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Original research article
Effectiveness of new antiplatelets in the prevention of recurrent myocardial infarction
  1. Lamiae Grimaldi-Bensouda1,2,
  2. Nicolas Danchin3,
  3. Jean Dallongeville4,
  4. Bruno Falissard5,
  5. Alain Furber6,
  6. Yves Cottin7,
  7. Laurent Bonello8,
  8. Olivier Morel9,10,
  9. Florence Leclercq11,
  10. Etienne Puymirat12,
  11. Fahmi Ghanem13,
  12. Nicolas Delarche14,
  13. Jacques Benichou15,
  14. Lucien Abenhaim16,17
  15. the PGRx-Acute Coronary Syndrome Study Group
    1. 1Pharmacoepidemiology, PGRx Study Group, PGRx, Paris, France
    2. 2London School of Hygiene and Tropical Medicine, London, UK
    3. 3Cardiologie, Hôpital européen Georges-Pompidou, Université René Descartes, Paris, France
    4. 4Epidemiologie, Institut Pasteur de Lille; INSERM 1167; Université de Lille, Lille, France
    5. 5Statistique, CESP INSERM U1018, Université Paris-Sud, Paris, France
    6. 6Laboratoire MITOVASC ’Physiopathologie Cardiovasculaire et Mitochondriale', Faculté de Médecine d’Angers; Service de Cardiologie, UMR CNRS 6015 – INSERM U1083, Centre hospitalo-universitaire (CHU) de Angers, Angers, France
    7. 7Service de Cardiologie, CHU Dijon, Dijon, France
    8. 8Service de Cardiologie, CHU de Marseille, Aix-Marseille Université, Assistance-Publique Hôpitaux de Marseille; MARS cardio, Mediterranean Association For Research And Studies In Cardiology, Hôpital Nord, Marseille, France
    9. 9Pôle d’activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
    10. 10Unité INSERM T770, Le Kremlin Bicêtre, France
    11. 11Cardiologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
    12. 12Cardiologie, Hôpital européen Georges-Pompidou, Paris, France
    13. 13Cardiologie, Hospital of Châteauroux, Châteauroux, France
    14. 14Centre hospitalier François Mitterrand, Pau, France
    15. 15Unité de Biostatistique, University Hospital of Rouen and U1219, University of Rouen, Rouen, France
    16. 16Pharmacoepidemiology, Analytica LA-SER, London, UK
    17. 17London School of Hygiene and Tropical Medicine, London, UK
    1. Correspondence to Dr Lamiae Grimaldi-Bensouda, PGRx Study Group, PGRx, Paris 75006, France; Lgrimaldi{at}pgrx.net

    Abstract

    Objective To compare ticagrelor and prasugrel with clopidogrel for recurrent fatal and non-fatal myocardial infarction (reMI) in real-life conditions.

    Methods Case-referent study using the Pharmacoepidemiological General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Cases were patients with reMI from a cohort with index ACS or external to the cohort (same sites). Referents from the cohort, without recurrent event, were matched on index ACS type and date, age and sex with reMI cases. Multivariate conditional logistic regression assessed the OR (95% CI) for reMI associated with ticagrelor and prasugrel vs clopidogrel, adjusted for aspirin use and cardiovascular risk factors.

    Results 1047 cases and 2234 matched referents were included. Compared with clopidogrel, ticagrelor and prasugrel were associated with respective ORs of 0.65 (95% CI 0.52 to 0.81) and 0.71 (95% CI 0.53 to 0.96) for reMI occurrence. ORs for ticagrelor and prasugrel vs clopidogrel were: 0.50 (95% CI 0.38 to 0.67) and 0.66 (95% CI 0.45 to 0.95), 0.39 (95% CI 0.24 to 0.62) and 0.44 (95% CI 0.26 to 0.75), 0.63 (95% CI 0.43 to 0.92) and 1.20 (95% CI 0.69 to 2.07), 1.11 (95% CI 0.72 to 1.72) and 0.82 (95% CI 0.44 to 1.54) when index ACS was a first MI, a first ST-elevated MI (STEMI), a first non-STEMI and a recurrent ACS, respectively, and 0.63 (95% CI 0.45 to 0.87) and 0.77 (95% CI 0.41 to 1.45) forpatients aged ≥70 years.

    Conclusions This real-world study showed a significant reduction of reMI with new antiplatelets compared with clopidogrel, ticagrelor being associated with a greater decrease of risk notably for first, either STEMI or non-STEMI. The larger magnitude of effect may be attributed to potential residual confounding or higher effectiveness compared with efficacy reported in trials (EMA Post Authorisation Study Registry Number EUPAS5905).

