Biomedical subjects

Christophe Lançon

Publications and source records attributed to Christophe Lançon.

6 recordsLinked to original sources

PubMed2006

Duloxetine compared with fluoxetine and venlafaxine: use of meta-regression analysis for indirect comparisons.

BACKGROUND: Data comparing duloxetine with existing antidepressant treatments is limited. A comparison of duloxetine with fluoxetine has been performed but no comparison with venlafaxine, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken. In the absence of relevant data to assess the place that duloxetine should occupy in the therapeutic arsenal, indirect comparisons are the most rigorous way to go. We conducted a systematic review of the efficacy of duloxetine, fluoxetine and venlafaxine versus placebo in the treatment of Major Depressive Disorder (MDD), and performed indirect comparisons through meta-regressions. METHODS: The bibliography of the Agency for Health Care Policy and Research and the CENTRAL, Medline, and Embase databases were interrogated using advanced search strategies based on a combination of text and index terms. The search focused on randomized placebo-controlled clinical trials involving adult patients treated for acute phase Major Depressive Disorder. All outcomes were derived to take account for varying placebo responses throughout studies. Primary outcome was treatment efficacy as measured by Hedge's g effect size. Secondary outcomes were response and dropout rates as measured by log odds ratios. Meta-regressions were run to indirectly compare the drugs. Sensitivity analysis, assessing the influence of individual studies over the results, and the influence of patients' characteristics were run. RESULTS: 22 studies involving fluoxetine, 9 involving duloxetine and 8 involving venlafaxine were selected. Using indirect comparison methodology, estimated effect sizes for efficacy compared with duloxetine were 0.11 [-0.14;0.36] for fluoxetine and 0.22 [0.06;0.38] for venlafaxine. Response log odds ratios were -0.21 [-0.44;0.03], 0.70 [0.26;1.14]. Dropout log odds ratios were -0.02 [-0.33;0.29], 0.21 [-0.13;0.55]. Sensitivity analyses showed that results were consistent. CONCLUSION: Fluoxetine was not statistically different in either tolerability or efficacy when compared with duloxetine. Venlafaxine was significantly superior to duloxetine in all analyses except dropout rate. In the absence of relevant data from head-to-head comparison trials, results suggest that venlafaxine is superior compared with duloxetine and that duloxetine does not differentiate from fluoxetine.

Antidepressive Agents↗

PubMed2006

Mortality in schizophrenia.

PURPOSE: The purpose of this article is to describe the current status of knowledge on excess mortality in schizophrenia and its causative factors, and to expand upon previous work evaluating approaches that may reduce mortality rates. METHODS: Literature available since 1995 was identified in a computerized search of the bibliographical databases Medline and Embase, using the topics 'mortality' and 'schizophrenia', and in a cross-reference search for articles that were particularly relevant. RESULTS: Schizophrenia is associated with mortality rates that are two to three times higher than those expected or observed in the general population. This excess of mortality is accounted for by a combination of an increased risk of suicide, in particular in young male patients soon after diagnosis, and more importantly, a higher number of natural deaths. In order to diminish the level of suicide among people with schizophrenia, the majority of research has focused on the identification of risk factors that predispose patients to attempt or commit suicide, while unhealthy styles, polypharmacy and inadequate healthcare have been shown to contribute to the high natural mortality. The link between the use of antipychotics and mortality has not been yet clarified. CONCLUSION: Dramatically increased mortality of schizophrenia patients is well established. It is time to move beyond this topic, and work towards interventions that aim at reducing the mortality risk in such patients.

Antipsychotic Agents↗

PubMed2006

Pharmacoeconomic modelling in schizophrenia. Trap or support for decision makers?

Pharmacoeconomic evaluations are important elements in the decision making process, and decision tree analyses are statistical models that analyse both clinical and economic consequences of medical actions. Using one theoretic model, key confounding variables were identified that constituted a standardised framework for economic evaluation of schizophrenia management. The extent to which they were included in several previously published schizophrenia models was appraised. Five different models were developed, and a systematic review of schizophrenia modelling studies was conducted. Results indicate that atypical antipsychotics may be more or less cost-effective depending upon whether key confounding variables were taken into account, but vigilance is warranted when assessing data because serious discrepancies can occur between different methods of analysis. A need for standardised schizophrenia pharmacoeconomic models exists. Additionally, social rehabilitation should be considered because this may also influence outcomes. Standardising modelling techniques will facilitate adherence to guidelines issued by decision makers.

