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Comparer les structures de consommations des antidiabétiques non insuliniques dans les cinq principaux pays européens et évaluer la place qu’occupent les classes innovantes, inhibiteurs de la dipeptidyl peptidase-4 (iDPP4 ou « gliptines »), agonistes des récepteurs du glucagon-like peptide-1(aGLP-1), et inhibiteurs des cotransporteurs sodium-glucose de type 2 (iSGLT2 ou « gliflozines »).

Purpose To compare the effectiveness of two treatment sequences, latanoprost–latanoprost timolol fixed combination (L-LT) versus travoprost–travoprost timolol fixed combination (T-TT), in the treatment of open-angle glaucoma (OAG) or ocular hypertension (OHT).Methods A discrete event simulation (DES) model was constructed. Patients with either OAG or OHT were treated first-line with a prostaglandin, either latanoprost or travoprost. In case of treatment failure, patients were switched to the specific prostaglandin-timolol sequence LT or TT. Failure was defined as intraocular pressure higher than or equal to 18 mmHg at two visits. Time to failure was estimated from two randomized clinical trials. Log-rank tests were computed. Linear functions after log-log transformation were used to model time to failure. The time horizon of the model was 60 months. Outcomes included treatment failure and disease progression. Sensitivity analyses were performed.Results Latanoprost treatment resulted in more treatment failures than travoprost (p<0.01), and LT more than TT (p<0.01). At 60 months, the probability of starting a third treatment line was 39.2% with L-LT versus 29.9% with T-TT. On average, L-LT patients developed 0.55 new visual field defects versus 0.48 for T-TT patients. The probability of no disease progression at 60 months was 61.4% with L-LT and 65.5% with T-TT.Conclusions Based on randomized clinical trial results and using a DES model, the T-TT sequence was more effective at avoiding starting a third line treatment than the L-LT sequence. T-TT treated patients developed less glaucoma progression.

Purpose To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) in France.Methods Second-line patients were recruited from September 14, 1998, to December 20, 2000, in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure (IOP) levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management. This article reports results of the final analysis of 2-year follow-up data for patients with at least two contacts with a study ophthalmologist.Results Data were analyzed for 346 patients and 672 treated eyes. Monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 2.8±0.2 years after diagnosis, primarily due to insufficient IOP control (60.3%) and adverse drug reactions (18.3%). Relative risk (RR) (95% CI) for adverse drug reactions (ADR) under monotherapy was 1.00 (1.00–1.00) under beta blockers (n=116) versus 0.40 (0.16–0.64) under latanoprost (n=21), 2.30 under carbonic anhydrase inhibitors (n=29), and 2.90 under adrenergics (n=38); RR for ADR under combination therapy was 1.00 (1.00–1.00) for unfixed combinations without latanoprost (n=66) versus 0.11 (0.00–0.22) for unfixed combinations of latanoprost + timolol (n=3). Cardiac or pulmonary problems have been reported in 26.9% of patients. Persistency on initial therapy was 62.5% (95% CI 53.0–72.0) for latanoprost monotherapy versus 41.1% (34.8–47.4) for beta-blocker monotherapy and 43.6% (26.6–60.6) for the latanoprost + timolol combination versus 29.8% (15.2–44.4) for combination therapies that did not include latanoprost. Average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy: latanoprost + timolol did not cost more than therapeutic combinations without latanoprost.Conclusions Insufficient IOP control and adverse drug reactions are the two main reasons for changing first-line treatment in patients with POAG or OH. After 2 years, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior safety and persistency to treatment at an acceptable cost.

Purpose To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with glaucoma or ocular hypertension (OH) in France.Methods Patients were recruited between 1998 and 2000 in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This article reports results of an interim analysis of 1-year follow-up data for patients having at least two contacts with a study ophthalmologist.Results Data were analyzed for 283 patients and 549 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 3.4 ± 0.5 years after diagnosis, primarily due to insufficient IOP control (62.8%). Mean IOP reductions after 1 year of second-line therapy were 3.0 mmHg in eyes treated with latanoprost monotherapy versus 2.1 mmHg in those receiving beta-blocker monotherapy (p=0.02) and 5.4 mmHg in eyes treated with the latanoprost + timolol combination versus 4.1 mmHg in those receiving combination therapies that did not include latanoprost (p=0.01). Although second-line treatment with latanoprost was more costly than treatment with beta blockers, the average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy, and latanoprost + timolol was less costly than therapeutic combinations without latanoprost.Conclusions Insufficient IOP control is the main reason for changing first-line treatment in patients with glaucoma or OH. After 1 year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.