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    Footnotes

    • Contributors LG-B and LA drafted the protocol and the statistical analysis plan and conducted the analyses. LG-B drafted the manuscript. LG-B supervised all aspects of the study including document screening, selection, reconciliations, data collection, extraction and management. All authors made substantial contributions to conception or design of the work, reviewed the manuscript for important intellectual content, approved the final manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The PGRx data registry is owned by Centre for Risk Research Inc., an independent research organisation, to which a subscription can be purchased for observational studies. AstraZeneca (AZ) subscribed data from PGRx data registry specifically for the AReMIS study. The conception and design of the study as well as the data collection, management and analysis were conducted independently of AZ, under the supervision of a Scientific Committee.

    • Competing interests LG-B is currently employed by PGRx, a company susceptible of collaborating with virtually all the pharmaceutical companies worldwide. NDa declares having received financial support from Abbott France, Amgen SAS, AstraZeneca, Bayer Healthcare SAS, Boehringer Ingelheim France, Bristol-Myers Squibb, GlaxoSmithKline France, Lilly France SAS, MSD France, Novo Nordisk, Pierre Fabre, Re-Imagine Health Agency, Sanofi-Aventis France and Servier during the conduct of the study. JD declares having received personal fees for participating in Scientific Boards from AstraZeneca, Bayer and MSD. BF reports personal fees from AstraZeneca during the conduct of the study. AF, OM, FL, FG and NDe declare no conflict of interest. YC declares having received financial support for participating in Scientific Boards and consulting for Bayer, Boehringer, Novartis, Pfizer and Servier outside the submitted work. LB declares having received financial support in the form of grants and/or personal fees from AstraZeneca during the conduct of the study and also outside the submitted work. EP declares having received fees for lectures and/or consulting from Amgen, AstraZeneca, Bayer, BMS, Daiichi-Sankyo, Lilly, MSD, The Medicine Company, Sanofi and Servier. JB declares having received financial support from Association pour le Développement de l’Enseignement et des Recherches auprès des universités des centres de recherches et des entreprises d’Aquitaine, AstraZeneca, Servier and LASER during the conduct of the study. LA is chairman and stock owner in Analytica LASER, a consultancy susceptible of collaborating with virtually all the pharmaceutical companies worldwide. PGRx has no commercial interests in any of the products studied. Members of the PGRx network have no interest in any drugs or other factors studied using data collected using PGRx.

    • Patient consent Not required.

    • Ethics approval Ethics Review Committee of Paris-Ile de France III (Comité de Protection des Personnes Ile de France III) and the French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available on request under certain conditions.

