{"id":1826,"date":"2006-10-01T01:00:00","date_gmt":"2006-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/utilisation-des-facteurs-de-croissance-hematopoietique-en-traitement-adjuvant-de-lhepatite-chronique-virale-c-une-enquete-nationale-francaise\/"},"modified":"2018-10-20T18:39:44","modified_gmt":"2018-10-20T16:39:44","slug":"utilisation-des-facteurs-de-croissance-hematopoietique-en-traitement-adjuvant-de-lhepatite-chronique-virale-c-une-enquete-nationale-francaise","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/utilisation-des-facteurs-de-croissance-hematopoietique-en-traitement-adjuvant-de-lhepatite-chronique-virale-c-une-enquete-nationale-francaise\/","title":{"rendered":"UTILISATION DES FACTEURS DE CROISSANCE HEMATOPOIETIQUE EN TRAITEMENT ADJUVANT DE L\u2019HEPATITE CHRONIQUE VIRALE C : UNE ENQUETE NATIONALE FRANCAISE"},"content":{"rendered":"<p><strong>2006<\/strong><\/p>\n<p><em>T. Th\u00e9venot (1), J.F. Cadranel (2), V. Di Martino (1), A. Pariente (3), X. Causse (4), C. Renou (5), H. Hagege (6), J. Denis (7),  F. Lunel-Fabiani (8) et l\u2019ANGH et l\u2019AFEF.<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02006-07-30 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Service d\u2019H\u00e9patologie, H\u00f4pital Minjoz, Besan\u00e7on (1), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie et de Diab\u00e9tologie, H\u00f4pital Laennec, Creil (2), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital Mitterrand, Pau (3), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, CHR d\u2019Orl\u00e9ans, Orl\u00e9ans (4), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital d\u2019Hy\u00e8res, Hy\u00e8res (5), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, Centre Hospitalier Intercommunal, Cr\u00e9teil (6), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital Sud Francilien, Evry (7), Laboratoire de Bact\u00e9riologie-Virologie et Hygi\u00e8ne Hospitali\u00e8re, H\u00f4pital Universitaire d\u2019Angers (8).<\/p>\n<p>Les facteurs de croissance h\u00e9matopo\u00ef\u00e9tiques (FdC) (\u00e9rythropo\u00ef\u00e9tine (EPO), G-CSF) optimisent le traitement de l\u2019h\u00e9patite chronique C mais aucune recommandation ni AMM n\u2019encadrent officiellement leur utilisation. Nous rapportons une enqu\u00eate nationale de pratique r\u00e9alis\u00e9e dans les h\u00f4pitaux g\u00e9n\u00e9raux et universitaires (CHU) renseignant sur la fr\u00e9quence, le motif et le mode de prescription des FdC chez les malades atteints d\u2019h\u00e9patite C. M\u00e9thodes : Des auto-questionnaires \u00e9taient adress\u00e9s \u00e0 chaque service r\u00e9pertori\u00e9 dans l\u2019annuaire de l\u2019ANGH (n=295) et dans chaque service d\u2019h\u00e9pato-gastroent\u00e9rologie des CHU (n=175). R\u00e9sultats : 274 praticiens (76% hommes, 96% h\u00e9pato-gastroent\u00e9rologues, 25% de CHU, \u00e2ge moyen 48 ans) ont r\u00e9pondu (taux de r\u00e9ponse : 58,3%). 