor immune responses and could be used to design efficient immunotherapies in multiple types of cancers.

[Analysis of 379 drug prescriptions at a call Center 15]. / Analyse de 379 prescriptions médicamenteuses téléphoniques dans un Centre 15.

INTRODUCTION: Prescription of medicines by telephone (PMT) in the call Center 15 is a reality, but has never been studied. OBJECTIVE: The objective was a Qualitative and quantitative study of the PMT. METHOD: A monocentric and observational study of calls for a week of the center 15 of Besançon (France) was performed. MATERIAL: Computer records and dial center 15 recordings of telephone conversations were analyzed. Variables analyzed were characteristics of callers, context of the requirement, analysis of compliance with the summary of product characteristics and mode of access to medicines. RESULTS: Among 1183 appeals studied, a PMT was performed in 379 cases (32%). New and isolated prescriptions are the most frequent. 68% of PMT correspond to optional prescriptions. The 539 drugs prescribed belong to 4 main groups: analgesics, non steroidal anti-inflammatory, anti spasmodic, anti-diarrheal. In 9 out of 10 cases these drugs are from the family pharmacy. CONCLUSION: The PMT at the center 15 is realized in one third of cases. This work helps highlight the shortcomings of the practice in terms of safety and security requirement of the proceedings against the recommendations of the French High Authority for Health.