Perceptions of Alzheimer's Disease in the French Population: Evolutions between 2008 and 2013 and Associated Factors in 2013.

BACKGROUND: The negative image surrounding AD has a substantial impact on caregiving and on those affected by the disease. Opinion surveys were created as part of the 2008-2012 Alzheimer Plan in France, which included two surveys of the general population, at the beginning and at the end. OBJECTIVE: To evaluate changes of the French population in perceptions, knowledge and beliefs over 5 years and to analyze dimensions with sociodemographics criteria and proximity with AD. METHODS: After selection by quota sampling, 2013 French people aged 18 years and over were interviewed by phone in 2008 and 2509 in 2013. Chi-squared tests were carried out to measure the changes between two periods and multivariate logistics regressions were used to assess perceptions. RESULTS: People who cited AD as one of the three most serious diseases increased in 2013 (33.6% versus 26.7% in 2008; p <  0.001). There was no significant change as regards the fear, the sense of being informed and the feeling of embarrassment. Opinions "there are treatments available to improve the wellbeing of patients" and "it is normal to suffer memory loss as you get older" decreased in 2013. Close family carers had a greater sense of the seriousness, a higher risk perception, a better sense of being informed and a greater ease in the presence of a person with AD. CONCLUSIONS: The results serve as indicators of the effects of the Alzheimer Plan on French society and testify to the rather weak impact of the Plan on public opinion.

Effects of alcoholic beverage control policies and contextual factors on alcohol consumption and its related harms in France from 1960 to 2000.

Important social changes such as urbanization, increases in female education and employment, and increased incomes have occurred in France from 1960 to 2000 along with a major decrease in alcoholic beverage consumption (from 25 L pure alcohol per inhabitant 15 years and old to 13 L); especially due to wine consumption decrease. These changes in drinking patterns are associated with significant decreases in alcohol consumption-related harms (liver disease mortality and transport accident mortality). Several alcoholic beverage consumption control policy measures were also created during this period. This study explores the impact of these policies measure on alcohol consumption and alcohol consumption-related harms, adjusted with selected social changes. France's control policy has been associated, partially, with regressive effects on alcohol consumption but not on alcohol consumption-related harms. Study limitations are noted.

Adverse drug reactions in patients with Alzheimer's disease and related dementia in France: a national multicentre cross-sectional study.

PURPOSE: To assess the prevalence of adverse drug reactions (ADRs) occurring in patients with Alzheimer's disease (AD) or other dementia in France. METHODS: A cross-sectional multicentre study was conducted by the French network of the 31 regional pharmacovigilance centres on a given day. The subjects were selected by random draw to be a representative sample of French patients with dementia: consultations of dementia clinics, nursing-homes, acute and long care geriatric units, rehabilitation care geriatric units. The staff of each medical structure together with that of the pharmacovigilance centre defined a day for including the patients. Socio-demographic data, history, ADR and drugs given were registered. RESULTS: There were 1332 subjects included, 51.1% living at home, 48.8% in institutions, aged 82.0 ± 8.0 years (46-108); 61.3% suffered from AD. Mean number of drugs was 6.3 ± 3.1. Anti-dementia drugs were given to 66.4% subjects. ADR prevalence was 5.0% (95% CI: 3.9-6.2) without a significant difference between at home and institutionalized patients. ADR consisted of gastro-intestinal (23.2%), central nervous system (17.4%) and psychiatric disorders (8.7%). Of the ADR, 31.9% were serious, and 47.8% preventable. The drugs most often involved were anti-dementia (28.9%), cardio-vascular (28.9%) and psychotropic drugs (26.4%, anxiolytics, hypnotics, antidepressants, neuroleptics). CONCLUSION: This national scale study showed that iatrogenesis in patients with AD and related dementia can at times be serious and preventable. Therefore, special attention is required when prescribing psychotropic and anti-dementia drugs, as they are frequently used and induce half of the ADR in this population.

Complications of BCG vaccine SSI® recent story and risk management plan: the French experience.