Purpose To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2000 in France.Methods Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Mean lengths of stay and hospital costs were estimated using national cost scales published by the French Ministry of Health. Numbers of patients treated per year with latanoprost, brimonidine, or the fixed combination of dorzolamide + timolol were estimated from drug unit sales using defined daily doses for each drug.Results Between 1997 and 2000, the number of patients treated with a glaucoma drug increased from 410,000 to 734,000 patients per year. This increase was associated with the introduction of three new glaucoma drugs: 245,000 patients received latanoprost (71.0%), brimonidine (28.8%), or the fixed combination of dorzolamide + timolol (0.2%). During the same period, the surgery rate in patients receiving medical treatment declined by 47%, from 5.9% to 3.1%. The total number of glaucoma interventions declined by 4.6% (-12% in public hospitals and 0% in private hospitals). This relative stability resulted mostly from a shift from trabeculectomies to other procedures, mainly to new filtering procedures in private hospitals.Conclusions Between 1997 and 2000, new glaucoma drugs, primarily latanoprost and brimonidine, improved intraocular pressure control and delayed surgery, reducing the glaucoma procedure rate in patients receiving glaucoma-related medical treatment by 47%.

The influence of chloride, sulfate and perchlorate anions on the behaviour of native oxide layers on aluminium is investigated using electrochemical techniques. Due to its influence on the open circuit potential and the cathodic side of the polarization curve the oxygen concentration has been carefully controlled. Two kinds of attack on a commercially pure aluminium (99.5 wt %) have been observed. In all the investigated 0.5 M Cl−, 0.5 M ClO−4and 0.5 M SO2−4aqueous solutions the metal is corroded around the iron and silicon containing precipitates, but only in Cl−and ClO−4solutions is crystallographic pitting observed. Comparison with high purity aluminium (99.99 wt %) shows that pitting corrosion is not influenced by the presence of impurities in the aluminium alloys, but by the presence of anions in solution. The pH and/or oxygen concentration determine whether or not the pitting potential coincides with the corrosion potential.

Radioactive gas or technetium-99m aerosols are used to perform pulmonary ventilation scintigraphy. The aim of this study was to compare three radiopharmaceuticals, Kryptoscan®, Technegas®and Venticis II®, in terms of their costs and user preferences rather than on the basis of diagnostic efficacy.

La prise en charge de la douleur chronique comprend les traitements opioïdes faible/fort ayant un potentiel de dépendance, d’abus et de mésusage élevé. Bien qu’une épidémie d’overdoses mortelles aux opioïdes hors cancérologie soit décrite aux Etats-Unis, ce phénomène semble moins observé en France. Néanmoins, les autorités sanitaires françaises ont accru la surveillance de ces traitements. L’objectif de l’étude FRANTALGIC est de décrire les nouveaux patients douloureux chroniques sous opioïdes et l’évolution de leur prise en charge à moyen terme.

La télémédecine est un sujet qui retient l’intérêt grandissant des acteurs de santé français. Néanmoins, les impacts médico-économiques restent à date peu évalués. L’Association des laboratoires japonais présents en France (LaJaPF) souhaite contribuer à la réflexion en initiant une étude sur l’impact économique de la télémédecine, dans la perspective d’améliorer l’efficience des systèmes de santé. L’approche retenue s’appuie sur des données en vie réelle pour couvrir l’exhaustivité des consommations de soins. La téléconsultation, télésurveillance et téléexpertise ont été privilégiées dans trois pathologies d’intérêt de santé publique en raison de leur prévalence en augmentation et des coûts associés importants : diabète de type 2, hypertension artérielle et cancer de la prostate.

Electropolishing copper in 14MH3PO4was studied using both ex situ and in situ optical techniques. First, an ex situ study revealed the influence of the electropolishing potential on the visual appearance and the surface topography. Gloss together with total integrated scattering reflected the changes in surface roughness as evidenced from optical profilometry images. Second, an in situ optical study using ellipsometry revealed the changes in the thickness of the surface film, as well as roughness modifications. Altogether, this provided the characterization of the whole electropolishing process in terms of roughness and film formation. From the polarization curve combined with the complementary analysis techniques it was observed in situ that an initial regime showed increased roughness of the copper surface, followed by a current limiting plateau exhibiting the best conditions of electropolishing: anodic brightening. For higher applied potentials, a region with pitting and deterioration of the appearance followed.