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Papers by Thierry Van Hees
Clinical & Experimental Allergy, Mar 6, 2018
Background: While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled... more Background: While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled corticosteroids (ICSs), studies assessing a step-down of ICS in this specific population are currently lacking. Objectives: To assess the proportion of non-eosinophilic asthmatics in whom ICS may be withdrawn without any clinical degradation and to determine the predictive markers of a failure to stop treatment with ICS. Methods: This prospective study was completed by 36 non-eosinophilic asthmatics, defined by sputum eosinophils <3% and blood eosinophils <400/lL. In these patients, whichever the baseline asthma control level, the dose of ICS was gradually reduced every 3 months until they met the failure criteria or successfully discontinued ICS for 6 months. The failure criteria were an ACQ score ≥1.5 with an increase from baseline >0.5 or a number of severe exacerbations during the study which was greater than the number during the year prior to the baseline visit. Receiver-operating characteristic (ROC) curves were constructed to assess predictors of a failure to stop ICS. This study is registered with ClinicalTrials.gov, number NCT02169323. Results: In 14 patients (39%), ICSs were completely withdrawn, and in 10 further patients (28%), ICS were stepped-down to a reduced ICS dose without any deterioration of asthma control and exacerbation rate. Baseline predictors of a failure to stop ICS were a greater age (area under ROC curve [ROC AUC] and [95% CI]: 0.77 [0.62-0.93]) and elevated blood eosinophils (ROC AUC [95% CI]: 0.77 [0.61-0.93]). After the first step-down of ICS, the best predictor was an elevated blood eosinophil count (ROC AUC [95% CI]: 0.85 [0.72-0.99]). Conclusions & Clinical Relevance: Withdrawing or reducing the dose of ICS is feasible in two-thirds of non-eosinophilic asthmatics irrespective of baseline asthma control. An elevated blood eosinophil count may predict the failure to stop ICS.
BMJ Open, Nov 1, 2017
Research strengths and limitations of this study ► Our study population consisted of patients fro... more Research strengths and limitations of this study ► Our study population consisted of patients from real life. ► We included a control group with patients not receiving inhaled corticosteroids (ICS) or keeping the same dose of ICS between two visits, in order to properly investigate the effects of an initiation/ increased dose and cessation/decreased dose of ICS between two visits. ► Our study was retrospective. ► No formal sample size calculation was performed. ► The cumulative dose of ICS received by the patients before the investigation was uncertain due to the variation in the delay between both visits and to the unknown adherence to treatment.
The Journal of Allergy and Clinical Immunology: In Practice, Sep 1, 2017
American Journal of Respiratory and Critical Care Medicine, 2018
Peer reviewe
Antimicrobial Resistance and Infection Control, 2017
Peer reviewe
International Journal of Clinical Pharmacy, Dec 1, 2013
Background and Objective: Graves' orbitopathy (GO) is an autoimmune inflammatory disease related ... more Background and Objective: Graves' orbitopathy (GO) is an autoimmune inflammatory disease related to a thyroidal disorder. Symptoms include exophthalmia, impaired vision, diplopia and even blindness due to the compression of the optic nerve. Usual treatments of GO: immunosuppressive therapies (steroids, cyclosporin), orbital irradiation and surgical decompression are limited due to recurrences. Some studies [1-3] have suggested that rituximab (RTX), an anti-CD20 monoclonal antibody, at a dose of 1,000 mg, might be effective in active GO by a B lymphocyte depletion. Preliminary data [4] suggests that 100 mg of RTX may induce effective peripheral B lymphocyte depletion and long term remission of GO. We report 8 cases of active GO treated with 100 mg of RTX. Setting and Method: Case report from Internal Medicine and Pharmacy departments. Safety and efficacy results of 100 mg RTX in active GO treatment are presented. Main outcome measures: Efficacy evaluation: clinical activity score (CAS). CAS is a specific score for GO that consists in 10 items related to the 4 clinical signs of inflammation (pain, redness, swelling and impaired function). For each item present, 1 point is given and the addition of these points leads to CAS (range 0-10) [5]. Safety evaluation: occurrence of adverse events (infection, hematologic and cardio-vascular events). Results: 8 patients (2 men, 6 women, mean age 45 years) with active GO steroid-resistant or intolerant were treated between April 2012 and July 2013 with 100 mg of RTX. 6 patients received 2 infusions at days 1 and 15, 1 patient received 1 infusion and 1 patient is presently waiting for the second infusion. Mean CAS for the 7 fully evaluated patients was 3.8/10 before infusion and dropped to 0.8/10 after. No adverse event was observed during and after RTX infusion except in one patient: an episode of palpitations was described the following
Résultats d'un enquête auprès des médecins et des infirmiers chef d'unité sur la percepti... more Résultats d'un enquête auprès des médecins et des infirmiers chef d'unité sur la perception, les besoins et les attentes à propos de la pharmacie clinique au CHU de Liège
- Introduction La préparation de semainiers pour les patients des maisons de repos et de soins (... more 1) Introduction La préparation de semainiers pour les patients des maisons de repos et de soins (MRS) par le pharmacien d’officine permet de diminuer les erreurs liées à l’administration des médicaments. Outre ce bénéfice, l’accès pour le pharmacien à l’ensemble du traitement devrait faciliter la validation pharmaceutique des prescriptions et le développement de soins pharmaceutiques de qualité pour les patients résidant en communauté. 2) Contexte de l’étude La MRS étudiée est une institution publique de la Communauté Germanophone où résident 143 patients répartis dans 6 services différents. Le système de gestion des médicaments est en phase de transition. Pour 3 salles, la préparation et la distribution des médicaments sont assurées par les infirmières de salle (=groupe contrôle). Pour les 3 autres salles, le pharmacien d’officine prépare des semainiers pour les formes orales solides, la préparation des autres formes pharmaceutiques et la distribution des médicaments étant assurées...
