{"id":184325,"date":"2020-09-21T00:00:00","date_gmt":"2020-09-20T22:00:00","guid":{"rendered":"https:\/\/www.bcfi.be\/covid-19-lagence-europeenne-des-medicaments-ema-approuve-lutilisation-de-la-dexamethasone-chez-les-patients-covid-19-necessitant-une-supplementation-en-oxygene-3\/"},"modified":"2020-09-21T00:00:00","modified_gmt":"2020-09-20T22:00:00","slug":"covid-19-lagence-europeenne-des-medicaments-ema-approuve-lutilisation-de-la-dexamethasone-chez-les-patients-covid-19-necessitant-une-supplementation-en-oxygene-3","status":"publish","type":"post","link":"https:\/\/h.cbip.be\/fr\/covid-19-lagence-europeenne-des-medicaments-ema-approuve-lutilisation-de-la-dexamethasone-chez-les-patients-covid-19-necessitant-une-supplementation-en-oxygene-3\/","title":{"rendered":"COVID-19: l&rsquo;Agence europ\u00e9enne des m\u00e9dicaments (EMA) approuve l&rsquo;utilisation de la dexam\u00e9thasone chez les patients COVID-19 n\u00e9cessitant une suppl\u00e9mentation en oxyg\u00e8ne"},"content":{"rendered":"<p>Ce 18 septembre&#x002C;<a href=&quot;https:\/\/www.ema.europa.eu\/en\/news\/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation&quot;> l&#39;Agence europ\u00e9enne des m\u00e9dicaments<\/a> (EMA) a donn\u00e9 son feu vert \u00e0 l&#39;utilisation de la dexam\u00e9thasone chez les patients COVID-19 n\u00e9cessitant un apport suppl\u00e9mentaire en oxyg\u00e8ne.<span class=&quot;folia-referentie-note&quot;><strong><sup>1<\/sup><\/strong><\/span><\/p>\n<ul>\n<li>\n<p>L&#39;EMA approuve la dexam\u00e9thasone comme option th\u00e9rapeutique dans le COVID-19 chez les adultes et les adolescents de 12 ans et plus qui n\u00e9cessitent une suppl\u00e9mentation en oxyg\u00e8ne (par ventilation artificielle ou non). La dose est de 6 mg p.j. pendant 10 jours&#x002C; aussi bien pour l&#39;administration par voie orale que par voie intraveineuse.<\/p>\n<\/li>\n<li>\n<p>La d\u00e9cision de l&#39;EMA fait suite \u00e0 l\u2019analyse des r\u00e9sultats de l&#39;\u00e9tude RECOVERY sur la dexam\u00e9thasone. L&#39;\u00e9tude RECOVERY est une \u00e9tude randomis\u00e9e ayant \u00e9valu\u00e9 les effets de divers m\u00e9dicaments chez des patients COVID-19 hospitalis\u00e9s. Les r\u00e9sultats obtenus avec la dexam\u00e9thasone avaient d\u00e9j\u00e0 bri\u00e8vement \u00e9t\u00e9 abord\u00e9s dans les <a href=&quot;https:\/\/www.cbip.be\/fr\/articles\/3398?folia=3392&quot;>Folia de juillet 2020<\/a>&#x002C; alors qu\u2019ils n&#39;avaient pas encore fait l\u2019objet d\u2019un <em>peer-reviewing<\/em>. Depuis lors&#x002C; les r\u00e9sultats ont \u00e9t\u00e9 publi\u00e9s dans le <a href=&quot;https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2021436&quot;><em>New England Journal of Medicine<\/em><\/a>.<span class=&quot;folia-referentie-note&quot;><sup>2<\/sup><\/span> En bref\u00a0: la dexam\u00e9thasone a r\u00e9duit la mortalit\u00e9 par rapport aux \u00ab\u00a0soins standard\u00a0\u00bb chez les patients COVID-19 les plus gravement malades&#x002C; c&#39;est-\u00e0-dire les patients sous ventilation artificielle (mortalit\u00e9 apr\u00e8s 28 jours\u00a0: 29% contre 41%) et les patients recevant de l&#39;oxyg\u00e8ne par un masque (mortalit\u00e9 apr\u00e8s 28 jours\u00a0: 23% contre 26%). La dexam\u00e9thasone n\u2019\u00e9tait pas associ\u00e9e \u00e0 un b\u00e9n\u00e9fice dans le groupe de patients ne n\u00e9cessitant pas d\u2019apport suppl\u00e9mentaire d\u2019oxyg\u00e8ne.<\/p>\n<\/li>\n<li>\n<p>L&#39;EMA fait \u00e9galement r\u00e9f\u00e9rence \u00e0 une m\u00e9ta-analyse de 7 \u00e9tudes randomis\u00e9es (incluant les patients de l&#39;\u00e9tude RECOVERY ayant \u00e9t\u00e9 plac\u00e9s sous ventilation artificielle)&#x002C; r\u00e9alis\u00e9e par l&#39;Organisation mondiale de la sant\u00e9&#x002C; sur l&#39;utilisation de corticost\u00e9ro\u00efdes chez des patients COVID-19 gravement malades. Cette m\u00e9ta-analyse montre \u00e9galement une diminution de la mortalit\u00e9 dans le groupe sous corticost\u00e9ro\u00efdes&#x002C; par rapport aux soins standard ou au placebo (mortalit\u00e9 apr\u00e8s 28 jours\u00a0: 32% contre 40%). Cette m\u00e9ta-analyse a r\u00e9cemment \u00e9t\u00e9 publi\u00e9e dans le <a href=&quot;https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2770279&quot;>JAMA<\/a>.