Pharmacological treatment profiles in the FACE-BD cohort: An unsupervised machine learning study, applied to a nationwide bipolar cohort✰.
Journal of Affective Disorders. 2021-05-01; 286: 309-319
DOI: 10.1016/j.jad.2021.02.036
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1. J Affect Disord. 2021 May 1;286:309-319. doi: 10.1016/j.jad.2021.02.036. Epub
2021 Feb 13.
Pharmacological treatment profiles in the FACE-BD cohort: An unsupervised
machine learning study, applied to a nationwide bipolar cohort(✰).
Brodeur S(1), Terrisse H(2), Pouchon A(1), Godin O(3), Aouizerate B(4), Aubin
V(5), Bellivier F(6), Belzeaux R(7), Bougerol T(1), Courtet P(8), Dubertret
C(9), Gard S(4), Haffen E(10), Henry C(11), Leboyer M(3), Olié E(8), Roux P(12),
Samalin L(13), Schwan R(14), Etain B(6), Bosson JL(2), Polosan M(15).
Author information:
(1)Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes,
Grenoble , T. Bougerol, B. Fredembach, A. Suisse, S. Brodeur, A. Pouchon, and M.
Polosan, France.
(2)TIMC-IMAG, University Grenoble Alpes, France.
(3)AP-HP, DHU PePSY, Pôle de Psychiatrie et d’Addictologie des Hôpitaux
Universitaires H Mondor, Créteil ; S. Hotier, A. Pelletier, N. Drancourt, JP.
Sanchez, E. Saliou, C. Hebbache, J. Petrucci, L. Willaume and E. Bourdin.
(4)Hôpital C. Perrens, Centre Expert Trouble Bipolaire, Service de Psychiatrie
Adulte, Pôle 3-4-7, Bordeaux, B. Antoniol, A. Desage, S. Gard, A. Jutant, K.
Mbailara, I. Minois, and L. Zanouy, France.
(5)Centre Hospitalier Princesse Grace, Monaco, V. Aubin, I. Cussac, M.A Dupont,
J. Loftus, and I. Medecin, Monaco.
(6)AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris,
F. Bellivier, M. Carminati, B. Etain, E. Marlinge, M. Meyrel, France.
(7)Pôle de Psychiatrie, addictologie et pédopsychiatrie, Hôpital Sainte
Marguerite, Marseille , R. Belzeaux, N. Correard, F. Groppi, A. Lefrere, L.
Lescalier., E. Moreau, J. Pastol, M. Rebattu, B. Roux and N. Viglianese, France.
(8)Département d’Urgence et Post Urgence Psychiatrique, CHRU Montpellier,
Montpellier , C. Abettan, L. Bardin, A. Cazals, P. Courtet, B. Deffinis, D.
Ducasse, M. Gachet, A. Henrion, E. Martinerie, F. Molière, B. Noisette, E. Olié
and G. Tarquini, France.
(9)AHPH, Departement de Psychiatrie, Hopital Louis Mourier, Colombes, France, C.
Dubertret, N. Mazer, C. Portalier, Monaco.
(10)Service de psychiatrie, CHU de Besançon, laboratoire de Neurosciences,
Université de Franche-Comté, E. Haffen, France.
(11)Université Paris Descartes, Pôle Hospitalo-Universitaire Paris 15ème, GHU,
Centre Hospitalier Sainte Anne, France.
(12)Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie
d’adultes, Le Chesnay, A. M. Galliot, I. Grévin, A. S. Cannavo, N. Kayser, C.
Passerieux, and P. Roux; Service de Psychiatrie, France.
(13)CHU de Clermont Ferrand, Pôle de Psychiatrie, Clermont Ferrand : Service de
Psychiatrie de l’adulte B, Centre Expert Trouble Bipolaire, CHU de
Clermont-Ferrand, Clermont-Ferrand, France , PM. Llorca, L. Samalin, L., C.
Moreau, D. Lacelle, S.Pires, C. Doriat, and O. Blanc, France.
(14)Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de
Brabois, Vandœuvre Les Nancy ; R. Cohen, Raymond Schwan, J. P. Kahn, M. Milazzo,
and O. Wajsbrot-Elgrabli, France.
(15)Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes,
Grenoble , T. Bougerol, B. Fredembach, A. Suisse, S. Brodeur, A. Pouchon, and M.
Polosan, France. Electronic address: .
BACKGROUND: Despite thorough and validated clinical guidelines based on bipolar
disorders subtypes, large pharmacological treatment heterogeneity remains in
these patients. There is limited knowledge about the different treatment
combinations used and their influence on patient outcomes. We attempted to
determine profiles of patients based on their treatments and to understand the
clinical characteristics associated with these treatment profiles.
METHODS: This multicentre longitudinal study was performed on a French
nationwide bipolar cohort database. We performed hierarchical agglomerative
clustering to search for clusters of individuals based on their treatments
during the first year following inclusion. We then compared patient clinical
characteristics according to these clusters.
RESULTS: Four groups were identified among the 1795 included patients: group 1
(« heterogeneous » n = 1099), group 2 (« lithium » n = 265), group 3 (« valproate »
n = 268), and group 4 (« lamotrigine » n = 163). Proportion of bipolar 1 disorder,
in groups 1 to 4 were: 48.2%, 57.0%, 48.9% and 32.5%. Groups 1 and 4 had greater
functional impact at baseline and a less favorable clinical and functioning
evolution at one-year follow-up, especially on GAF and FAST scales.
LIMITATIONS: The one-year period used for the analysis of mood stabilizing
treatments remains short in the evolution of bipolar disorder.
CONCLUSIONS: Treatment profiles are associated with functional evolution of
patients and were not clearly determined by bipolar subtypes. These profiles
seem to group together common patient phenotypes. These findings do not seem to
be influenced by the duration of disease prior to inclusion and neither by the
number of treatments used during the follow-up period.
Copyright © 2021 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.jad.2021.02.036
PMID: 33770539 [Indexed for MEDLINE]