Third Belgian Pharmaceutical Care Symposium, 2015
Prisma Symposium 2014, 2014
International Journal of Clinical Pharmacy, 2014
Peer reviewe
Journal de pharmacie de Belgique, 2019
Le Groupe de Gestion de l’Antibiothérapie du Centre Hospitalier Universitaire de Liègea souligné ... more Le Groupe de Gestion de l’Antibiothérapie du Centre Hospitalier Universitaire de Liègea souligné une utilisation importante et nonjustifiée de nystatine sous forme de bain debouche. Devant ce constat, nous avons réalisé une revue de la littérature sur l’efficacité et l’innocuité de la nystatine dans la candidose oropharyngée (COP) et nous partageons dans cet article quelques recommandations pratiques institutionnelles. La COP est une infection fongique fréquente avec un bon pronostic si elle est diagnostiquée et traitée de manière appropriée. La nystatine sous forme de pastille ou de suspension buvable est recommandée comme traitement alternatif en cas de COP bénigne par la Société Américaine des Maladies Infectieuses. Néanmoins, la littérature évaluant l’efficacité et la sécurité de la nystatine dans la COP est pauvre. En Belgique, la nystatine est commercialisée sous forme de suspension buvable et sous forme de matière première. Aucun consensus national n’est disponible sur la formulation, le dosage ou encore la durée de traitement de la nystatine en cas de COP. Au CHU de Liège, il a été décidé d’arrêter la préparation de bain de bouche à base de nystatine et de privilégier l’utilisation d’une suspension de nystatine en cas de COP bénigne.Peer reviewe
The Canadian journal of clinical pharmacology, 2015
Background Pharmacovigilance is defined as the science and activities relating to the detection, ... more Background Pharmacovigilance is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse drug reactions (ADRs). Although pharmacovigilance is a responsibility for all healthcare professionals, this activity is an important part of a pharmacist’s practice . Hospital pharmacy residents are expected to have the necessary skills to monitor, manage, report and prevent ADRs as a part of their academic curriculum. Assessing and comparing perceptions of pharmacovigilance of hospital pharmacy residents from four dif ferent countries can contribute to a reflection about their education and their role in pharmacovigilance. Objectives To assess and compare the perception of pharmacovigilance of hospital pharmacy residents from Belgium, France, Canada and Switzerland . Methods A cross- sectional study was conducted in March 2014 using an online -questionnaire administrated to 229 hospital pharmacy residents. Nineteen questions were orga...
Journal de pharmacie de Belgique, 2016
Aim Aims are: 1] Identify causes of Drug Related Problems (DRPs), interventions performed by phar... more Aim Aims are: 1] Identify causes of Drug Related Problems (DRPs), interventions performed by pharmacists and results of corticosteroid- related problems and 2] distinguish between problems related to inhaled and general corticosteroids. Methods During 5 days of their internship, 534 final year students of pharmaceutical sciences in six Belgian universities collected DRPs encountered in community pharmacies, as well as related interventions performed by pharmacists and the result of the intervention. The DRPs' electronic registration was done through an adapted tool for Belgium based on the classification of Pharmaceutical Care Network Europe [PCNE- v 6.2]. Findings The frequency of DRPs is 24,8%. 766 DRPs (4,8%) related to corticosteroids, of which 351 were inhaled corticosteroids. The most common causes of corticosteroid-related problems (53- 59%) were technical causes. The most represented category of clinical causes was the inappropriate choice of drug [33-41%]. Pharmacists&#...