    • Collaborators PGRx-Acute Coronary Syndrome (ACS) Study Group Reda Aarras (Cabinet Privé, Beausoleil,), Nacera Abbou (Hôpital Stell, Rueil Malmaison); Kamel Abdennbi (Cabinet Privé, Paris), Ramzi Abi Akar (Georges Pompidou European Hospital, Paris), Corine Aboa Eboule (Centre Hospitalier de Semur-en-Auxois), Michel Adda (Cabinet Privé, Nice), Fifa Agbessi (Cabinet Privé, Lille), Bruno Agout (Cabinet Privé, Montoire Sur Le Loir), Saïd Ahres (Hopitaux Civls de Colmar), Linda Aissou (HU-Paris Seine Saint Denis, APHP, Bobigny), Franck Albert (Le Les Hôpitaux de Chartres, Le Coudray), Joachim Alexandre(Centre Hospitalier Universitaire de Caen), Alexandre Alies (Cabinet Privé, Montelimar), Thierry Allaouchiche (Cabinet Privé, Salon De Provence), Jean-Marc Amans (Cabinet Privé, Metz, Walid Amara (Groupe hospitalier intercommunal Le Raincy, Montfermeil), Ahmed Amiar (Groupe Hospitalier de Seclin Carvin), Gladys Amiel Oster (Cabinet Privé, Aubervilliers), Ahmed Amlaiky (Cabinet Privé, Mulhouse), Marc Amzallag (Cabinet Privé, Paris), Stephane Andrieu (Centre Hospitalier d’Avignon), Jean Marie Annic (Cabinet Privé, Neuville-sur-Saône), Sébastien Ansaldi (Cabinet Privé, Bastia), Cyprian Anton (Centre hospitalier de villeneuve, Villeneuve-sur-Lot), Luc Ardouin (Cabinet Privé, Fosses), Sebastien Armero (Hopital Européen Marseille), Abderrahmane Assaf (Cabinet Privé, Bapaume), Pierre Attali (Les Hôpitaux Universitaires de Strasbourg), Gilles Audebert(Cabinet Privé, La Seyne Sur Mer), Jean-Luc Auffray (Hôpital cardiologique, CHR Lille), Pierre-Antoine Ayrivie (Cabinet Privé, Beziers), Jean-Claude Azambourg (Cabinet Privé, Elbeuf), Olivier Azzano (Cabinet Privé, Cluses), Margarita Baert (Centre Hospitalier d’Albi), Jean-Philippe Baguet (CHU Grenoble Alpes, Grenoble), Souleyman Bai Sepou (Centre Hospitalier Verdun Saint-Mihiel, Verdun), Xavier Balaire (CHU Caen), Laurent Bali (Centre Hospitalier de Cannes), Jonathan Banayan (CH Tours, Chambray-Lès-Tours), Yves Banus (Clinique, Nantes), Charles Baranés (Cabinet Privé, Paris), Michel Barboteu (Clinique, Evecquemont), Franck Barbou (Hôpital Militaire, Paris), Alain Bardoux (Cabinet Privé, Maubeuge), Nicolas Baron (Hôpital Versailles, Le Chesnay), Maruan Barri (CH Longjumeau), Olivier (CH Avignon), Abdelkader Belhassane (Centre Hospitalier Cambrai), Jean Paul Bellefleur (Cabinet Privé, Saint-André-les-Vergers), Olivier Belliard (Clinique, Neuilly Sur Seine), Claudia Bemba (Centre Hospitalier du Centre Bretagne, Noyal Pontivy), Laurence Ben Cheikh M Hamed (Cabinet Privé, Longeville-en-Barrois), Tewfik Benchaa (CH Aix en Provence), Bouziane Benhalima (Cabinet Privé, Le Bourget), Lamjed Bensaad (Centre Hospitalier Stell, Rueil Malmaison), Jacques Berland (Clinique, Rouen), Yves Bermond (Cabinet Privé, Vannes), Jean Baptiste Berneau (Centre Hospitalier de la Côte Basque, Bayonne), Patrick Bert-Marcaz (Centre Hospitalier de Mâcon), David Bertora (Centre Hospitalier de Nice), Arnaud Bertrand (Cabinet Privé, Sigean), Sylvain Beurtheret (Hôpital Saint Joseph, Marseille), Yves Biron (Clinique, Rennes), Pierre Bizieux (Cabinet Privé, Marmande), Elodie Blicq (Centre Hospitalier de Versailles, Le Chesnay), Benoit Blondin (Cabinet Privé, Audun-le-Roman), Gerard Bocquillon (Cabinet Privé, Camblain-l’Abbé), Vera Bogdanova (Clinique, Paris), Emmanuel Boige (Cabinet Privé, La Teste-de-Buch), Marie-Thérèse Boire (Cabinet Privé, Ollioules), Jacques Bonnet (Hôpital Haut Leveque, CHU, Pessac), Thierry Bontemps (Cabinet Privé, Limoges), Sebastien Bosle (Centre Hospitalier de Brive), Khaled Karim Bouchlaghem (Cabinet Privé, Marseille), Georges Bouharb (Cabinet Privé, Montpellier), Fatima Boukhsibi (Centre Hospitalier Stell, Rueil Malmaison), Claire Bouleti (HU-Paris Nord site Bichat, APHP, Paris), Valerie Bourdin (Cabinet Privé, Azerailles), Guillaume Breard (Centre Hospitalier Blois), Myriam Brunehaut (Cabinet Privé, Clermont), Claude Brunschwig (Cabinet Privé, Cannes), Martine Cadoret (Cabinet Privé, Sablé-sur-Sarthe), Bruno Camenen (Cabinet Privé, St