INTRODUCTION: As of January 2006, the BCG vaccine SSI® became the only BCG vaccine available for tuberculosis vaccination in France. The use of this vaccine led to significant changes in vaccination technique which were accompanied by a rapid increase in the number of adverse reactions (ADRs) reported. A national pharmacovigilance follow-up began in February 2006, and a risk management plan (RMP) was put in place in April 2006, made of three phases (carried out in June 2006, July 2006 and September 2006) with risk minimisation measures. The goal of this study was to evaluate the impact of the RMP on the amount of ADRs reported. METHODS: Based on data collected by the regional pharmacovigilance centres and the MSD laboratory, the cases of locoregional ADRs spontaneously reported were analysed retrospectively from January 2005 to February 2006, and then prospectively up to June 2008, the date at which the national follow-up ended. The locoregional ADRs were divided into three categories: abscesses, local reactions or lymphadenopathy of more than 1 cm and suppurative lymphadenopathy. A parallel was then drawn between these data and the different phases of the RMP. RESULTS: During the entire follow-up period, we note 1050 locoregional ADRs, of which 764 were abscesses (73% of all cases), 266 were local reactions and 20 involved suppurative lymphadenopathy.Locoregional ADRs increased rapidly from January 2006 onward, reaching a peak in August 006 and then falling and stabilising from December 2007 onward.The RMP was implemented when there was an increase in the number of ADRs reported. The drop in the number of these effects began 3 months after the first phase and 2 months after the second phase of the RMP. The third phase was not accompanied by a variation in the number of ADRs reported. CONCLUSION: The RMP appears to have positive effect on the evolution of the number of ADRs, their decrease occurring rapidly after the risk minimisation measures of the first two phases. Nonetheless, these data should be confirmed by other studies on the efficacy of RMPs.

First French experience of ADR reporting by patients after a mass immunization campaign with Influenza A (H1N1) pandemic vaccines: a comparison of reports submitted by patients and healthcare professionals.

BACKGROUND: Available data concerning the contribution of patient adverse drug reaction (ADR) reporting in practice are scarce. Few studies have compared patients' reports with reports from healthcare professionals (HCPs). During the 2009-10 mass immunization campaign with A (H1N1)v2009 pandemic influenza vaccines, a reinforced pharmacovigilance plan was introduced in France according to European Medicines Agency recommendations. For the first time, patients were offered the opportunity to report suspected ADRs to pandemic vaccines directly to regional pharmacovigilance centres. OBJECTIVE: The aim of the study was to compare the characteristics of patient and HCP ADR reports in order to assess the qualitative and quantitative contribution of patient reporting to the French Pharmacovigilance System. METHODS: All spontaneous ADRs registered into the French Pharmacovigilance Database from 21 October 2009 to 15 June 2010, in which either one of the most frequently administered pandemic vaccines (i.e. Panenza® or Pandemrix®) was involved, were analysed. ADRs were classified as 'serious', 'medically serious' and 'non-serious'. This study focused on 'serious' and 'medically serious' ADRs. An ADR was ranked as 'medically serious' when it required medical intervention or hospitalization within less than 24 hours. In each level of seriousness, frequency of 'unlabelled' ADRs, ADRs of 'special interest', imputability scores and category of ADRs according to Medical Dictionary for Regulatory Activitives (MedDRA®) primary System Organ Class were compared between patient and professional reports. RESULTS: Among the 4746 reports received during the study period, 1006 (21.2%) originated from patients. HCPs reported significantly more 'medically serious' or 'serious' ADRs than patients (15.1% [565/3740] vs 8.4% [85/1006], respectively; p < 0.001). No difference was found in 'unlabelled, serious' ADRs between patients and HCPs (56.5% [n = 13] vs 56.7% [n = 136], respectively). CONCLUSIONS: In this first French experience of formal patient participation to ADR reporting, patient contribution to the total number of ADRs reached 21.2%. This study revealed no major qualitative difference between patient and HCP reports. ADR profiles reported by patients appeared to be consistent with those from professionals. Further investigations are necessary to assess the intrinsic quality of notification forms coming from non-professional reporters. However, this study is of particular interest in the context of publication of the first governmental decree that will formally integrate patient participation to the current French ADR reporting scheme.

Early detection of pharmacovigilance signals with automated methods based on false discovery rates: a comparative study.

