References of "SCHEEN, André"
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See detailRelations entre marqueurs de neuropathie autonome, pression pulsée et insuffisance rénale chronique chez le patient diabétique de type 2
SCHEEN, André ULg; MARCHAND, Monique ULg; PHILIPS, Jean-Christophe ULg

in Annales de Cardiologie et d'Angeiologie (2015), 64(s1), 23-361-09

Relations entre marqueurs de neuropathie autonome, pression pulsée et insuffisance rénale chronique chez le patient diabétique de type 2 Relationships between markers of autonomic neuropathy, pulse ... [more ▼]

Relations entre marqueurs de neuropathie autonome, pression pulsée et insuffisance rénale chronique chez le patient diabétique de type 2 Relationships between markers of autonomic neuropathy, pulse pressure and chronic kidney disease in patients with type 2 diabetes Objectifs : Le patient diabétique de type 2 (DT2) est exposé à un risque accru de neuropathie autonome cardiovasculaire (NAC), de rigidité artérielle et d’insuffisance rénale chronique (IRC). Le but du travail est d’étudier les relations entre la NAC, PP et le débit de filtration glomérulaire (DFG) chez le patient DT2. Méthodes : L’étude comprend 79 patients DT2 (53H, 26F; âge initial : 56±8 années; durée connue du DT2 : 11±8 années; IMC : 28,4±4,6 kg/m²) analysés par enregistrement continu de la pression artérielle (PA) et de la fréquence cardiaque lors d’un test postural standardisé (test de «squatting» : 1min debout – 1min accroupi – 1min debout). Le gain baro-réflexe (GBR) est calculé par la pente de la relation entre les espaces R-R et PA systolique lors du redressement. La pression pulsée (PP = PAS-PAD) est analysée pendant tout le test et par son augmentation durant l’accroupissement (delta PP). DFG est estimé par la formule MDRD au début et après un suivi moyen de 12±5 ans. Résultats : Les valeurs initiales sont : HbA1c : 8,8± 1,7%; DFG : 86±25 ml/min ; PP : 62±10 mmHg; BRG : 1,8±1,4 msec/mmHg. DFG est inversement corrélé à l’âge (r=-0,317; p=0,020), sans relation avec HbA1c (r=-0,023; p=0,935). DFG est fortement corrélé avec GBR (r=0,453; p=0,008) et, moins, avec SqTs (un autre indice d’atteinte sympathique) (r=0,213; p=0,020), mais pas avec le classique indice de NAC R-R E/I ratio (r=0,092 ; p=0,262). Il n’y a pas de corrélation significative entre DFG et PA moyenne, PAS, PP ou encore delta PP. La diminution de DFG (-12±23 ml/min) lors du suivi de 12 ans n’a pu être corrélée de façon significative aux valeurs initiales et finales d’HbA1c, aux trois marqueurs initiaux de NAC (GBR, RR E/I ratio et SqTs) ou aux divers paramètres initiaux évaluant la PA, même si la relation est proche de la signification pour delta PP, un marqueur de la rigidité artérielle (r= 0,20 p= 0,060). Conclusion : La forte relation inverse initiale entre DFG et GBR suggère que IRC et NAC sont aggravées de façon conjointe et, possiblement, qu’une des deux complications influence l’autre. L’absence de corrélations avec HbA1c et les paramètres PA ou PP pourraient s’expliquer par les interférences liées au traitement en cours. L’absence de toute corrélation entre la chute ultérieure de DFG et les autres paramètres initiaux peut s’expliquer par l’origine multifactorielle de la progression de l’IRC chez le patient DT2. [less ▲]

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See detailSyndrome coronarien aigu et traitement hypolipemiant. L'etude IMPROVE-IT change-t-elle la donne?
Lancellotti, Patrizio ULg; Pierard, Luc ULg; Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(9), 450-5

Statins reduce both LDL cholesterol (LDL-C) levels and the risk of cardiovascular events in patients with and without cardiovascular disease. Intensive statin therapy, compared with moderate-dose statin ... [more ▼]