Herblain), Guillaume Canu (Centre Hospitalier de Bourg-en-Bresse), Claudine Carville (Cabinet Privé, Antony), Frederic Casassus (CHU Hopitaux de Bordeaux, Hôpital Haut-Leveque, Pessac), Rozenn Castera (Cabinet Privé, Bassussarry), Pierre Causse (Cabinet Privé, Saint Etienne), Philippe Cayron (Cabinet Privé, Montpellier), Isabelle Centa (Cabinet Privé, Le Kremlin-Bicêtre), Alexandre Chabrun (Cabinet Privé, Poitiers), Abdeslem Chalani (Centre Hospitalier de Narbonne), Stephane Champagne (Centre Hospitalier Universitaire Henri Mondor, Creteil), Philippe Chapon (Centre Hospitalier de Valence), Warren Chasseriaud (Hôpital Haut Leveque, CHU, Pessac), Nassim Chebahi (Hôpital prive Le Bois, Lille), Nicolas Chedru (Cabinet Privé, St Nazaire), Saida Cheggour El Bouazzaoui (Centre Hospitalier d’Avignon), Philippe Chemin (Cabinet Privé, Bordeaux), Nouredine Chemmam (Centre Hospitalier de l’Ouest Vosgien, Neufchateau), Kamal Chennouf (Clinique, Brou-Sur-Chantereine), Sami Cheriaa (CH Meaux), Paul Chiri (Cabinet Privé, Marseille), Claire Chisseray-Pramotton (Cabinet Privé, Nante), Guy Chivoret (Cabinet Privé, Toul), Frederic Chometon (Cabinet Privé, Firminy), Rene Codjia (CH GHPSO Creil, Creil), Philippe Commeau (Clinique, Ollioules), André Corbin (Cabinet Privé, Dinan), Yves Cottin (CHU Dijon, Dijon), Ulun Crimizade (Les Hôpitaux Universitaires de Strasbourg), Bernard Crousillat (Centre Hospitalier General Salon de Provence), Julie Curjol-Soto (Cabinet Privé, Bouc-Bel-Air), Adib Dabboura (Cabinet Privé, Villefranche-sur-Saône), Alphonse Dacunto (Cabinet Privé, St Fons), Nicolas Danchin (Hôpital européen Georges-Pompidou, Paris)Bernard Darmon (Cabinet Privé, Colomars), Patrick Dary (Cabinet Privé, Saint-Yrieix-la-Perche), Olivier Dascotte (Cabinet Privé, Saint-André-lez-Lille), Guillaume De Geeter (Cabinet Privé, Anzin), Axel De Labriolle (Cabinet Privé, Montauban), Roland De Ladreit (Cabinet Privé, Saint-Germain-au-Mont-d’Or), Olivier De Sauniere (Hôpital de Roanne), Jean Louis Deaux (Cabinet Privé, Condom), Matthieu Debonne (Cabinet Privé, Marcq En Baroeul), Eric Decoulx (CH Tourcoing), Georges Delamare (Cabinet Privé, Blois), Nicolas Delarche (Centre hospitalier François Mitterrand, Pau), Bernard Delfour (Cabinet Privé, Greasque), Dominique Delsart (Cabinet Privé, Bersee), Mathieu Deltreuil (Centre Hospitalier Jacques Boutard, Saint-Yrieix-la-Perche), Philippe Dematteo (Cabinet Privé, Valognes), Chems Eddine Deramchi (Cabinet Privé, Montevrain), Mohamed Derbali (Centre Hospitalier de Châteauroux), Jacques Derycke(Cabinet Privé, Saint-Laurent-de-la-Salanque), Josyane Devico Palacci (Cabinet Privé, Marseille), Olivier Dibon (Centre Hospitalier Régional d’Orléans), Katy Didier Petit (Centre Hospitalier Intercommunal de la Haute Saône, Vesoul), Romain Didier(Centre Hospitalier Universitaire de Brest), Abdelkader Djebabra (Cabinet Privé, Venissieux), Charly Djeumen Wandji (Centre Hospitalier Lucien Hussel, Vienne), Bernard Doucet (Cabinet Privé, Chambery), Christophe Dromnelle (Cabinet Privé, Chamalieres), Philippe Duc (Cabinet Privé, Fontenay-sous-Bois), Valerie Duchatelle (Hôpital Paris Saint Joseph, Paris), Audrey Duchemin (CH Tourcoing), Agathe Dumont (Cabinet Privé, Dammartin-en-Goële), Daniel Dumortier (Cabinet Privé, Lille), Pierre Dumoulin (Cabinet Privé, Courbevoie), Sylvie Dunica (Cabinet Privé, Paris), Arnauld Dupoizat (Cabinet Privé, Toulouse), Catherine Dupont Biscaye (Cabinet Privé, Preignac), Patrick Dupouy (Clinique, Melun), Philippe Durandet (Cabinet Privé, La Rochelle), Pierre Duron (Cabinet Privé, Chaville), Laurent Dutoit (Centre hospitalier