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Resume Objectif Decrire les caracteristiques et la prise en charge de patients migraineux suivis medicalement en officines. Methodes Des questionnaires et des historiques medicamenteux ont permis de rassembler des informations sur les migraines, la consommation medicamenteuse et les habitudes de vie de patients traites pour migraines. Resultats Sept cent soixante deux patients ont participe a cette etude. Les crises se caracterisaient par une douleur intense chez plus de 80 % des patients. La frequence etait superieure a 2 crises par semaine dans 16 % des cas. Quatre vingt quatre pour cent des patients avaient une prescription de triptan et 45 % suivaient un traitement de fond. Les antalgiques non specifiques etaient prescrits pour 55 % des patients. Une consommation excessive des traitements de la crise etait supposee dans 46 % des cas. Conclusion Le recours aux antalgiques non specifiques est encore eleve. Le pharmacien pourrait contribuer a l’amelioration de la prise en charge.

Summary Background Patient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated. Methods Asthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified. Results During the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR = 3.36, 95%CI = [1.47–7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR = 0.24, 95%CI = [0.08–0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR = 0.35, 95%CI = [0.13–0.89]). Conclusions Our study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy.

Background Patients' perception of their ability to influence their asthma symptoms has not been sufficiently addressed. Objective To study the relationship between patients' perceived ability to self-care, as approached by internal locus of control (LOC) orientation, and concomitant level of asthma control. Methods A cross-sectional study was conducted from May 19, 2004, through July 7, 2005. Asthma patients receiving inhaled corticosteroids and supervised in primary care were identified. Asthma control was measured with the Asthma Control Test. Patients reported their LOC orientation on a 100-mm visual analog scale (0%, "I have absolutely no influence on asthma change," to 100%, "this change only depends on me"). Asthma therapy was obtained from a prescription database. The risk of an internal LOC of less than 50% was studied. Results Among the 163 patients with documented LOC (mean age, 52 years; 58% female), 72 (44.2%) had an internal LOC of less than 50%. Asthma control was inadequate for 65 of the 157 patients with available data on the global score of the Asthma Control Test (41.4%). Patients with inadequately controlled asthma had a higher risk of a LOC of less than 50% (odds ratio, 2.68; 95% confidence interval, 1.23-5.81). A 3-fold increased risk also appeared for patients older than 65 years compared with those younger than 45 years. Conversely, no association was identified with sex, asthma severity markers, or therapy. Conclusions Asthma control was related to internal LOC orientation (ie, perceived ability to self-care). Improved self-care efficiency is a target for adequate disease management.

International audience; AIMS: To identify the correlates of accidental omissions and intentional interruptions of respiratory therapy in COPD. METHODS: COPD patients (GOLD stages II-IV) were recruited by general practitioners or respiratory physicians. Patients reported in self-report questionnaires their adherence to respiratory drugs (over the past three months) and their perception of therapy. RESULTS: 179 patients were included (mean age 63 years, 24% females). 45% forgot their respiratory therapy, while 30% interrupted it in the absence of any perceived benefit. The risks of accidental omissions were significantly higher when patients complained about having too many medications to take on a daily basis (OR=2.35; 95%CI=1.13-4.89), and among current smokers (OR=2.14; 95%CI=1.07-4.29). Females were more likely to interrupt therapy intentionally (OR=2.40; 95%CI=1.04-5.53). Surprisingly, there was no significant relationship with the number of drugs actually taken by patients. CONCLUSIONS: Adherence to respiratory drugs is inadequate in COPD patients. In order to improve adherence, patients' perception of the burden of therapy should not be overlooked.

