D Levêque

CHRU de Strasbourg, Strasburg, Alsace, France

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Publications (83)199.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed(®) database with the following keywords (2000-2013), "surgery", "pharmacy", "pharmacist", "pharmaceutical care", "impact" and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value.
    Annales Pharmaceutiques Françaises 05/2014; 72(3):152-163.
  • Dominique Leveque, Amina Delpeuch, Benedicte Gourieux
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    ABSTRACT: Clinical pharmacy (or clinical pharmacy services) aims to contribute to safe medication use by providing comprehensive management to patients and medical staff, both in the community and the hospital. In oncology, these services include comprehensive medication reviews integrating chemotherapy, supportive care and ambulatory treatment for co-morbidities, medication information for the medical staff and patients, therapeutic drug monitoring (anticancer agents, anti-infective agents, immunosuppressive drugs in recipients of allogeneic stem cell transplantation), supportive care counseling (nutritional support, pain management, chemotherapy side-effects prophylaxis and treatment), elaboration of therapeutic guidelines, optimal use of economic resources. With regard to new anticancer agents, pharmacists both in the community and in hospitals are faced with a growing body of complex information as well as the development of ambulatory treatment (oral agents, subcutaneous administration). Clinical pharmacists with oncology training have the potential to optimize drug use both in the hospital and the community. With the understanding and recognition of drug interactions and side-effects, pharmacists can provide timely interventions and information to health providers, as well as counseling to patients.
    Anticancer research 04/2014; 34(4):1573-8. · 1.71 Impact Factor
  • Dominique Levêque
    The Lancet Oncology 02/2014; 15(2):e51. · 25.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed® database with the following keywords (2000–2013), “surgery”, “pharmacy”, “pharmacist”, “pharmaceutical care”, “impact” and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value.
    Annales Pharmaceutiques Françaises 01/2014;
  • Le Pharmacien Hospitalier et Clinicien. 01/2014; 49(2):e18–e19.
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    ABSTRACT: The medication iatrogenic events are responsible for nearly one iatrogenic event in five. The main purpose of this prospective multicenter study is to determine the effect of pharmaceutical consultations on the occurrence of medication adverse events during hospitalization (MAE). The other objectives are to study the impact of age, of the number of medications and pharmaceutical consultations on the risk of MAE. The pharmaceutical consultation is associated to a complete reassessment done by both a physician and a pharmacist for the home medication, the hospital treatment (3 days after admission), the treatment during chemotherapy, and/or, the treatment when the patient goes back home. All MAE are subject to an advice for the patient, additional clinical-biological monitoring and/or prescription changes. Among the 318 patients, 217 (68%) had 1 or more clinically important MAE (89% drug-drug interaction, 8% dosing error, 2% indication error, 1% risk behavior). The patients have had 1121 pharmaceutical consultations (3.2 ± 1.4/patient). Thus, the pharmaceutical consultations divided by 2.34 the risk of MAE (unadjusted incidence ratio, P ≤ 0.05). Each consultation decreased by 24% the risk of MAE. Moreover, adding one medication increases from 14 to 30% as a risk of MAE on the population. Pharmaceutical consultations during the hospital stay could reduce significantly the number of medication adverse effects.
    Annales Pharmaceutiques Françaises 01/2014;
  • Source
    Médecine et Maladies Infectieuses 01/2013; · 0.75 Impact Factor
  • D. Levêque, B. Gourieux
    Médecine et Maladies Infectieuses. 01/2013; 43(1):35–36.
  • D Levêque, B Gourieux
    Médecine et Maladies Infectieuses 12/2012; · 0.75 Impact Factor