Henri Mondor, Aurillac), Fawaz El Damen (Hôpital Albert Schweitzer. Colmar), Fouad El Ghelbazouri (Cabinet Privé, Montargis), Abdellatif El Hallak (Clinique, Evecquemont), Adnan El Jabali (Centre Hospitalier de Bagnols-Sur-Ceze), Rami El Mahmoud (Hôpital Ambroise-Paré, Boulogne-Billancourt), Meyer Elbaz (Centre Hospitalier Universitaire de Toulouse), Mariam Elkohen (Clinique, Villeneuve D’Ascq), Frederic Gad Elmkies (Cabinet Privé, Compiegne), Pascale Enguehard (Cabinet Privé, Coutances), Alfonso Epicureo (Cabinet Privé, Carvin), Michele Escande Orthlieb (Clinique, Marseille), Ghazaleh Esna (Cabinet Privé, Rambouillet), Jean-François Falquier (Cabinet Privé, Bergerac), Jean Louis Farges (Cabinet Privé, Bethune), Abderrazah Farza (Cabinet Privé, Fontainebleau), Fouad Fattah (Centre Hospitalier René Dubos, Pontoise), Maurice Fauvel (Cabinet Privé, Colomiers), Jihad Fawaz (Cabinet Privé, Talence), Maxime Fayard (Centre Hospitalier Chalon-Sur-Saône), Zohir Fekhar (Cabinet Privé, Narbonne), Israel Feldmann (Cabinet Privé, Haguenau), Emile Ferrari (Centre Hospitalier, Nice), Gérard Fhal (Cabinet Privé, Marseille), Pierre Fichter (Cabinet Privé, Marseille), Laurent Fischbein (Cabinet Privé, Bourg Les Valence), Pascale Flinois (Cabinet Privé, Rognac), Stéphane Fol (Cabinet Privé, La Roche sur Foron), Eric Forest (Cabinet Privé, Vannes), Christian Fournier (Cabinet Privé, Sabres), Pierre Frances (Cabinet Privé, Banyuls sur Mer), Eric François (Cabinet Privé, Aire sur la Lys), Jean-Marc Frey (Cabinet Privé, Sète), Reynald Friedmann (Cabinet Privé, Montpellier), Alain Furber (Centre Hospitalier, Angers), Karim Gacem (Centre Hospitalier, Cholet), Pierre-Henry Gacon (Centre Hospitalier Dijon), Olivier Gaillard (Cabinet Privé, Annonay), Thierry Garban (Cabinet Privé, Carquefou), Eric Garbarz (Centre Hospitalier, Clichy), Waddah Garman (Cabinet Privé, Paris), Jean-Pierre Garnier Crussard (Cabinet Privé, Orange), Olivier Gartenlaub (Cabinet Privé, Maisons-Alfort), Tatiana Gavrilina (Centre Hospitalier, Chambéry), Audrey Gehanne (Cabinet Privé, Vannes), Michel Gehanne (Cabinet Privé, Vannes), Michel Geneves (Cabinet Privé, Paris), Jean-Louis Georges (Centre Hospitalier, Le Chesnay), Fahmi Ghanem (Centre Hospitalier, Châteauroux), Nachwan Ghanem (Centre Hospitalier, Eaubonne), Catherine Gigandet (Cabinet Privé, Mérignac), Jean-Marie Gil (Hôpital des Armées, Marseille), Mathieu Gillet (Cabinet Privé, Nantes), Aude Girard-Girod (Cabinet Privé, Thonon les Bains), Jean-Pierre Giuliani (Cabinet Privé, Toulon), Chandrah Goburdhun (Centre Hospitalier, Tulle), Antonio Gongora (Clinique, Lievin), Marc Goralski (Centre Hospitalier, La Source), Hervé Gourio (Cabinet Privé, Douarnenez), Stéphane Greciano (Centre Hospitalier, Colmar), Michel Gudin De Vallerin (Cabinet Privé, Paris), Hajar Lahbabi Guennioui (Centre Hospitalier, Tourcoing), Pierre Guéranger (Centre Hospitalier, Villefranche de Rouergue), Anne-Lise Gugenheim (Centre Hospitalier, Corbie), Philippe Guillot (Cabinet Privé, Sète), Jean-Paul Guillot (Centre Hospitalier, Bayeux), Véronique Haddad (Clinique, Aubagne), Djamel Hamani (Clinique, Paris), Karim Hasni (Centre Hospitalier Intercommunal, Toulon), Eric Helms (Cabinet Privé, Saint-Priest), Richard Hersh (Cabinet Privé, Longwy), Sébastien Hess (Centre Hospitalier Universitaire, Strasbourg), Bernard Hijazi (Cabinet Privé, Nîmes), Agnès Holeman (Cabinet Privé, Clichy), Charlotte Honore (Clinique, Rouen), Daniel Horovitz (Cabinet Privé, Savigny sur Orge), Franck Houeze (Centre Hospitalier, Charleville-Mézières), Jean-Sébastien Hulot (Hôpital