BACKGROUND: Improving the detection of drug safety signals has led several pharmacovigilance regulatory agencies to incorporate automated quantitative methods into their spontaneous reporting management systems. The three largest worldwide pharmacovigilance databases are routinely screened by the lower bound of the 95% confidence interval of proportional reporting ratio (PRR02.5), the 2.5% quantile of the Information Component (IC02.5) or the 5% quantile of the Gamma Poisson Shrinker (GPS05). More recently, Bayesian and non-Bayesian False Discovery Rate (FDR)-based methods were proposed that address the arbitrariness of thresholds and allow for a built-in estimate of the FDR. These methods were also shown through simulation studies to be interesting alternatives to the currently used methods. OBJECTIVE: The objective of this work was twofold. Based on an extensive retrospective study, we compared PRR02.5, GPS05 and IC02.5 with two FDR-based methods derived from the Fisher's exact test and the GPS model (GPS(pH0) [posterior probability of the null hypothesis H0 calculated from the Gamma Poisson Shrinker model]). Secondly, restricting the analysis to GPS(pH0), we aimed to evaluate the added value of using automated signal detection tools compared with 'traditional' methods, i.e. non-automated surveillance operated by pharmacovigilance experts. METHODS: The analysis was performed sequentially, i.e. every month, and retrospectively on the whole French pharmacovigilance database over the period 1 January 1996-1 July 2002. Evaluation was based on a list of 243 reference signals (RSs) corresponding to investigations launched by the French Pharmacovigilance Technical Committee (PhVTC) during the same period. The comparison of detection methods was made on the basis of the number of RSs detected as well as the time to detection. RESULTS: Results comparing the five automated quantitative methods were in favour of GPS(pH0) in terms of both number of detections of true signals and time to detection. Additionally, based on an FDR threshold of 5%, GPS(pH0) detected 87% of the RSs associated with more than three reports, anticipating the date of investigation by the PhVTC by 15.8 months on average. CONCLUSIONS: Our results show that as soon as there is reasonable support for the data, automated signal detection tools are powerful tools to explore large spontaneous reporting system databases and detect relevant signals quickly compared with traditional pharmacovigilance methods.

Implementation of an automated signal detection method in the French pharmacovigilance database: a feasibility study.

PURPOSE: In France, early detection of adverse effects does not currently involve any automatic signal detection method. The present objective was to assess the feasibility and measure the potential benefit of the incorporation of an automatic signal detection tool (GPS(pH0)) in the French pharmacovigilance system. METHODS: GPS(pH0) was first applied to the data collected from 1 January 2000 to 31 December 2008 and then to the data collected from 1 January 2000 to 31 March 2009. A total of 1,414 original signals were detected. They were shared out for further expertise among 32 centres, i.e. the 31 Regional Pharmacovigilance Centres and the French medicine agency (AFSSAPS) pharmacovigilance department. RESULTS: The participating centres (n = 28) analysed 1,292 signals in May 2009. Overall, 277 signals whether known or unknown were thus considered worth following up. Half of the other 893 categorised signals were "well-known" (35.7%) and non-interpretable/non-pertinent signals (36.6%); 4% were not categorised because of a lack of time. Analysis of the signals was time-consuming, but the working time estimated by the participants was highly variable (median time: 6 h; minimum: 2 h maximum: 26 h). CONCLUSIONS: The results of this study are in favour of the integration of an automated signal detection tool to complement the current pharmacovigilance activities. The Anatomic Therapeutic Chemical for drug classification poses difficulties in many situations; the international proprietary name might be more efficient. The variability observed in the time needed for analysis suggests that a standardised methodology should be employed. Overall, the findings of this prospective study will contribute to refining the signal management procedure to be implemented in the future.

[National Campaign of Vaccination against the flu A (H1N1)v: National Follow-up of Pharmacovigilance]. / Campagne nationale de vaccination contre la grippe A (H1N1)v : suivi national de pharmacovigilance.