203 (74%) voyaient 1 \u00e0 30 h\u00e9patites C\/an. 126 (46%) prescrivaient de l\u2019EPO (EPO-a : 20%, darbepoetin a : 30%, EPO-b : 38%) \u00e0 la posologie m\u00e9diane de 30000 UI\/semaine (extr\u00eames 2000-80000) en 1 \u00e0 3 injections\/semaine. Les principaux motifs de recours \u00e0 l\u2019EPO \u00e9taient diff\u00e9rents selon les praticiens: patients \u00ab\u00a0fragiles\u00a0\u00bb (34%), rapide diminution d&rsquo;Hb (12%), chiffre \u00ab\u00a0bas\u00a0\u00bb d\u2019Hb (19%), an\u00e9mie symptomatique (7%). Les facteurs associ\u00e9s \u00e0 la prescription d\u2019EPO \u00e9taient l\u2019exercice en CHU (84% vs 33%, p&lt;0,0001), l\u2019\u00e2ge du praticien30\/an (82% vs 33,5%, p&lt;0,0001) et la prescription de G-CSF (59% vs 7%, p&lt;0,0001). En analyse multivari\u00e9e, les facteurs ind\u00e9pendants de prescription d\u2019EPO \u00e9taient l\u2019\u00e2ge &lt;45 ans (OR=1,96, p=0,03), l\u2019exercice en CHU (OR=5,89, p&lt;0,0001), et le nombre \u00e9lev\u00e9 d\u2019h\u00e9patite C vu par an (OR=6,18, p&lt;0,0001). 84 (31%) prescrivaient 1 \u00e0 2 injections de G-CSF\/semaine (filgrastim 56%, l\u00e9nograstime 27%, pegfilgrastim 9%). La nature de la population (cirrhose, transplantation, comorbidit\u00e9s) justifiait la prescription de G-CSF dans 26% des cas. Les facteurs associ\u00e9s \u00e0 la prescription de G-CSF \u00e9taient l\u2019exercice en CHU (63% vs 20%, p&lt;0,0001), l\u2019\u00e2ge30\/an (60% vs 21%, p&lt;0,0001) et la prescription d\u2019EPO (88% vs 27%, p&lt;0,0001). En analyse multivari\u00e9e, les facteurs ind\u00e9pendants de prescription de G-CSF \u00e9taient l\u2019\u00e2ge&lt;45 ans (OR=2,27, p=0,004), l\u2019exercice en CHU (OR=2,39, p=0,003), le nombre \u00e9lev\u00e9 d\u2019h\u00e9patites C vu par an (OR=2,58, p=0,002). Des effets ind\u00e9sirables attribu\u00e9s aux FdC ont \u00e9t\u00e9 rapport\u00e9s dans 13% des cas. Conclusion: malgr\u00e9 l\u2019absence d\u2019AMM, la moiti\u00e9 des praticiens prescrivent des FdC. Les facteurs associ\u00e9s \u00e0 ces prescriptions sont le nombre \u00e9lev\u00e9 de cas d\u2019h\u00e9patite C pris en charge, l\u2019exercice en CHU, et le jeune \u00e2ge des praticiens. La grande disparit\u00e9 de prescription (indication, nature, fr\u00e9quence d\u2019administration et posologie) des FdC encouragent la poursuite d\u2019\u00e9tudes randomis\u00e9es visant \u00e0 d\u00e9montrer leur efficacit\u00e9 sur la r\u00e9ponse virologique \u00e0 long terme et la mise en place de recommandations officielles.<\/p>\n<p>WHO USE HEMATOPOIETIC GROWTH FACTORS AS ADJUVANT THERAPY OF CHRONIC HEPATITIS C ? A FRENCH NATIONAL SURVEY<\/p>\n<p>Thierry THEVENOT (1), Jean-Fran\u00e7ois CADRANEL (2), Vincent DI MARTINO (1), Alex PARIENTE (3), Xavier CAUSSE (4), Christophe RENOU (5), Herv\u00e9 HAGEGE (6), Jacques DENIS (7), Fran\u00e7oise LUNEL-FABIANI (8) et l\u2019ANGH et l\u2019AFEF.<\/p>\n<p>Service d\u2019H\u00e9patologie, H\u00f4pital Minjoz, Besan\u00e7on (1), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie et de Diab\u00e9tologie, H\u00f4pital Laennec, Creil (2), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital Mitterrand, Pau (3), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, CHR d\u2019Orl\u00e9ans, Orl\u00e9ans (4), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital d\u2019Hy\u00e8res, Hy\u00e8res (5), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, Centre Hospitalier Intercommunal, Cr\u00e9teil (6), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie, H\u00f4pital Sud Francilien, Evry (7), Laboratoire de Bact\u00e9riologie-Virologie et Hygi\u00e8ne Hospitali\u00e8re, H\u00f4pital Universitaire d\u2019Angers (8).