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    ABSTRACT: Trastuzumab is used for the adjuvant (postoperative) treatment of (HER2)-positive early breast cancer. The duration of treatment is set at one year. The goal of our study was to examine the effective duration of trastuzumab treatment in routine clinical practice. We performed a retrospective review of all patients with early breast cancer, treated with trastuzumab at our hospital between 2005 and 2008. Data concerning patterns of use and safety were collected from patient charts and pharmacy records. The cohort comprised of 96 patients, with a median age of 50 years (range=25-79 years). The majority of patients (63.5%) had node-negative disease. Besides trastuzumab, most patients underwent chemotherapy (before or after surgery). Trastuzumab was administered every three weeks and the median duration of treatment was 52 weeks (range=6-81 weeks). Only half of the patients received the monoclonal antibody for 52 weeks, 36.6% had therapy more than 52 weeks and 12.5% discontinued treatment before 52 weeks due to adverse effects (8.4%) and refusal (4.1%). Two (2.1%) patients discontinued trastuzumab therapy because of cardiotoxicity, a recognized side-effect of the monoclonal antibody. Regarding treatment durations of more than 52 weeks, 15/35 were due to the off-label use of trastuzumab in the neoadjuvant setting (before surgery). The 3-year rate of disease-free survival was 91.6%. Half of the patients completed the 52-week treatment of trastuzumab after surgery for early breast cancer. Trastuzumab was well-tolerated and the rate of discontinuation due to cardiotoxicity was low, compared to published results.
    Anticancer research 10/2012; 32(10):4585-8. · 1.71 Impact Factor
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    ABSTRACT: The aim of our study was to assess the adherence to labelling and international guidelines for antifungal prescribing. A retrospective study was performed in intensive care units in addition to the oncology and haematology department, which covered 70% of antifungal consumption at Hautepierre Hospital, Strasbourg, France. On reviewing medical charts, the antifungal prescription was examined in relation to the recommendations of indication, dosage, risk of drug-drug interactions and, where appropriate, antifungal susceptibility testing. Treatments were considered appropriate, inappropriate or debatable. Between January and April 2007, 199 treatments were given for 179 different episodes in 133 adult patients. Treatments were prescribed for pre-emptive or targeted therapy (n = 90, with 60 for candidiasis, 26 for aspergillosis and 4 for other mould diseases), empirical therapy (n = 17) and primary (n = 81) or secondary (n = 11) prophylaxis. Fluconazole accounted for 67% of prescriptions, followed by voriconazole (19%), caspofungin (10%), posaconazole (2%), conventional or liposomal amphotericin B (2%), itraconazole (<1%) and terbinafine (<1%). Indication and dosage were found to be appropriate in 65% and 62% of cases, inappropriate in 22% and 21%, and debatable in 13% and 17%, respectively. The overall (by combining all assessment criteria) rate of inappropriate use was 40%. The overall survival rate at 12 weeks was highest in patients receiving appropriate therapy (81% versus 72% and 68% in the debatable and inappropriate therapy groups, respectively), with between-group differences not being significant (P = 0.49). Our evaluation revealed a high proportion of inappropriate or debatable use of antifungal agents, while highlighting significant issues, such as inadequate dosage or indications.
    Journal of Antimicrobial Chemotherapy 07/2012; 67(10):2506-13. · 5.34 Impact Factor
  • Le Pharmacien Hospitalier et Clinicien. 03/2012; 47(1):54–55.
  • Le Pharmacien Hospitalier et Clinicien. 03/2012; 47(1):55–56.
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    ABSTRACT: CASE: We report a case of ventricular bigeminy with concomitant administration of methadone, voriconazole and esomeprazole in a Caucasian woman aged 26 with acute lymphoblastic leukaemia. Plasma concentrations of voriconazole and methadone were high, 12.4 mg/l (therapeutic range: 1-4 mg/l) and 1.6 mg/l (therapeutic range: 0.2-0.4 mg/l), respectively. In the absence of esomeprazole, no more episode of cardiac arrhythmia occurred and 7 days after, methadone plasma concentration fell at 0.57 ml/l while voriconazole concentration was at 5.5 mg/l. We speculate that a pharmacokinetic interaction between methadone and voriconazole was amplified by the addition of esomeprazole. This led to the large increase of the plasma concentration of methadone and was potentially responsible for its cardiac toxicity. CONCLUSION: Physicians should be aware of the potential interaction between voriconazole, esomeprazole and methadone leading to arrhythmia. The inhibitory potential of voriconazole is possibly increased by esomeprazole.
    International journal of clinical pharmacy. 11/2011; 33(6):905-8.
  • Source
    Dominique Levêque
    The Lancet Oncology 11/2011; 12(12):1093. · 25.12 Impact Factor