Antipsychotic Agents↗

PubMed2006

[Neurofibromatosis type 1: psychiatric disorders and quality of life impairment].

Neurofibromatosis type 1 (NF1) is often associated with psychiatric disorders, which are more frequent in NF1 than in general population (33% of patients). Dysthymia is the most frequent diagnosis (21% of patients). There is also a high prevalence of depressive mood (7%), anxiety (1-6%), and personality (3%) disorders. The risk of suicide is four times greater than in the general population. Bipolar mood disorders or schizophrenia appear to be rare. The impaired quality of life associated with NF1 may play an important role in the development of psychiatric disorders. Quality of life assessments may help to identify a population at high risk.

Adult↗

PubMed2006

A new evaluation concept and its measurement: "male sexual anticipating cognitions".

CONTEXT: The development of sex-active drugs justifies the use of scales for evaluating changes induced by such forms of therapy. Among the tools available for evaluating erectile dysfunction (ED), the International Index of Erectile Function is the most widely used. Analysis of the scientific literature shows that these instruments remain primarily focused on functional aspects of ED. The vulnerability factors involved in ED are mainly based upon organic characteristics, e.g., age, cardiovascular diseases, or diabetes, but the psychological factors involved in the occurrence and maintenance of ED are less studied. OBJECTIVE: This conclusion led us to develop a French self-administered instrument, based on patients' subjective sexual experiences, to evaluate "male sexual anticipating cognitions," using Apter's reversal theory as a framework. DESIGN, SETTING, AND PATIENTS: We present here the first stages of the development of this new instrument. We carried out semistructured, one-to-one interviews with patients with psychogenic ED and patients with mixed ED. Eighteen one-to-one interviews were held in several urologic/andrologic and psychiatric sexologist services. Interviews were continued until the required information was obtained. Analyses of the content were performed to generate items for the new instrument. RESULTS: Dimensions isolated were those of (a) sexual beliefs; (b) metamotivational modes; and (c) dysfunctional coping. Pools of items are currently being analyzed by 108 experts (psychologists, sexologists, andrologists, urologists) to determine if additional items are required. The acceptability and the comprehensiveness of this preliminary questionnaire will be tested by 320 patients in a multicentric study, to produce a shorter questionnaire featuring the most relevant items. Once validated, this multidimensional instrument could be used to assess treatment efficacy of the mixed and psychogenic components of ED.

Aged↗

PubMed2003

The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France.

OBJECTIVES: This survey was conducted in order to determine the extent and nature of disorders of sexual function in depressed patients treated in the community in France. METHODS: Patients with DSM-IV major depressive episodes were included. The inclusion criteria stipulated that only patients with no antecedents of sexual dysfunction could be included. Information on sexual function was collected with a questionnaire which included physician observations as well as the Arizona Sexual Experience Scale. RESULTS: Overall, 4557 patients were included in the study. The prevalence of disorders of sexual function observed was 35% for spontaneously reported problems and 69% for problems identified by physician questioning. Impaired sexual function in depressed patients is also revealed by a high score on the Arizona Sexual Experience Scale (mean overall score of 21.4). Frequency of sexual dysfunction was somewhat higher in patients treated with antidepressants than in untreated patients (71% and 65% respectively). Treatment with tianeptine was associated with a lower incidence of sexual dysfunction than was treatment with tricyclic antidepressants or with selective serotonin reuptake inhibitors. Although in 39% of cases, physicians managed the sexual problems encountered by changing the antidepressant treatment, the most frequently adopted approach (42% of cases) was to await spontaneous remission. Drug holidays or adjunctive therapy were very rarely proposed. CONCLUSIONS: The prevalence of sexual dysfunction in patients with major depression is high. Antidepressant drugs appear to aggravate such problems, with certain classes of drug better tolerated than others. Sexual dysfunction in depressed patients is often not optimally treated.

Adult↗