Statins reduce both LDL cholesterol (LDL-C) levels and the risk of cardiovascular events in patients with and without cardiovascular disease. Intensive statin therapy, compared with moderate-dose statin therapy, incrementally lowers LDL-C levels and rates of cardiovascular events in patients presenting with acute coronary syndrome. Ezetimibe, by diminishing the absorption of cholesterol from the intestine, additionally reduces LDL-C when added to statins. In this article, we discuss the potential benefits of the combination of simvastatin and ezetimibe for the long-term management of patients with acute coronary syndrome through an analysis of the IMPROVE-IT results (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial). This randomised double blind trial included 18,144 patients with a LDL-C of 50 to 100 (with statin) or 125 (without statin) mg/dl and had a median follow-up of 6 years. The objective of the study was to test the efficacy of simvastatin 40 mg versus simvastatin 40 mg and 10 mg ezetimibe. The primary endpoint included cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina and coronary revascularization. The addition of ezetimibe to simvastatin resulted in an incremental lowering of LDL-C (reached value 53.2 versus 69.9 mg/dl, p < 0.001) and a further improvement of the patient prognosis (relative reduction of primary endpoint: -6.4%, p = 0.016). In addition, the combined therapy showed no significant adverse effects, particularly regarding the risk of cancers, which confirms the safety of ezetimibe. In acute coronary syndrome, the prescription of ezetimibe should be considered (class HA, level of evidence B) in patients with a LDL-C a 70 mg/dl despite maximally tolerated dose of statin. [less ▲]

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See detailLa vignette diagnostique de l'etudiant. Reflexion diagnostique a propos de la triade physiopathologique conduisant a la complication du "pied diabetique".
Rorive, M.; Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(9), 465-71

Diabetic foot is a common complication of diabetes mellitus. Its pathophysiology is most often complex with the interconnection of three different components: diabetic neuropathy, arterial disease and ... [more ▼]

Diabetic foot is a common complication of diabetes mellitus. Its pathophysiology is most often complex with the interconnection of three different components: diabetic neuropathy, arterial disease and infection. The diagnostic approach should specify the respective role of each component, firstly thanks to a thorough medical interview and a careful clinical examination. Afterwards, well selected complementary exams will confirm the hypotheses generated by the initial clinical approach. Consequently, a specific care strategy will be implemented, ideally with the help of a multidisciplinary team. This educational clinical case is devoted to the sequential diagnostic approach of a patient with a foot ulcer in the context of a diabetic foot. [less ▲]

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See detailLe Medicament du mois empagliflozine (Jardiance): nouvel inhibiteur des cotransporteurs rnaux SGLT2 comme traitement du diabete de type 2.
Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(9), 472-9

Empagliflozin is a new inhibitor of sodiumglucose cotransporters type 2 (SGLT2) for the treatment of type 2 diabetes mellitus (T2DM). Its specific action inhibits glucose reabsorption in renal tubules and ... [more ▼]

Empagliflozin is a new inhibitor of sodiumglucose cotransporters type 2 (SGLT2) for the treatment of type 2 diabetes mellitus (T2DM). Its specific action inhibits glucose reabsorption in renal tubules and thus promotes glucosuria. This effect results in a reduction in fasting and postprandial glycaemia and a decrease of glycated haemoglobin (HbA(Ic)), independently of insulin. Furthermore, calorie urinary loss promotes weight reduction and osmotic diuresis lowers arterial blood pressure. The efficacy of empagliflozin increases according to the level of hyperglycaemia but decreases in patients with renal insufficiency. In 24 to 104-week controlled trials versus placebo, empagliflozin reduces HbA(1c) (approximately 0.8%), without hypoglycaemia (except in patients already treated with insulin or sulphonylureas). This improvement in glucose control is rather similar to that observed with active comparators (metformin, glimepiride or sitagliptin), with the advantage for empagliflozin of reducing body weight (approximately 2 kg) and blood pressure (systolic approximately 4 mm Hg and diastolic approximately 2 mm Hg). Empagliflozin has shown a cardiovascular protection in the EMPA-REG OUTCOME trial. Mycotic genital infections occur more frequently, especially in women, while a negligible increase in mild urinary tract infections may be observed. The risk of hypotension and volume depletion is low, although it should be carefully checked in more fragile and at risk patients. Empagliflozin (Jardiance), which is commercialized at the doses of 10 mg and 25 mg once daily, is indicated for the treatment of T2DM and reimbursed in Belgium with conditions as add-on to a background glucose-lowering therapy. [less ▲]

