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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Pharmacoépidémiologie de la thrombopénie immunologique en France : suivi de cohorte issue du Système national d'information inter-régimes de l'Assurance maladie et création d'un registre clinique / Pharmacoepidemiology of immune thrombocytopenia in France : follow-up of a cohort built in the French national health insurance database and creation of a clinical registry

Moulis, Guillaume 05 January 2016 (has links)
La thrombopénie immunologique (TI) est une maladie auto-immune rare. Son épidémiologie est mal connue. Le traitement de la TI aiguë repose sur les corticoïdes et les immunoglobulines. Passée la phase aiguë, plusieurs traitements sont possibles, dont la splénectomie, le rituximab et les agonistes du récepteur à la thrombopoiétine. L'exposition aux traitements de la TI en vie réelle n'a jamais été évaluée, et leur risque infectieux jamais comparé. Des vaccinations sont recommandées avant le rituximab et la splénectomie, mais la couverture vaccinale n'est pas connue. Nous avons constitué deux matériels complémentaires : 1) la cohorte French Adult Immune Thrombocytopenia : a pHarmacoepidemiological study (FAITH) est la cohorte des patients adultes incidents ayant une TI primaire traités de façon persistante (plus de 3 mois), bâtie dans le Système National d'Information Inter-régimes de l'Assurance Maladie (SNIIRAM) au niveau national ; 2) le registre Cytopénie Auto-immune : Registre Midi-PyrénéEN (CARMEN) est une étude observationnelle en vie réelle suivant les patients incidents de TI dans la région Midi-Pyrénées. Grâce à ces deux cohortes, nous avons décrit l'épidémiologie de la TI incidente en France, l'exposition aux traitements et la couverture vaccinale chez l'adulte, et évalué le risque infectieux des traitements et l'effet protecteur des vaccins. / Immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. ITP epidemiology is not well known. ITP treatment is based on glucocorticoids, and intravenous polyvalent immunoglobulin in case of severe bleeding. ITP becomes persistent (lasting more than 3 months) or chronic (more than 12 months) in about 70% of adults. In that case, non-corticosteroid treatments are suggested, mostly splenectomy, rituximab and thrombopoietin receptor agonists. The use of these treatments have never been assessed in the real life practice as well as their effectiveness and safety, particularly as regards the risk of infection. Vaccinations are recommended before splenectomy or rituximab. However, the vaccination rates and their effectiveness has not been assessed. We build two complementary materials: 1) the French Adult Immune Thrombocytopenia: a pHarmacoepidemiological study (FAITH) is the cohort of all incident primary ITP adults persistently treated (more than 3 months), built in the French health Insurance system database (Système national d'information inter-régimes de l'Assurance Maladie, SNIIRAM) at the national level; 2) the Cytopénie Auto-immune : Registre Midi-PyrénéEN (CARMEN) registry that includes and follows all incident ITP adults in the French Midi-Pyrénées region. Thanks to these two cohorts, we could assess the epidemiology of incident ITP in France; describe the exposure ITP treatments; assess the vaccination coverage in rituximab treated and splenectomized patients in France; and assess the risk of infection according to ITP treatments and the protective effect of the vaccines in this population.

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