OBJECTIVES: The present study was performed to evaluate safety data collected by the French Network of Pharmacovigilance centres network, from October 21, 2009 to June 15, 2010. METHODS: French Health Authorities (Afssaps [Agence française de sécurité sanitaire des produits de santé]) heightened awareness to extensive notifications with online health practitioners' reports and patients' reports via the Regional Centre concerned. RESULTS: During the campaign, 4.1 millions doses of Pandemrix(®) and 1.6 million doses of Panenza(®) were administered. Following Pandemrix(®), 4 183 adverse effects (AEs) were reported including 193 "serious" AEs. Concerning Panenza(®), 591 AEs were reported including 70 "serious" AE. The most frequently reported "serious" AEs were neurological for both Pandemrix(®) (38.9%, mainly isolated ascending paresthesia without any other neurological symptom and complication) and Panenza(®) (28.9%). Febrile convulsions were the most common neurological AEs with Panenza(®) in children. All reported deaths (n = 22) described causes other than recent A(H1N1)v vaccination. No causal relationship was established between these AEs and vaccination. Among AEs of "special" interest, 13 reports of confirmed GBS and 15 reports of demyelinating disorders were notified. No report of narcolepsy was made during the study period. CONCLUSION: For both vaccines, neurological AEs (isolated ascending paresthesia with Pandemrix(®) and febrile convulsions with Panenza(®)) were among the most frequently reported "serious" AEs. Despite limits of this survey based on spontaneous reporting, the study did not detect any safety signals, at least with an 8-month follow-up.

Isotretinoin exposure during pregnancy: assessment of spontaneous reports in France.

BACKGROUND: In three previous studies, we have shown that pregnant women were still being exposed to isotretinoin and that compliance with recommendations was incomplete. The relaxation of these recommendations (summary of product characteristics 2004), combined with the release of generic brands, encouraged us to carry out a fourth study. OBJECTIVE: To assess isotretinoin exposure during pregnancy following the application of less stringent recommendations and the marketing of generic isotretinoin brands. METHODS: All cases of isotretinoin exposure during pregnancy, between 1 January 2003 and 31 December 2006, spontaneously reported to pharmacovigilance centres, the Teratogenic Agent Information Centre, and pharmaceutical companies in France were assessed. Cases were classified for analysis into the following groups: 'conception <1 month after isotretinoin discontinuation', 'conception during isotretinoin treatment' and 'patient already pregnant when isotretinoin was started'. The rate of spontaneously reported isotretinoin exposure during pregnancy was estimated by dividing the number of isotretinoin-exposed pregnancies by the number of women of childbearing age treated with isotretinoin. RESULTS: Over 4 years, 147 cases of isotretinoin exposure during the teratogenic risk period were spontaneously reported, i.e. 'conception <1 month after isotretinoin discontinuation' (23%), 'conception during isotretinoin treatment' (61%), and 'patient already pregnant when isotretinoin was started' (16%). Nineteen percent of the patients did not use any form of contraception. In 23% of the patients, the method of contraception used did not comply with recommendations, while in 86% of the cases, isotretinoin was prescribed by a dermatologist. Among the 44 pregnancies with available data on fetuses or neonates, there were two (4.5%) malformations compatible with the time of exposure and with isotretinoin embryopathy. The rate of spontaneously reported isotretinoin exposure during pregnancy has increased by approximately 30%, from 0.32 (95% CI 0.26, 0.38) to 0.41 (95% CI 0.34, 0.49) per 1000 women of childbearing age treated since 1999-2002. CONCLUSIONS: We suggest that recommendations be tightened, with specific information regarding the most effective contraceptive method combined with compulsory monthly pregnancy testing during treatment. The French Drug Agency has informed the European Medicines Agency of the need for measures aimed at improving compliance.

Antipsychotics-induced ischaemic colitis and gastrointestinal necrosis: a review of the French pharmacovigilance database.

PURPOSE: First- and second-generation antipsychotics commonly cause mild gastrointestinal hypomotility. Intestinal necrosis may be a consequence of such gastrointestinal perturbations. MATERIAL AND METHODS: We reviewed all the observations of ischaemic colitis and gastrointestinal necrosis notified to the French Pharmacovigilance database (FPD) between 1997 and the end of 2006. RESULTS: Thirty-eight cases of ischaemic colitis and gastrointestinal necrosis associated with antipsychotics were analysed. The average age of the patients was 42.7 +/- 14.7 years (15-77 years). The digestive complication was an intestinal necrosis in 27 cases, an ischaemic colitis in 10 cases (with perforation in three cases), and one perforation. Surgical procedure (partial or total resection of the colon and/or small intestine) was performed in 24 patients. Six patients died despite surgery. Among the whole population, the outcome was fatal in 14 patients, 13 patients recovered with sequelae, six patients fully recovered, and the outcome remained unknown in five cases.In 55.2% of the cases, the patients were treated with more than one antipsychotic medication. The most frequently involved antipsychotics were: clozapine, levomepromazine, cyamemazine, haloperidol. Associated antimuscarinic drugs (excluding antipsychotics) were found in 68.4% of patients. DISCUSSION/CONCLUSION: Intestinal necrosis associated with antipsychotics is very rare; however mortality is high, with a rapid worsening of patients towards septic shock in spite of mild clinical symptoms. It is therefore essential to monitor the patients receiving antipsychotics especially when they are prescribed concomitant medications. The occurrence of non-specific clinical symptoms such as abdominal pain associated with vomiting and/or diarrhea should draw attention.