Background: There have been few epidemiologic studies on neuromyelitis optica (NMO) and none used the recent 2006 diagnostic criteria. Here we describe the clinical, laboratory, MRI, and disability course of NMO in a French cohort of 125 patients. Methods: We performed an observational, retrospective, multicenter study. Data were collected from September 2007 through August 2008, corresponding to the endpoint of the study. We identified 125 patients fulfilling the 2006 NMO criteria. Selection was made using hospital files and a specific clinical questionnaire for NMO. Results: Mean age at onset was 34.5 years (range 4–66) with a mean disease duration of 10 ± 7.8 years at the endpoint. The patients were mainly (87%) Caucasian, with a female:male ratio of 3:1. In 90% of cases, the association of optic neuritis, longitudinal extensive myelitis, and a Paty-negative initial brain MRI was sufficient to fulfill the supportive criteria. Eighty-eight percent of patients were treated with immunosuppressive therapies. Median delay from onset to Expanded Disability Status Scale (EDSS) score 4 was 7 years; score 6, 10 years; and score 7, 21 years. The first episode of myelitis was immediately followed by an EDSS score ≥4 in 37.3% of cases, and a severe residual visual loss was observed in 22% of patients after the first episode of optic neuritis. Multivariate analysis did not reveal any predictors of a poor evolution other than a high number of MRI brain lesions at diagnosis, which were predictive of a residual visual acuity ≤1/10. Conclusions: Our demographic data provide new data on disability in patients with neuromyelitis optica, most of whom were receiving treatment.

International audience; AIM: To estimate the prevalence of triglyceride and/or high density lipoprotein cholesterol (HDL-C) disorders and their relationships with other cardiovascular risk factors among patients with dyslipidaemia on lipid-lowering therapy. METHODS: In this cross-sectional study in dyslipidaemic patients receiving lipid-lowering therapy, lipid disorders were defined as triglyceride greater than 1.5 g/L, HDL-C lesser than 0.4 g/L and low-density lipoprotein cholesterol (LDL-C) above the recommended concentration according to French guidelines. Based on these disorders, patients were classified into four groups: group 1, no lipid disorders; group 2, low HDL-C and/or high triglyceride concentration with normal LDL-C; group 3, isolated elevated LDL-C; and group 4, elevated LDL-C and low HDL-C and/or high triglyceride. Patients' cardiovascular risk levels were compared across groups. RESULTS: Among the 2727 patients (mean age 64.7 years, 46.7% women), 28% did not reach the target LDL-C concentration as defined by French guidelines. Prevalence rates of high triglyceride and low HDL-C were 27.2 and 10.3%, respectively. Over half (51.2%) of the patients were in group 1, 20.5% were in group 2, 16.2% in group 3 and 12.1% in group 4. Among patients meeting the target LDL-C, those with high triglyceride and/or low HDL-C exhibited a significantly higher number of risk factors (1.83 vs 1.68, p\\textless0.001). Smoking, diabetes and hypertension were associated separately with low HDL-C and/or high triglyceride (p=0.01, p\\textless0.0001, p=0.03, respectively). Conversely, these associations were not observed in patients who did not achieve the target LDL-C, with the exception of smoking (p\\textless0.0001). CONCLUSION: HDL-C and triglyceride disorders are relatively frequent among treated patients, particularly when cardiovascular risk level increased.

Background The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies. Methods A convenience sample of patients with a Body Mass Index ≥ 28 kg/m2 were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension. Results QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m2 was significantly associated with poorer QOL scores on physical, relational and psychological dimensions. Conclusion Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.

International audience; BACKGROUND: LDL-cholesterol therapeutic objectives attainment under lipid lowering therapy remains inadequate. The correlates of LDL-cholesterol therapeutic objective attainment have not been thoroughly explored in an observational setting. METHODS: Patients under lipid lowering therapy and managed by general practitioners were included. LDL-cholesterol therapeutic objective was defined according to the number of cardiovascular risk factors associated with dyslipidemia (AFSSAPS-2005 guidelines). RESULTS: Most of the 2727 patients (mean age: 64.7+/-11.0) received a statin (70.0%) or a fibrate (24.3%) in monotherapy. 58.5% of patients at high cardiovascular risk did not reach therapeutic objective. Compared to simvastatin, patients receiving fibrates were less likely to be at therapeutic objective (OR=0.38, 95% CI=[0.26-0.54]). So were patients receiving fluvastatin (OR=0.41, IC95%=[0.26-0.64]) or pravastatin (OR=0.49, IC95%=[0.35-0.70]) at the dosages used by GPs. No significant difference appeared with atorvastatin (OR=0.99, 95% CI=[0.71-1.39]) or rosuvastatin (OR=1.25, CI95%=[0.77-2.02]). Patients with LDL-cholesterol levels\\textless0.7 g/L tended to be prescribed high doses of lipid lowering therapy. CONCLUSIONS: In real conditions of lipid lowering therapy use, LDL-cholesterol therapeutic objective attainment was inadequate in high-risk patients, and TO differences were observed between drugs at prescribed doses.

