[mediEVAL: a new evaluating tool for the medication-use system]. / mediEVAL : un nouvel outil d'évaluation de la prise en charge médicamenteuse.

PURPOSES: A new methodology to evaluate the medication-use system based on a risk cartography tool, has been developed. This work has been promoted by the Observatoire du médicament et des dispositifs médicaux stériles et de l'innovation thérapeutique (OMEDIT) from Provence-Alpes-Côte d'Azur (PACA)-Corse regions. METHODS: This new methodology has been developed with Excel (Microsoft(®)) and has led to the mediEVAL tool. It consists in two categories of Excel files: evaluating Excel files (1 for each job of the medication-use system) and synthesis Excel files which allow to compile a group of evaluating files for a defined area (department, hospital…). RESULTS AND CONCLUSION: mediEVAL is a new tool to evaluate quality and risk management of the entire medication-use system which has to be used by private or public hospitals of PACA and Corsica areas in their appropriate medication-use contract. Then, the OMEDIT can get data to provide an inventory of fixtures of the PACA-Corse area medication-use system situation.

Fluoroquinolone prescriptions in a teaching hospital: a prospective audit.

The aim of this study was to identify prospectively the prevalence of unnecessary or inappropriate fluoroquinolone prescriptions in our teaching hospital and to identify the contributing factors. 55% of the 110 prescriptions evaluated were unnecessary or inappropriate. Ward and combination therapies were significantly associated with misuse.

TNFalpha antagonist continuation rates in 442 patients with inflammatory joint disease.

OBJECTIVE: To evaluate TNFalpha antagonist continuation rates in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA). METHODS: We retrospectively reviewed the charts of patients treated with etanercept, infliximab, or adalimumab at our teaching hospital. Drug continuation was evaluated using Kaplan-Meier survival curves. The logrank test was used to compare continuation rates. RESULTS: We identified 442 patients who were prescribed 571 TNFalpha antagonist treatments between August 1999 and June 2005. Among them, 304 had RA, 92 AS, and 46 PsA. In the RA group, continuation rates were high with etanercept (n=157; 87% after 12 months and 68% after 24 months) and adalimumab (n=43, 83% and 66%) but significantly lower with infliximab (n=104, 68% and 46%; P=0.0001 vs. etanercept and P=0.01 vs. adalimumab). In the AS group, in contrast, infliximab (n=53) showed significantly higher continuation rates (89% and 83%) than did etanercept (n=39; 76% after 12 months: P=0.03). Overall continuation rates were higher in AS than in RA (P=0.01). CONCLUSION: Continuation was better with etanercept than with infliximab in patients with RA, whereas the opposite was noted in patients with AS.

Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study.

BACKGROUND: Chronic erosive oral lichen planus (EOLP) is a severe form of lichen of the buccal mucosa that is often resistant to systemic or topical therapies. OBJECTIVE: To evaluate the efficacy and safety of topical tacrolimus, 0.1 mg per 100 mL of water, in treating EOLP. DESIGN: Open-label, prospective, noncomparative study, with 6 months of treatment and 6 months of follow-up. SETTING: Dermatology department at a university hospital in Nice, France. PATIENTS: Ten patients with histologically proved EOLP that was refractory to treatment. Two patients were withdrawn because of noncompliance; findings in 8 were available for evaluation. INTERVENTIONS: Mouthwashes with tacrolimus, 0.1 mg per 100 mL of distilled water, 4 times daily for 6 months. MAIN OUTCOME MEASURES: Efficacy was assessed using a calculated score that combined the intensity of spontaneous and meal-triggered pain and the surface area of erosions. Safety assessment included the monitoring of adverse effects, clinical laboratory values, and blood concentrations of tacrolimus. RESULTS: Among the 8 patients evaluated, 1 had no improvement and 7 were improved. The mean score decreased from 7.00 at baseline to 5.43 (a 22.43% decrease) at 1 month, 4.14 (a 40.86% decrease) at 2 months, 3.00 (a 57.14% decrease) at 3 months, 2.43 (a 65.29% decrease) at 4 months, 2.57 (a 63.29% decrease) at 5 months, and 3.43 (a 51.00% decrease) at 6 months. A decrease of symptoms was reported by the 7 responding patients as soon as the first month of treatment. No severe adverse effects were observed. All patients had whole-blood concentrations of tacrolimus below the detection limit of the assay (1.5 ng/mL) at all intervals. At 9 months, 6 patients had had a relapse within a mean of 38.6 days. At 12 months, all patients had had a relapse and required treatment with topical corticosteroids or systemic hydroxychloroquine sulfate. CONCLUSION: Results of our study suggest a rapid and important palliating effect of low concentration of topical tacrolimus in distilled water in patients with EOLP.