Bayesian pharmacovigilance signal detection methods revisited in a multiple comparison setting.

Pharmacovigilance spontaneous reporting systems are primarily devoted to early detection of the adverse reactions of marketed drugs. They maintain large spontaneous reporting databases (SRD) for which several automatic signalling methods have been developed. A common limitation of these methods lies in the fact that they do not provide an auto-evaluation of the generated signals so that thresholds of alerts are arbitrarily chosen. In this paper, we propose to revisit the Gamma Poisson Shrinkage (GPS) model and the Bayesian Confidence Propagation Neural Network (BCPNN) model in the Bayesian general decision framework. This results in a new signal ranking procedure based on the posterior probability of null hypothesis of interest and makes it possible to derive with a non-mixture modelling approach Bayesian estimators of the false discovery rate (FDR), false negative rate, sensitivity and specificity. An original data generation process that can be suited to the features of the SRD under scrutiny is proposed and applied to the French SRD to perform a large simulation study. Results indicate better performances according to the FDR for the proposed ranking procedure in comparison with the current ones for the GPS model. They also reveal identical performances according to the four operating characteristics for the proposed ranking procedure with the BCPNN and GPS models but better estimates when using the GPS model. Finally, the proposed procedure is applied to the French data.

Association between concomitant use of several systemic NSAIDs and an excess risk of adverse drug reaction. A case/non-case study from the French Pharmacovigilance system database.

AIMS: To examine whether the risk of some selected adverse effects increases with the number of systemic non-steroidal anti-inflammatory (NSAID) drugs. METHODS: The French Pharmacovigilance database was examined for an association between drug reaction reports and the exposure to one and two or more NSAIDs using a case/non-case study design. In the analysis, 54,583 spontaneous reports of adverse drug reactions were included, consisting of 2270 reports of hepatic injury, 994 reports of acute renal failure, 194 reports of gastrointestinal bleeding and 525 reports of angioedema, among others. RESULTS: Use of NSAIDs significantly increased the risk of hepatic injury, gastrointestinal bleeding, acute renal failure and angioedema. The odds ratios tended to increase with the number of NSAIDs for hepatic injury, gastrointestinal bleeding and acute renal failure but not for angioedema. In comparison with reports that did not mention any use of NSAIDs, the odds ratios associated with the use of a single NSAID and two or more NSAIDs were respectively 1.2 (95%CI: 0.9-1.5) and 2.2 (95%CI: 1.3-3.8) for hepatic injury, 7.3 (95%CI: 4.9-10.9) and 10.7 (95%CI: 2.9-40.2) for gastrointestinal bleeding, 3.2 (95%CI: 2.5-4.1) and 4.8 (95%CI: 2.6-8.8) for acute renal failure. For angioedema, the odds ratios were roughly similar when a single NSAID (OR=2.7; 95% CI: 2.2-3.4) or two or more NSAIDs (OR=2.0; 95%CI: 0.7-6.0) were used. The risk of severe ADRs (hepatic injury and acute renal failure) was six- to sevenfold higher in reports mentioning concomitant use of two NSAIDs or more than in those that did not. CONCLUSION: This study shows that concomitant use of two or more NSAIDs was associated with an excess risk of adverse effects such as hepatic injury, acute renal failure and gastrointestinal bleeding. Although simultaneous use of several systemic NSAIDs has no pharmacological justification, this may raise a serious public health problem with the increasing use of over-the-counter non-steroidal anti-inflammatory agents.