<span class=&quot;folia-referentie-note&quot;><strong><sup>3<\/sup><\/strong><\/span><\/p>\n<\/li>\n<\/ul>\n<p><strong>Il est important de rappeler que dans l&#39;\u00e9tude RECOVERY&#x002C; la dexam\u00e9thasone n&#39;a pas \u00e9t\u00e9 associ\u00e9e \u00e0 un b\u00e9n\u00e9fice chez les patients hospitalis\u00e9s non gravement malades&#x002C; et qu\u2019il n\u2019est pas question de l\u2019extrapoler aux patients COVID-19 trait\u00e9s en ambulatoire.<\/strong><br \/> \u00a0<\/p>\n<h2>Sources sp\u00e9cifiques<\/h2>\n<p><span class=&quot;folia-referentie-nummer&quot;>1.\u00a0 <\/span><span class=&quot;folia-referentie-tekst&quot;>EMA. EMA endorses use of dexamethasone in COVID-19 patients on oxygen or mechanical ventilation. Communiqu\u00e9 du 18\/09\/20.<\/span> <span class=&quot;folia-referentie-tekst&quot;>Sur <\/span><span class=&quot;folia-referentie-link&quot;><a href=&quot;https:\/\/www.ema.europa.eu\/en\/news\/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation&quot;>https:\/\/www.ema.europa.eu\/en\/news\/ema-endorses-use-dexamethasone-covid-19-patients-oxygen-mechanical-ventilation<\/a><\/span><\/p>\n<p><span class=&quot;folia-referentie-nummer&quot;>2.\u00a0 <\/span><span class=&quot;folia-referentie-tekst&quot;>The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 \u2014 Preliminary Report. <\/span><span class=&quot;folia-referentie-link&quot;><a href=&quot;https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2021436&quot;>New Engl J Med&#x002C; 17 juli 2020<\/a><\/span><span class=&quot;folia-referentie-tekst&quot;> (doi: 10.1056\/NEJMoa2021436)&#x002C; avec <\/span><span class=&quot;folia-referentie-link&quot;><a href=&quot;https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe2024638?query=recirc_curatedRelated_article&quot;>\u00e9ditorial<\/a> <\/span><span class=&quot;folia-referentie-tekst&quot;>dans le New Engl J Med (doi: 10.1056\/NEJMe2024638)<\/span><\/p>\n<p><span class=&quot;folia-referentie-nummer&quot;>3.\u00a0<\/span> <span class=&quot;folia-referentie-tekst&quot;>The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19. A Meta-analysis. <\/span><span class=&quot;folia-referentie-link&quot;><a href=&quot;https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2770279&quot;>JAMA<\/a><\/span><span class=&quot;folia-referentie-tekst&quot;>&#x002C; en ligne le 2 septembre 2020 (doi:10.1001\/jama.2020.17023)&#x002C; avec<\/span> <span class=&quot;folia-referentie-link&quot;><a href=&quot;https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2770275&quot;>\u00e9ditorial<\/a><\/span> <span class=&quot;folia-referentie-tekst&quot;>dans le JAMA (doi:10.1001\/jama.2020.16747)<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ce 18 septembre&#x002C; l&#39;Agence europ\u00e9enne des m\u00e9dicaments (EMA) a donn\u00e9  [&#8230;]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,61],"tags":[48,20213],"class_list":["post-184325","post","type-post","status-publish","format-standard","hentry","category-actualites","category-2020-fr","tag-actualites-covid-19","tag-import_tags"],"_links":{"self":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts\/184325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/comments?post=184325"}],"version-history":[{"count":0,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts\/184325\/revisions"}],"wp:attachment":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/media?parent=184325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/categories?post=184325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/tags?post=184325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}