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See detailSGLT2 inhibition: efficacy and safety in type 2 diabetes treatment.
Scheen, Andre ULg

in Expert opinion on drug safety (2015)

INTRODUCTION: Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) offer a new opportunity for the management of type 2 diabetes mellitus. These agents reduce hyperglycemia by decreasing the renal ... [more ▼]

INTRODUCTION: Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) offer a new opportunity for the management of type 2 diabetes mellitus. These agents reduce hyperglycemia by decreasing the renal glucose threshold and thereby increasing urinary glucose excretion. Subsequent reduction of glucotoxicity improves beta-cell sensitivity to glucose and tissue insulin sensitivity. Areas covered: This article analyzes the efficacy and safety data of canagliflozin, dapagliflozin and empagliflozin in randomized controlled trials of 24 - 104 weeks duration, compared with placebo or an active comparator, in patients treated with diet/exercise, metformin, dual oral therapy or insulin. Expert opinion: SGLT2 inhibitors significantly and consistently reduce glycated hemoglobin, with a minimal risk of hypoglycemia. The improvement of glucose control is similar or slightly better compared with metformin, sulfonylureas or sitagliptin, with the add-on value of significant reductions in body weight and blood pressure. However, caution is recommended in fragile elderly patients and patients with chronic kidney disease. An increased risk of genital mycotic infections is observed, but urinary tract infections are rare. Concern about an unexpected risk of euglycemic ketoacidosis has been recently reported. A possible renal protection deserves further attention. A remarkable reduction in cardiovascular mortality was reported in EMPA-REG OUTCOME with empagliflozin. [less ▲]

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See detailActualisation 2015 du traitement de l'hyperglycemie dans le diabete de type 2.
Scheen, Andre ULg; Paquot, Nicolas ULg

in Revue medicale suisse (2015), 11(483), 15181520-5

The strategy for the management ot type 2 diabetes, summarized by a group of European and American experts, has been updated early 2015. A patient-centered approach is recommended and the first drug ... [more ▼]

The strategy for the management ot type 2 diabetes, summarized by a group of European and American experts, has been updated early 2015. A patient-centered approach is recommended and the first drug choice is metformin combined with lifestyle improvement. After failure of metformin monotherapy, the selection of a second drug should be based on the efficacy, safety and cost of each pharmacological class. When compared to the position statement of 2012, the most important changes are the possible addition of a gliptin to a dual oral therapy or even to insulin, the commercialization of sodium-glucose cotransporters type 2 (SGLT2) inhibitors (gliflozins, to be used in dual or triple therapy, even in combination with insulin) and the possible combination of a glucagon-like peptide-I receptor agonist together with a basal insulin. [less ▲]

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See detailLa maladie renale diabetique: prise en charge actuelle et perspectives d'avenir.
Krzesinski, Jean-Marie ULg; Scheen, Andre ULg

in Revue medicale suisse (2015), 11(483), 1534-81540-2

The diabetic kidney disease is the most frequent cause of end stage renal disease in Western countries. Its detection is obtained by simultaneously measuring urinary albumin excretion and estimating ... [more ▼]

The diabetic kidney disease is the most frequent cause of end stage renal disease in Western countries. Its detection is obtained by simultaneously measuring urinary albumin excretion and estimating glomerular filtration rate through serum creatinine dosage. Many type 1 and type 2 diabetic patients can present decreased glomerular filtration rate before the occurrence of increased urinary albumin. While waiting for promising new pharmacological approaches currently evaluated in clinical trials, the best approach to stop the epidemic of diabetic nephropathy remains an early and individual multifactorial approach controlling the glucose level (without inducing hypoglycaemia), blood pressure (using a renin-angiotensin blocker), dyslipidaemia and over-weight. [less ▲]

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See detailGliptines, securite cardio-vasculaire et insuffisance cardiaque: le point apres l'etude TECOS.
Scheen, Andre ULg

in Revue medicale suisse (2015), 11(483), 1526-31

The cardiovascular safety of dipeptidyl peptidase-4 inhibitors (gliptins) has been well studied. Favourable effects of these oral antidiabetic agents have been reported in meta-analyses of phase II-III ... [more ▼]