Clinical & Experimental Allergy, Mar 6, 2018
Background: While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled... more Background: While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled corticosteroids (ICSs), studies assessing a step-down of ICS in this specific population are currently lacking. Objectives: To assess the proportion of non-eosinophilic asthmatics in whom ICS may be withdrawn without any clinical degradation and to determine the predictive markers of a failure to stop treatment with ICS. Methods: This prospective study was completed by 36 non-eosinophilic asthmatics, defined by sputum eosinophils <3% and blood eosinophils <400/lL. In these patients, whichever the baseline asthma control level, the dose of ICS was gradually reduced every 3 months until they met the failure criteria or successfully discontinued ICS for 6 months. The failure criteria were an ACQ score ≥1.5 with an increase from baseline >0.5 or a number of severe exacerbations during the study which was greater than the number during the year prior to the baseline visit. Receiver-operating characteristic (ROC) curves were constructed to assess predictors of a failure to stop ICS. This study is registered with ClinicalTrials.gov, number NCT02169323. Results: In 14 patients (39%), ICSs were completely withdrawn, and in 10 further patients (28%), ICS were stepped-down to a reduced ICS dose without any deterioration of asthma control and exacerbation rate. Baseline predictors of a failure to stop ICS were a greater age (area under ROC curve [ROC AUC] and [95% CI]: 0.77 [0.62-0.93]) and elevated blood eosinophils (ROC AUC [95% CI]: 0.77 [0.61-0.93]). After the first step-down of ICS, the best predictor was an elevated blood eosinophil count (ROC AUC [95% CI]: 0.85 [0.72-0.99]). Conclusions & Clinical Relevance: Withdrawing or reducing the dose of ICS is feasible in two-thirds of non-eosinophilic asthmatics irrespective of baseline asthma control. An elevated blood eosinophil count may predict the failure to stop ICS.
BMJ Open, Nov 1, 2017
Research strengths and limitations of this study ► Our study population consisted of patients fro... more Research strengths and limitations of this study ► Our study population consisted of patients from real life. ► We included a control group with patients not receiving inhaled corticosteroids (ICS) or keeping the same dose of ICS between two visits, in order to properly investigate the effects of an initiation/ increased dose and cessation/decreased dose of ICS between two visits. ► Our study was retrospective. ► No formal sample size calculation was performed. ► The cumulative dose of ICS received by the patients before the investigation was uncertain due to the variation in the delay between both visits and to the unknown adherence to treatment.
The Journal of Allergy and Clinical Immunology: In Practice, Sep 1, 2017
American Journal of Respiratory and Critical Care Medicine, 2018
Peer reviewe
Antimicrobial Resistance and Infection Control, 2017
Peer reviewe
International Journal of Clinical Pharmacy, Dec 1, 2013
Background and Objective: Graves' orbitopathy (GO) is an autoimmune inflammatory disease related ... more Background and Objective: Graves' orbitopathy (GO) is an autoimmune inflammatory disease related to a thyroidal disorder. Symptoms include exophthalmia, impaired vision, diplopia and even blindness due to the compression of the optic nerve. Usual treatments of GO: immunosuppressive therapies (steroids, cyclosporin), orbital irradiation and surgical decompression are limited due to recurrences. Some studies [1-3] have suggested that rituximab (RTX), an anti-CD20 monoclonal antibody, at a dose of 1,000 mg, might be effective in active GO by a B lymphocyte depletion. Preliminary data [4] suggests that 100 mg of RTX may induce effective peripheral B lymphocyte depletion and long term remission of GO. We report 8 cases of active GO treated with 100 mg of RTX. Setting and Method: Case report from Internal Medicine and Pharmacy departments. Safety and efficacy results of 100 mg RTX in active GO treatment are presented. Main outcome measures: Efficacy evaluation: clinical activity score (CAS). CAS is a specific score for GO that consists in 10 items related to the 4 clinical signs of inflammation (pain, redness, swelling and impaired function). For each item present, 1 point is given and the addition of these points leads to CAS (range 0-10) [5]. Safety evaluation: occurrence of adverse events (infection, hematologic and cardio-vascular events). Results: 8 patients (2 men, 6 women, mean age 45 years) with active GO steroid-resistant or intolerant were treated between April 2012 and July 2013 with 100 mg of RTX. 6 patients received 2 infusions at days 1 and 15, 1 patient received 1 infusion and 1 patient is presently waiting for the second infusion. Mean CAS for the 7 fully evaluated patients was 3.8/10 before infusion and dropped to 0.8/10 after. No adverse event was observed during and after RTX infusion except in one patient: an episode of palpitations was described the following
Résultats d'un enquête auprès des médecins et des infirmiers chef d'unité sur la percepti... more Résultats d'un enquête auprès des médecins et des infirmiers chef d'unité sur la perception, les besoins et les attentes à propos de la pharmacie clinique au CHU de Liège
- Introduction La préparation de semainiers pour les patients des maisons de repos et de soins (... more 1) Introduction La préparation de semainiers pour les patients des maisons de repos et de soins (MRS) par le pharmacien d’officine permet de diminuer les erreurs liées à l’administration des médicaments. Outre ce bénéfice, l’accès pour le pharmacien à l’ensemble du traitement devrait faciliter la validation pharmaceutique des prescriptions et le développement de soins pharmaceutiques de qualité pour les patients résidant en communauté. 2) Contexte de l’étude La MRS étudiée est une institution publique de la Communauté Germanophone où résident 143 patients répartis dans 6 services différents. Le système de gestion des médicaments est en phase de transition. Pour 3 salles, la préparation et la distribution des médicaments sont assurées par les infirmières de salle (=groupe contrôle). Pour les 3 autres salles, le pharmacien d’officine prépare des semainiers pour les formes orales solides, la préparation des autres formes pharmaceutiques et la distribution des médicaments étant assurées...