Pitié-Salpêtrière, Paris) Frédéric Hurson (Cabinet Privé, St-Maur-des-Fosses), Messaoud Idir (Centre Hospitalier, Périgueux), Karim Ikhlef (Centre Hospitalier, Belfort), Adi Issa (Centre Hospitalier, Bourges), Olivier Jaboureck (Centre Hospitalier, Bourges), Gildas Jacob (Cabinet Privé, Saint-Brieuc), Saed Jazayeri (Centre Hospitalier Universitaire, Dijon), Christophe Jego (Centre Hospitalier, Maubeuge), Philippe Jessen (Clinique, Aubervilliers), Marc Jobbe Duval (Cabinet Privé, Neuilly sur Seine), Thierry Joseph (Centre Hospitalier Intercommunal, Quimper), Jean-Philippe Joubert (Cabinet Privé, Orange), Patrick Jourdain (Centre Hospitalier, Pontoise), Rémy Juste (Cabinet Privé, Lagny sur Marne), Thomboj Theostyphyl Kabsel (Centre Hospitalier, Le Puy en Velay), Yasser Kalaaji (Centre Hospitalier, Gonesse), Gaetan Karrillon (Centre Hospitalier, Eaubonne), Didier Kassehin (Centre Hospitalier Intercommunal, Poissy), Sébastien Kerebel (Hôpital des Armées, Toulon), Ryad Khallaayoune (Centre Hospitalier Intercommunal, Marmande), Idriss Kioueh (Centre Hospitalier, Semur en Auxois), Alain Kojfer (Cabinet Privé, Hénin-Beaumont), Bassel Koujan (Centre Hospitalier, Châteauroux), Mouhammad Mazen Kouzez (Centre Hospitalier, Vichy), Jérome Kozak (Cabinet Privé, Marcq en Baroeul), Hélène Kremer (Centre Hospitalier Universitaire, Strasbourg), Fabien Labombarda (Centre Hospitalier Universitaire, Caen), Cécile Lacote Roiron (Centre Hospitalier Universitaire, Bron), Alain Lacroix (Cabinet Privé, Brive), Christian Lagiewka (Clinique, Aubervilliers), Emmanuel Lamaze (Cabinet Privé, Bussang), Bruno Lambert (Cabinet Privé, Pleumeur-Gautier), Eric Lamy (Cabinet Privé, Caen), Ingrid Landragin Martin (Cabinet Privé, Angoulême), Pascal Lauvergnat (Cabinet Privé, Auray), Tahar Lazizi, Centre Hospitalier, Laval), Pierre Le Franc (Cabinet Privé, Rouen), Jean-Michel Le Hir (Cabinet Privé, Marseille), Laurent Leborgne (Centre Hospitalier Universitaire, Salouel), Florence Leclercq (Centre Hospitalier Régional Universitaire, Montpellier), Guillaume Lecoq (Clinique, Caen), Didier Lefevre (Cabinet Privé, Castres), Yves Lemiere (Cabinet Privé, Conflants Ste Honorine), Gérard Lesage (Cabinet Privé, Plancher les Mines), Pierre-François Lesault (Clinique, Le Havre), Nicolas Lhoest (Clinique, Strasbourg), Yann Lize (Cabinet Privé, Challans), Pierre Llaty (Cabinet Privé, Poitiers), Judith Loeb Mansour (Cabinet Privé, Argences), Jean-Louis Long (Cabinet Privé, Vichy), Philippe Longere (Cabinet Privé, Draguignan), Christian Lorentz (Cabinet Privé, Belfort), Jean-Christophe Louchart (Cabinet Privé, Bethune), Jules Louembe (Hôpital des Armées, Clamart), Arezki Lounis (Centre Hospitalier Intercommunal, Montfermeil), Olivier Lozinguez (Clinique, Noisy le Grand), Anne Luycx Bore (Cabinet Privé, Compiègne), Jean-Louis Lysakowski (Cabinet Privé, Lyon), Daniel Bey (Centre Hospitalier du Centre-Bretagne, Noyal Pontivy), Pascal Mabire (Cabinet Privé, Fleury sur Orne), Amine Madi (Centre Hospitalier, Vénissieux), Patricia Magnus (Cabinet Privé, Thann), Benaouda Mahdjoub (Cabinet Privé, Bressuire), Muhyjealdeen (Centre Hospitalier, Soissons), Hamid Makki (Cabinet Privé, Châtillon sur Seine), Henri Malaterre (Cabinet Privé, Marseille), Gregory Malbranque (Cabinet Privé, Hénin-Beaumont), Bernard Manne (Cabinet Privé, Le Blanc Mesnil), Michel Mansour (Centre Hospitalier, Belfort), Jacques Mantoux (Cabinet Privé, Limoux), Denis Manzi (Cabinet Privé, Chate), Stéphanie Manzo Silberman (Hôpital Lariboisière, Paris), Arnaud Marchand (Cabinet Privé, Aix en Othe), Mounir Maroun (Cabinet Privé, Givet), Michel Marsaux (Cabinet Privé, Conflants-Ste-Honorine), Michael Martelet (Centre Hospitalier, Langres), Olivier Martin (Cabinet Privé, Nice), Victor Mateus (Centre Hospitalier, Laval), Serge Mazouz (Cabinet Privé, Chelles), Daniel M’bey (Centre Hospitalier, Noyal Pontivy), Karine Mear (Centre Hospitalier, Bourges), Fatiha Mehlal (Centre Hospitalier, Saumur), Dominique Mellin (Cabinet Privé, L’isle sur la Sorgue), Bruno Meme (Cabinet Privé, La Riche), Paul Menu (Centre Hospitalier Universitaire, Poitiers), François-Xavier Meriaux (Cabinet Privé, Fougères), Zoubir Mesli (Cabinet Privé, Montpellier), Nathan Messas (Centre Hospitalier Universitaire, Strasbourg), Charlotte Mestrallet Rivet (Centre Hospitalier Intercommunal, Rumilly), Marie Metivier (Cabinet Privé, Paris), Thibaud Meurice (Cabinet Privé, Lille), Jonathan Meurice, Centre Hospitalier Universitaire, Lille), Philippe Meurin (Clinique, Villeneuve Saint-Denis), Stéphane Mielot (Cabinet Privé, Marseille), Christopher Mielot (Cabinet Privé, Plan de Cuques), Alexandre Mischie (Centre Hospitalier Intercommunal, Chateaubernard), Marcin Mlotek (Cabinet Privé, Saint-Etienne), Patrick Montant (Cabinet Privé, Cluses), Daniel Montaut (Cabinet Privé, Negrepelisse), Olivier Morel (Centre Hospitalier Universitaire, Strasbourg), Claudine Morillon (Cabinet Privé, Vannes), Pierre-Julien Moro (Clinique, Marseille), Saleh Mortada (Centre Hospitalier, Forbach), Yann Morvan (Cabinet Privé, Joigny), Lakri Mouaci (Cabinet Privé, Beauvais), Joseph Mouallemm (Centre Hospitalier, Langres), Maan Moulla (Centre Hospitalier, Soissons), Jean-Philippe Mouret (Centre Hospitalier, Marseille), Samer Mousi (Centre Hospitalier, Niort), Gérard Muller (Centre Hospitalier, Ste Feyre), Jean-Joseph Muller (Cabinet Privé, Strasbourg), Melchior Munet (Cabinet Privé, Decines Charpieu), Lyassine Nait Saidi (Centre Hospitalier Intercommunal, Toulon), Olivier Nallet (Centre Hospitalier Intercommunal, Montfermeil), Marc Nejman (Cabinet Privé, La Villedieu), Le Anh Tuan Nguyen (Centre Hospitalier, Niort), Van Hung Nguyen (Centre Hospitalier, Aurillac), Dorian Nitu (Centre Hospitalier, Eaubonne), Elisabeth Nyom (Centre Hospitalier, Laon), Alice Ohanessian (Centre Hospitalier, Briis sous Forges), Codin Olariu (Cabinet Privé, Moulins), Bernard Olivieri (Cabinet Privé, Juan les Pins), Azeddine Ouguoujil (Cabinet Privé, Gennevilliers), Michel Ovize (Centre Hospitalier Universitaire, Bron), Didier Pacaud (Centre Hospitalier, Sens), Franck Paganelli (Centre Hospitalier Universitaire, Marseille), Mathieu Pankert (Centre Hospitalier, Marseille), Francesco Paparoni (Centre Hospitalier, Seclin), Kumaressen Pareathumby (Cabinet Privé, Prades), Serge Pariente (Cabinet Privé, Paris), Philippe Paule (Hôpital des Armées, Brest), Julie Peroz (Hôpital Américain, Neuilly sur Seine), Eric Pichon (Cabinet Privé, Vesoul), Alain Pinzani (Cabinet Privé, Sète), Christophe Piot (Clinique, Montpellier), Renaud Piquemal (Cabinet Privé, Thionville), Eric Plantrou (Cabinet Privé, Pont de l’Arche), Alain Pleskof (Cabinet Privé, Chelles), Grégoire Poletti (Centre Hospitalier Régional Universitaire, Nîmes), Jean-Marc Ponzio (Cabinet Privé, Nîmes), Iulia Popescu (Centre Hospitalier Intercommunal, Chantepie), François Poulain (Cabinet Privé, Paris), Bruno Pouzet (Clinique, Le Chesnay), Raphael Poyet (Hôpital des Armées, Toulon), Etienne Puymirat (Hôpital Européen Georges Pompidou, Paris), Gonzalo Quaino (Centre Hospitalier, Chambéry), Virginie Rachenne-Barthomeuf (Cabinet Privé, Bourgoin-Jallieu), Benjamin Ramanamamonjy (Clinique, Tarbes), Mamy Randriamora (Centre Hospitalier, Arras), Patrice