Background Natalizumab, a monoclonal antibody, has shown efficacy in reducing the relapse rate and delaying disability accumulation in relapsing remitting (RR) multiple sclerosis (MS) patients. However, severe opportunistic infections and infusion reactions have been observed in clinical trials. Therefore, a national risk management plan (RMP) has been launched in France by AFSSAPS with the participation of FFN. Evaluation of the benefit/risk ratio (BRR) of natalizumab in real life settings will give a measurement of the RMP impact. Objectives The main objective of the TYSEDMUS study is to establish the safety profile of natalizumab in real life settings. Secondary objectives are to describe the conditions for use of the treatment, the clinical evolution of the patients in terms of relapses and disability, and to compare the occurrence of malignancies and serious infections in this natalizumab-exposed population vs a non-exposed one. Methods TYSEDMUS is a multicentre observational cohort study promoted by AFSSAPS (Agence Francaise de Securite Sanitaire des Produits de Sante) involving French neurologists prescribing natalizumab. It aims at including all the patients exposed at least once to natalizumab. Patients9 characteristics under natalizumab (including clinical evolution), utilisation patterns of natalizumab and occurrence of adverse events are described and included in EDMUS databases. A group of non-exposed patients, never treated with natalizumab, either receiving or not other immuno-active therapies, will be later extracted from the EDMUS databases for comparison. Preliminary Results The study has been launched in November 2007. The follow-up duration is planned to be at least 5 years. By October 2009, a total of 1296 patients had been recruited. Study methods and descriptive results regarding the first 873 patients (76% female) are presented. The French neurologists mainly followed the requirements of the RMP recommendations. The overall tolerance of natalizumab was quite good. Less than 4% of the patients experienced a serious adverse event (SAE), and there had been no report of unexpected side effects. 31 serious adverse events had been reported in 29 patients, some of them not life-threatening. 16 led to treatment discontinuation; the other patients remained on TYSABRI®. Reported SAE were one cardiac arrest 3 weeks after the second infusion, 10 allergic or anaphylactic reactions, 5 suicide attempts, 7 non-opportunistic infections which fully and rapidly recovered, 1 liver enzyme increase (persisting after natalizumab discontinuation), 1 hypereosinophilia, 1 rectal carcinoma (discovered after 7 infusions), 1 severe MS relapse and 4 miscellaneous. No case of Progressive Multifocal Leucoencephalopathy had yet been reported by October 2009 in the data base. 47/873 patients discontinued treatment (5.4%). Among patients followed 1 year or more, the Annualized Relapse Rate (ARR) decreased from 2.0±1.2 to 0.2±0.4 (N=286, 90% reduction, p Conclusion The TYSEDMUS study should allow to evaluate the BRR and the good practice in the long term use of natalizumab in France. Etat des lieux Le natalizumab, anticorps monoclonal, reduit la frequence des poussees et retarde la progression du handicap des patients atteints de scleroses en plaques (SEP) remittentes. Toutefois des infections opportunistes graves et des reactions allergiques ont ete observees dans les essais therapeutiques. Un plan de gestion de risque a ete mis en place en France par l9AFSSAPS avec l9aide de la FFN. L9evaluation du rapport benefice risque en situation de vie reelle permettra de mesurer l9efficience de ce plan de gestion de risque. Objectifs L9objectif principal de l9etude Tysedmus consiste en l9analyse du profil de securite du natalizumab en situation d9utilisation reelle. Les objectifs secondaires sont la description des conditions d9utilisation en relation avec le plan de gestion de risque, l9evolution clinique des patients en terme de frequence des poussees et de progression du handicap, et de comparer la frequence de survenue d9affections malignes et/ou d9infections severes chez les patients exposes au natalizumab versus une groupe de SEP non exposes. Methodes TYSEDMUS est une etude observationnelle multicentrique de cohorte dont le promoteur est l9AFSSAPS soutenue par la FFN. Elle implique les neurologues francais qui prescrivent le natalizumab. Son objectif est d9inclure tous les patients exposes au moins une fois a une perfusion de natalizumab. Les caracteristiques cliniques et evolutives des patients, les strategies d9utilisation et le recensement des effets indesirables sont decrits et inclus dans la base de donnees EDMUS. Un groupe de patients atteints de SEP non exposes, recevant ou pas d9autres immunosuppresseurs, sera secondairement extrait de la base de donnees pour comparaison. Resultats preliminaires L9etude a debute en novembre 2007. La duree de suivi prevue est de 5 ans au moins. Au mois d9octobre 2009, un nombre total de 1296 patients avait ete recrute. Les resultats concernant les 873 premiers patients (76% de femmes) est presente. Les neurologues francais suivent en majorite les recommandations d9utilisation du plan de gestion de risques. La tolerance generale du produit est plutot bonne. Moins de 4% des patients ont presente un evenement indesirable grave (EIR) et aucun effet indesirable inattendu n9a ete rapporte (31 EIR pour 29 patients). 16 EIR ont conduit a une interruption de traitement ; les autres patients ont ete maintenus sous traitement. Les EIR rapportes sont les suivants : 1 arret cardiaque 3 semaines apres la 2eme perfusion, 10 reactions anaphylactiques ou allergiques, 5 tentatives de suicide, 7 infections non-opportunistes avec guerison complete rapide, 1 augmentation des enzymes hepatiques ayant persiste apres l9arret du natalizumab, 1 hypereosinophilie, 1 carcinome rectal (decouvert a la 7eme perfusion), 1 poussee severe de SEP et 4 EIR classes divers. A la date de l9analyse des donnees aucun cas de LEMP n9avait encore ete rapporte dans la base de donnees. Parmi les patients suivis au moins un an ou plus, la frequence annuelle des poussees a diminue de 2±1.2 a 0.2±0.4 (N=286, 90% reduction, p Conclusion L9etude Tysedmus permettra l9evaluation du plan de gestion de risques et des pratiques d9utilisation du natalizumab en France.