Third Belgian Pharmaceutical Care Symposium, 2015
Prisma Symposium 2014, 2014
International Journal of Clinical Pharmacy, 2014
Peer reviewe
Journal de pharmacie de Belgique, 2019
Le Groupe de Gestion de l’Antibiothérapie du Centre Hospitalier Universitaire de Liègea souligné ... more Le Groupe de Gestion de l’Antibiothérapie du Centre Hospitalier Universitaire de Liègea souligné une utilisation importante et nonjustifiée de nystatine sous forme de bain debouche. Devant ce constat, nous avons réalisé une revue de la littérature sur l’efficacité et l’innocuité de la nystatine dans la candidose oropharyngée (COP) et nous partageons dans cet article quelques recommandations pratiques institutionnelles. La COP est une infection fongique fréquente avec un bon pronostic si elle est diagnostiquée et traitée de manière appropriée. La nystatine sous forme de pastille ou de suspension buvable est recommandée comme traitement alternatif en cas de COP bénigne par la Société Américaine des Maladies Infectieuses. Néanmoins, la littérature évaluant l’efficacité et la sécurité de la nystatine dans la COP est pauvre. En Belgique, la nystatine est commercialisée sous forme de suspension buvable et sous forme de matière première. Aucun consensus national n’est disponible sur la formulation, le dosage ou encore la durée de traitement de la nystatine en cas de COP. Au CHU de Liège, il a été décidé d’arrêter la préparation de bain de bouche à base de nystatine et de privilégier l’utilisation d’une suspension de nystatine en cas de COP bénigne.Peer reviewe
The Canadian journal of clinical pharmacology, 2015
Background Pharmacovigilance is defined as the science and activities relating to the detection, ... more Background Pharmacovigilance is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse drug reactions (ADRs). Although pharmacovigilance is a responsibility for all healthcare professionals, this activity is an important part of a pharmacist’s practice . Hospital pharmacy residents are expected to have the necessary skills to monitor, manage, report and prevent ADRs as a part of their academic curriculum. Assessing and comparing perceptions of pharmacovigilance of hospital pharmacy residents from four dif ferent countries can contribute to a reflection about their education and their role in pharmacovigilance. Objectives To assess and compare the perception of pharmacovigilance of hospital pharmacy residents from Belgium, France, Canada and Switzerland . Methods A cross- sectional study was conducted in March 2014 using an online -questionnaire administrated to 229 hospital pharmacy residents. Nineteen questions were orga...
Journal de pharmacie de Belgique, 2016
Aim Aims are: 1] Identify causes of Drug Related Problems (DRPs), interventions performed by phar... more Aim Aims are: 1] Identify causes of Drug Related Problems (DRPs), interventions performed by pharmacists and results of corticosteroid- related problems and 2] distinguish between problems related to inhaled and general corticosteroids. Methods During 5 days of their internship, 534 final year students of pharmaceutical sciences in six Belgian universities collected DRPs encountered in community pharmacies, as well as related interventions performed by pharmacists and the result of the intervention. The DRPs' electronic registration was done through an adapted tool for Belgium based on the classification of Pharmaceutical Care Network Europe [PCNE- v 6.2]. Findings The frequency of DRPs is 24,8%. 766 DRPs (4,8%) related to corticosteroids, of which 351 were inhaled corticosteroids. The most common causes of corticosteroid-related problems (53- 59%) were technical causes. The most represented category of clinical causes was the inappropriate choice of drug [33-41%]. Pharmacists&#...