The cardiovascular safety of dipeptidyl peptidase-4 inhibitors (gliptins) has been well studied. Favourable effects of these oral antidiabetic agents have been reported in meta-analyses of phase II-III randomised controlled trials. Three large prospective trials, which were specifically designed to investigate cardiovascular safety, showed non-inferiority of saxagliptin (SAVOR-TIMI 53), alogliptin (EXA-MINE) and sitagliptin (TECOS) versus placebo as far as major cardiovascular events are concerned, including mortality. The suspected increase in the rate of hospitalisation due to congestive heart failure reported in SAVOR-TIMI 53 was neither found in EXAMINE nor recently confirmed in TECOS. Direct comparative trials, evaluating not only safety but also efficacy, with other oral antidiabetic medications would be of major interest. [less ▲]

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See detailForces et faiblesse des essais cliniques . Evolution en fonction de l'essor de la medecine personnalisee.
Ernest, Ph; Jandrain, B.; Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(5-6), 232-6

Randomised Controlled Trials (RCTs) represent the cornerstone of Evidence-Based Medicine (EBM). Based upon the rules of Good Clinical Practice (GCP), they offer many strengths but also present some ... [more ▼]

Randomised Controlled Trials (RCTs) represent the cornerstone of Evidence-Based Medicine (EBM). Based upon the rules of Good Clinical Practice (GCP), they offer many strengths but also present some weaknesses. The rigorous methodology used allows avoid bias related to confounding factors (through a control group), selection bias (through randomisation) and interpretation bias (through double blinding). However, patients recruited in clinical trials and study experimental conditions markedly differ from the situation in real life. Furthermore, clinical trials recruit a mix of good and poor responders, so that the average therapeutic response is most often mitigated. Clinical trials must evolve according to the new concepts of personalized medicine to become even more performing. In a near future, they must progress from a statistical analysis on large cohorts of patients to a more individualized analysis guided by patient phenotype and genotype characteristics. [less ▲]

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See detailApproche personnalisée du traitement des dyslipidémies
Scheen, Andre ULg; Descamps, O

in Revue medicale de Liege (2015), 70(5-6), 292-8

Individualized therapeutic strategy of dyslipidemias, classically relies upon a phenotypic approach. The pattern of lipid profile allows the choice of the best pharmacological option (statin, fibrate) and ... [more ▼]

Individualized therapeutic strategy of dyslipidemias, classically relies upon a phenotypic approach. The pattern of lipid profile allows the choice of the best pharmacological option (statin, fibrate) and the patient's clinical risk profile allows the definition of therapeutic goals, especially LDL cholesterol target levels. Dyslipidemias have a major genetic component, which is best illustrated by familial hypercholesterolemia, with its two heterozygous and homozygous forms. There is a huge between-subject variability in the response to lipid-lowering therapies (especially to statins) and ongoing pharmacogenetic and pharmacogenomic studies should help to better understand this inter-individual heterogeneity. The recent discovery of mutations in the PCSK9 rene opened new perspectives regarding the understanding of some forms of familial hypercholesterolemia and led to the development of monoclonal antibodies that selectively inhibit PCSK9. These PCSK9 inhibitors allow, when combined to a statin, drastic reductions in LDL cholesterol concentrations, even when familial hypercholesterolemia is present. They are currently tested in large prospective controlled trials aiming to demonstrate a significant reduction in the residual cardiovascular risk in statin-treated patients. [less ▲]

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See detail"Omics" et "big data", avancees majeures vers une medecine personnalisee du futur ?
Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(5-6), 262-8

The increasing interest for personalized medicine evolves together with two major technological advances. First, the new-generation, rapid and less expensive, DNA sequencing method, combined with ... [more ▼]