<\/p>\n<p>Hematopoietic growth factors (HGF) (EPO, G-CSF) optimize PegIFN-ribavirin therapy in chronic hepatitis C (CHC). However, no guidelines for their use are available in France. We aim to assess the frequency of the use of EPO or G-CSF, and the factors associated with their use in a representative panel of French practitioners. Methods: surveys were sent to every unit listed in the ANGH yearbook (French association of hepato-gastroenterologists of primary referral hospitals) (n=295) and in every hepato-gastroenterology unit of university hospitals (n=175). Results: 274 (58%) practitioners (76% males, 25% from university hospitals, 48 yrs) completed the survey. 203 (74%) followed 1 to 30 cases of CHC\/yr. 126 (46%) prescribed EPO (EPOa 20%, darbepoetin-a  30%, EPOb 38%) at the median dose of 30000 UI\/wk (range 2000 to 80000) with 1 to 3 injections\/wk. The reported indication of EPO were different between practitioners: \u201cfragile\u201d patients (34%), rapid Hb decrease (12%), \u201clow\u201d Hb level (19%), or symptoms of anemia (7%). The practitioners characteristics associated with EPO prescription were: practise in university hospital (84% vs. 33%, p&lt;0.0001), age&lt;45 years (59% vs. 41%, p=0.005), female sex (61% vs. 42.5 %, p=0.009), and more than 30 CHC seen\/yr (82% vs. 33.5%, p&lt;0.0001). In multivariate analysis, independent predictors of EPO prescription were age&lt;45 years (OR=1.96, p=0.03), practise in university hospital (OR=5.89, p&lt;0.0001), and the high number CHC seen\/yr (OR=6.18, p&lt;0.0001). 84 (31%) prescribed 1 to 2 injections of G-CSF\/wk (filgrastim 56%, lenograstim 27%, pegfilgrastim 9%). The practitioners characteristics associated with G-CSF prescription were practise in university hospital (63% vs. 20%, p&lt;0.0001), age&lt;45 years (41% vs. 27%, p=0.018), female sex (43.5 % vs. 28 %, p=0.023), more than 30 CHC seen\/yr (60% vs. 21%, p&lt;0.0001) and use of EPO (88% vs. 27%, p&lt;0.0001). In multivariate analysis, independent predictors of G-CSF prescription were age&lt;45 years (OR=2.27 , p=0.004), practise in university hospital (OR=2.39 , p=0.003), high number of CHC seen\/yr (OR=2.58, p=0.002). Side effects of EPO or G-CSF were reported by 13% of practitioners. Conclusion: despite the lack of official guidelines, half of the French Hepato-Gastroenterologists prescribe HGF. A high number of CHC seen\/yr, the practise in university hospital and the young age of the practitioners are associated with these prescriptions. The wide disparity of prescriptions (indications, drugs used, frequency and dose administered) of these molecules encourages randomised studies evaluating the efficacy of HGF on sustained virological response and the implementation of official recommendations.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2006 T. Th\u00e9venot (1), J.F. Cadranel (2), V. Di Martino (1), A. Pariente (3), X. Causse (4), C. Renou (5), H. Hagege (6), J. Denis (7), F. Lunel-Fabiani (8) et l\u2019ANGH et l\u2019AFEF. H\u00e9patologie &#8211; \u00a02006-07-30 &#8211;\u00a0CO &#8211; ________________________________ Service d\u2019H\u00e9patologie, H\u00f4pital Minjoz, Besan\u00e7on (1), Service d\u2019H\u00e9pato-Gastroent\u00e9rologie et de Diab\u00e9tologie, H\u00f4pital Laennec, Creil (2), Service [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[17],"class_list":["post-1826","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-17"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UTILISATION DES FACTEURS DE CROISSANCE HEMATOPOIETIQUE EN TRAITEMENT ADJUVANT DE L\u2019HEPATITE CHRONIQUE VIRALE C : UNE ENQUETE NATIONALE FRANCAISE - 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