Introduction De recentes etudes ont montre une evolution du sex-ratio de la Sclerose en Plaques (SEP) au cours des dernieres decennies. Nous avons souhaite confirmer ces resultats sur des donnees francaises. Objectifs Evaluer l’evolution du ratio femmes/hommes au cours du temps dans l’ensemble de la cohorte francaise de patients atteints de SEP constituant l’Observatoire Francais de la SEP. Methodes En janvier 2008, les centres francais utilisant le logiciel EDMUS ont fourni une extraction automatique et anonyme de leur base de donnees. Les doublons ont ete exclus. Seuls les diagnostics certains et probables selon Poser ont ete retenus. L’evolution du sex-ratio a ete analysee selon l’annee de debut, l’annee de naissance et la forme clinique initiale. Un modele de regression lineaire et un test de Wald ont ete utilises pour evaluer la significativite des tendances. Resultats 24 754 dossiers provenant de 20 centres ont ete pooles. 430 patients etaient enregistres dans deux bases ou plus. Il y avait 71 % de femmes. Il existait une augmentation du sex-ratio de 29% sur une periode de 39 ans, pour les patients nes de 1941 a 1980, et de 29% en 32 ans pour patients ayant debute leur SEP entre 1974 a 2006. Cette evolution du sex-ratio ne concernait que les formes a debut remittent. Discussion Nos resultats confirment la description canadienne princeps. Ils rapportent pour la premiere fois une distinction entre les formes evolutives initiales. L’explication de cette observation pourrait etre artefactuelle, par les changements de modalites diagnostiques de la SEP, ou plus certainement environnementale, impliquant un ou plusieurs facteurs ayant affecte de maniere differente les hommes et les femmes au cours des dernieres decennies. Conclusion Il existe une augmentation progressive du sex-ratio de la SEP, la maladie affectant une proportion plus importante de femmes ayant un debut remittent. L’explication de ce phenomene reste a trouver.