The increasing interest for personalized medicine evolves together with two major technological advances. First, the new-generation, rapid and less expensive, DNA sequencing method, combined with remarkable progresses in molecular biology leading to the post-genomic era (transcriptomics, proteomics, metabolomics). Second, the refinement of computing tools (IT), which allows the immediate analysis of a huge amount of data (especially, those resulting from the omics approaches) and, thus, creates a new universe for medical research, that of <<big data>> analyzed by computerized modelling. This article for scientific communication and popularization briefly describes the main advances in these two fields of interest. These technological progresses are combined with those occurring in communication, which makes possible the development of artificial intelligence. These major advances will most probably represent the grounds of the future personalized medicine. [less ▲]

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See detailMédecine personalisée: nouveaux defis pour le praticien.
Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(5-6), 242-6

The clinician has to cope with new advances in medicine. Traditional medicine, which is based upon pathophysiological reasoning and clinical experience, has been reinforced by evidence-based medicine ... [more ▼]

The clinician has to cope with new advances in medicine. Traditional medicine, which is based upon pathophysiological reasoning and clinical experience, has been reinforced by evidence-based medicine, which relies on levels of evidence provided by controlled clinical trials carried out on cohorts of patients. Since a few years, personalized medicine has been put at the forefront. A therapy tailored to every patient, if possible characterized by biomarkers, among which, since the achievement of the whole human genome sequencing, an increasing number of genetic markers. Personalized medicine should be used as a complement of traditional and evidence-based medicine. Physicians should progressively integrate this new strategy in their therapeutic approach. Hence, clinicians have to face new challenges as far as scientific knowledge, practical applications and physician-patient relationship are concerned. [less ▲]

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See detailDiabètes iatrogènes : importance d’une analyse critique du rapport bénéfices/risques des traitements en cause
SCHEEN, André ULg

in Médecine des Maladies Métaboliques (2015), 9(3), 1-3

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See detailMédecine personalisée: tout bénéfice pour le patient, mais nouveau challenge pour la relation médecin-malade.
Scheen, Andre ULg; Giet, Didier ULg

in Revue medicale de Liege (2015), 70(5-6), 247-50

Personalized medicine should lead to major advances for patient care since it contributes to deliver the <<right drug to the right patient>>. In curative medicine, this approach should improve the ... [more ▼]

Personalized medicine should lead to major advances for patient care since it contributes to deliver the <<right drug to the right patient>>. In curative medicine, this approach should improve the efficacy of medications by initial selection of "good responders", and should reduce adverse events due to poor tolerance or toxicity by a better pharmacological choice and a more appropriate individualized dose adjustment. Over recent years, considerable technical advances have increasingly linked personalized medicine with predictive and preventive medicine. This progress raises hopes for major advancements in medicine, but may also cause some concern among the lay public. The patient should actively be involved in the decisions related to his/her health, in a true model of participatory medicine. Finally, personalized medicine should leave its strict technical nature and become more interested in the person as a whole, within a holistic approach also integrating psychosocial aspects that are so important in the physician-patient relationship. [less ▲]

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See detailUn nouveau florilege estival de cas cliniques.
Scheen, Andre ULg

in Revue Médicale de Liège (2015), 70(7-8), 349-50

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See detailL'industrie pharmaceutique face à la médecine personalisée: changement de paradigme dans le développement des nouveaux medicaments.
Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(5-6), 237-41

The cost of pharmacotherapy is increasing in the health care budget. The pharmaceutical industry is facing the exhaustion of medications that are largely prescribed and have a high profitability ... [more ▼]

The cost of pharmacotherapy is increasing in the health care budget. The pharmaceutical industry is facing the exhaustion of medications that are largely prescribed and have a high profitability (blockbusters). Because of patient heterogeneity, there is a great interindividual variability of the responses to drug therapy. Thus, it is essential to better detect potential <<good responders>> to avoid waste of resources resulting from the prescription of expensive drugs to poor responders. The development of personalized medicine, or precision medicine, certainly offers opportunities to the pharmaceutical industry, but also exposes it to new big challenges. [less ▲]

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See detailMedecine conventionnelle, medecine factuelle, medecine personnalisee: trois approches complementaires.
Scheen, Andre ULg

in Revue medicale de Liege (2015), 70(5-6), 221-4

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See detailCardiovascular safety of albiglutide and other glucagon-like peptide-1 receptor agonists.
Scheen, Andre ULg

in The lancet. Diabetes & endocrinology (2015), 3(9), 667-9

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