[Use of dronabinol in the treatment of resistant neuropathic pain: Feedback from patients followed in a multidisciplinary pain center]. / Utilisation du dronabinol dans le traitement des douleurs neuropathiques réfractaires : retour d'expérience des patients suivis dans un Centre d'évaluation et de traitement de la douleur.

INTRODUCTION: Dronabinol is a drug composed of synthetic delta-9-tetrahydrocannabinol. In France, dronabinol requires a named Temporary Utilisation Authorisation (TUA), for the treatment of refractory neuropathic pain. Few data currently exist concerning its efficacy and tolerance. We present our feedback on its use for chronic pain patients, the multidisciplinary supervision and the monitoring set up by the clinical pharmacist. METHOD: This retrospective monocentric study presents Patients Global Impression of Change and tolerance data from patients treated with dronabinol in a pain center between October 2020 and July 2021. We present their satisfaction towards the care process. RESULTS: Nineteen patients were treated with dronabinol during the study period. - The clinical pharmacist issued 180 advices for patients and doctors. Patients reported a positive impact of the telephone follow-up carried out by the clinical pharmacist. - 75% (n=9/12) of patients who continued treatment for more than 3 months reported improvement in their health. - 74% (n=14/19) of patients had at least one adverse event, six patients needed to discontinue the treatment. DISCUSSION-CONCLUSION: Dronabinol represents an alternative that can improve the quality of life of some patients suffering from refractory neuropathic pain. Nevertheless, as with any medicine, its initiation requires a rigorous evaluation of the benefit-risk balance. The close collaboration between the physician and the clinical pharmacist allows a secure management patients and makes this complex drug circuit easer.

Meningoradiculitis due to varicella zoster virus reactivation in a patient treated with ixekizumab.

INTRODUCTION: Ixekizumab is a recently developed biopharmaceutical used since 2016 in the US and Europe for the treatment of plaque psoriasis. Few adverse effects have been reported in the literature and ixekizumab is not known to increase the risk of viral reactivation. Herein we report the case of an immunocompetent female patient treated with ixekizumab who presented meningoradiculitis due to varicella zoster virus (VZV) reactivation. PATIENTS AND METHODS: A 51-year-old woman, treated with ixekizumab for psoriasis, consulted in March 2018 for left hemicrania headache associated with left facial paralysis, but without fever. Brain MRI scans revealed cerebral venous thrombosis of the superior sagittal sinus. Analysis of cerebrospinal fluid (CSF) revealed lymphocytic meningitis and positive VZV-PCR. PCR blood assay for VZV was negative. Blood concentrations of anti-VZV IgG antibody increased while Anti-VZV IgM antibodies remained negative. The final diagnosis was VZV meningoradiculitis complicated by cerebral thrombophlebitis. The absence of skin rash, the rapid increase in anti-VZV IgG antibodies, the absence of anti-VZV IgM antibodies, and the negative blood PCR assay suggested viral reactivation rather than primary infection. The patient received acyclovir and coumadin and her condition improved rapidly. After multidisciplinary discussion, ixekizumab was reintroduced together with valacyclovir prophylaxis. CONCLUSION: This case raises the question of the risk of viral reactivation during treatment with an IL-17 inhibitor and with biologics in general. Neurological and vascular complications of VZV may occur without skin lesions and their occurrence during ixekizumab therapy must be investigated by PCR testing of CSF for VZV DNA.

[Hemorrhagic bullous dermatosis (HBD): A rare side-effect of heparins]. / Dermatose bulleuse hémorragique (DBH) : un effet indésirable rare des héparines.

BACKGROUND: Bullous haemorrhagic dermatosis (BHD) induced by heparin is a rare and benign side effect of which we report two cases. PATIENTS AND METHODS: Case 1: an 81-year-old man presented haemorrhagic bullae on the limbs and trunk 7 days after starting enoxaparin. The laboratory haemostasis assessment was normal. A diagnosis was made of BHD induced by enoxaparin and the patient's treatment was switched to apixaban, resulting in a favourable outcome with resolution of the lesions within 15 days. Case 2: a 71-year-old woman hospitalised for pulmonary embolism was given tinzaparin. At two months of treatment, haemorrhagic bullae were observed on her forearms at distance from the injection sites. A diagnosis of BHD induced by tinzaparin was made. Treatment with tinzaparin was continued and the lesions resolved within 15 days. DISCUSSION: Heparin-induced BHD is a rare entity initially described in 2006. Ninety-five cases of heparin-induced BHD have been reported. It is characterized by multiple haemorrhagic bullae at a distance from the injection sites. Time to onset of lesions after heparin initiation ranges from 24h to 4 months. Laboratory assessment should be routinely performed to rule out any haemostasis disorders. Lesions subside within 15 days whether heparin is continued or withdrawn. CONCLUSION: Heparin-induced BHD is a rare but benign side effect of heparins. In the absence of recommendations, therapeutic management should be adapted to the individual situation.

Aripiprazole: a new risk factor for pathological gambling? A report of 8 case reports.

OBJECTIVE: It is commonly accepted that pathological gambling results from the interaction of multiple risk factors. Among these, dopamine replacement therapy (DRT) prescribed for Parkinson disease can be cited. Another dopamine agonist, aripiprazole, could be a new risk factor. We decided to explore this potential adverse drug reaction (ADR). METHOD: Based on a cohort of 166 pathological gamblers starting treatment in our department, data of each of the 8 patients treated by aripiprazole at inclusion were analyzed. RESULTS: The patients involved were schizophrenic or bipolar, mostly young men with a history of addictive disorders and regular gambling prior to the prescription of aripiprazole. For each one of them, the causality of aripiprazole was considered, using an algorithm. The probability that pathological gambling is actually due to aripiprazole is "possible" in 7 cases out of 8, and "doubtful" in one. CONCLUSIONS: Adverse drug reactions were confronted with other already published case reports. Dopamine partial agonist mechanism of aripiprazole could explain the occurrence of pathological gambling.