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    ABSTRACT: Methotrexate is an antifolate agent used in the treatment of various cancers and some autoimmune diseases. In oncology, methotrexate is frequently administered at a high dose (>1 g/m(2)) and comes with various procedures to reduce the occurrence of toxicity and particularly to ensure optimal renal elimination. Drug-drug interactions involving methotrexate are the origin of severe side effects owing to delayed elimination of the antifolate and, more rarely, of decreased efficacy in relation to suboptimal exposure. Most of these interactions are driven by membrane drug transporters whose activity/expression can be inhibited by the interacting medication. In the last 10 years, research on drug transporters has permitted retrospective identification of the molecular mechanisms underlying drug-drug interactions with methotrexate. This article summarizes reported drug-drug interactions involving methotrexate in clinical oncology with reference to the role of drug transporters that control the disposition of the antifolate agent.
    Expert Review of Clinical Pharmacology 11/2011; 4(6):743-50.
  • Energy Economics - ENERG ECON. 07/2011;
  • Médecine et Maladies Infectieuses 05/2011; 41(7):396-7. · 0.75 Impact Factor
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    ABSTRACT: Oxaliplatin is an anticancer agent only approved for treatment of colorectal cancer, but that has shown some activity in metastatic breast cancer in phase II studies. Herein, we examine the off-label use of oxaliplatin in unselected patients with metastatic breast cancer. A retrospective review was performed of all patients with metastatic breast cancer treated with oxaliplatin at our hospital between February 2003 and November 2009. Data concerning patterns of use, safety and activity were collected from patient charts. The cohort comprised 30 female patients with a median age of 49 (range, 34-68 years) and a median of two involved organs (range, 1-4). All patients had been pretreated for metastatic breast cancer (median number of previous lines: 3; range:1-6). Oxaliplatin was only given in association either with fluorouracil and folinic acid (n=23) or with gemcitabine (n=7). The most commonly used dose was 100 mg/m(2) given every other week or every 3 weeks. As of December 15, 2009, the median duration of treatment was 4 (range, 0.75-11) months. Most of the discontinuations occured due to disease progression (n=11) and adverse effects or worsening condition (n=8). Twelve (40%) patients presented side-effects related to oxaliplatin use including hematotoxicity (n=8), gastrointestinal disorders (n=4) and neuropathies (n=2). Among patients evaluable for antitumoral activity (n=15), one patient achieved a complete response and one patient demonstrated a partial response. Most of the patients (57%) continued to be treated by chemotherapy after oxaliplatin. Median overall survival for the evaluable patients was 10 (range, 1-51) months. In our population of heavily pretreated women with metastatic breast cancer, off-label use of oxaliplatin was of little worth. This off-label treatment was not the last therapeutic option for most of these patients.
    Anticancer research 05/2011; 31(5):1765-7. · 1.71 Impact Factor
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    ABSTRACT: The aim of our work was to assess the potential clinical impact of therapeutic education in patients treated with anticancer drugs. One hundred-one ambulatory adult patients (mean age: 60 years, range: 24-88) treated by anticancer chemotherapy were included. The occurrence of adverse events was reported by 83% of the patients. Twenty-one percent (14/67) of the patients were not compliant with their supportive care treatment, 60% (60/101) took over-the-counter medications (one contraindication identified) and 14% (14/101) claimed they had received no counsel on risk behaviour (UV exposure, lack of contraception, driving) from health care professionals. Overall, 11% (44/397) of adverse events were associated with a lack of information. Twelve percent (4/33) of the calls to the doctor, 6% (1/17) of the visits to the physician and 21% (3/14) of the hospitalizations could be associated with a lack of therapeutic education. These data enlighten the importance of therapeutic education of cancer patients treated by chemotherapy.
    Bulletin du cancer 02/2011; 98(2):176-81. · 0.61 Impact Factor

Publication Stats

522 Citations
199.52 Total Impact Points

Institutions

  • 2001–2012
    • CHRU de Strasbourg
      • Pôle Pharmacie-pharmacologie
      Strasburg, Alsace, France
  • 1993–2008
    • Institut de France
      Lutetia Parisorum, Île-de-France, France
  • 1995–2006
    • University of Strasbourg
      • Institut de Bactériologie
      Strasburg, Alsace, France
  • 1998
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 1997
    • IHU de Strasbourg
      Strasburg, Alsace, France