Raymond (Cabinet Privé, Asnie), Pierre Reins (Cabinet Privé, Schiltigheim), Caroline Richalet (Cabinet Privé, Echirolles), Christian Roche (Cabinet Privé, Saint-Etienne), Nicolas Charles Roche (Hôpital des Armées, St-Mande), Jérome Roncalli (Centre Hospitalier Universitaire, Toulouse), Roger Rosario (Hôpital Saint-Joseph, Marseille), Chantal Rosati Gretere (Cabinet Privé, Montrouge), Guillaume Rosey (Cabinet Privé, Toulouse), Vincent Roule (Centre Hospitalier Universitaire, Caen), Philippe Rouquette (Cabinet Privé, Mauguio), Olivier Rousseau (Cabinet Privé, Saint-Etienne), Dorine Rousseau (Cabinet Privé, Neuville en Ferrain), Christophe Roussel (Centre Hospitalier Intercommunal, Fréjus), Simon Saad (Centre Hospitalier, Chateaubriant), Rim Saad Blidi (Centre Hospitalier, Eaubonne), Maurice Saade (Cabinet Privé, Hesdin), Rémi Sabatier (Centre Hospitalier Universitaire, Caen), François Saint-Pierre (Centre Hospitalier Intercommunal, Arles), Adrien Salem (Cabinet Privé, Marseille), Emmanuel Salengro (Centre Hospitalier Intercommunal, Villeneuve St-Georges), Eric Saloux (Centre Hospitalier Universitaire, Caen), Ali Reza Samadi (Centre Hospitalier Intercommunal, Villeneuve St-Georges), Alain Sandalian (Cabinet Privé, Marseille), Marc Sander (Cabinet Privé, Saint-Germain-en-Laye), Alexandru Sarbu Pop (Centre Hospitalier, Charleville-Mézières), Virginie Sarrau (Cabinet Privé, Gennevilliers), Bachir Sayegh (Centre Hospitalier, Colmar), Armand Sbaiti (Cabinet Privé, Montpellier), Antony Scemama (Clinique ,Suresnes), Patrick Schlageter (Cabinet Privé, Marckolsheim), Gregory Schoukroun (Cabinet Privé, Cornebarrieu), Philippe Schraub (Cabinet Privé, Ajaccio) Olivier Selton (Cabinet Privé, Toul), Jamal Seoud (Cabinet Privé, Creil), Sylvain Sifaoui (Cabinet Privé, Cannes), Laurent Simonnet (Cabinet Privé, Obernai), Cristina Sirbu (Centre Hospitalier Universitaire, Vandoeuvre les Nancy), Joelle Sissmann (Cabinet Privé, Paris), Charles Sokic (Cabinet Privé, Bischwiller), Renaud Solanet (Cabinet Privé, Roubaix), Jean-Pierre Soulard (Cabinet Privé, Cholet), Jean Souyri (Cabinet Privé, Valentine), Philippe Gabriel Steg (Hôpital Bichat, Paris), Stéphane Tabet (Cabinet Privé, Enghien les Bains), Jean-Yves Tabet (Clinique, Villeneuve Saint-Denis), Samira Taihi (Centre Hospitalier, Bar le Duc), Marc Takla (Centre Hospitalier Intercommunal, Epinal), Sunhok Tan (Cabinet Privé, Arles), Roger Tanguy (Cabinet Privé, Plouzane), Philippe Tanielian (Cabinet Privé, Marseille), Frédéric Targosz (Centre Hospitalier, Perpignan), Jean Tartar (Cabinet Privé, St Pol sur Mer), Jacques Teboul (Clinique, Saint-Laurent-du-Var), Mohamed Terbah (Hôpital de la Source, Orléans), Sébastien Terrazzoni (Clinique, Antony), Pascal Tessier (Cabinet Privé, Saint-Raphael), Catherine Thiebaut (Cabinet Privé, Saint-Mandrier-sur-Mer), Denix Tixier (Cabinet Privé, Clamart), Pascal Toban (Clinique, Tours), Kossi Lolonyo Tonyiga (Centre Hospitalier, Rueil-Malmaison), Philippe Trehou (Cabinet Privé, Guise), Olivier Tricot (Centre Hospitalier, Dunkerque), Charlotte Trouillet (Centre Hospitalier, La Rochelle), Xavier Troussier (Clinique, Massy), Basile Tsoumbou (Centre Hospitalier, Chateaubriant), Albert Mudiambi Tuambilangana (Centre Hospitalier, Cherbourg Octeville), Philippe Uge (Cabinet Privé, Bordeaux), Clément Unal (Cabinet Privé, Vaison la Romaine), Denis Uzan (Cabinet Privé, Aulnay sous Bois), Franck Valero (Cabinet Privé, Anzin), Richard Valla (Cabinet Privé, Digne), Frédéric Vallet (Centre Hospitalier, Niort), Yann Valy (Centre Hospitalier, La Rochelle), Bruno Vaquette (Centre Hospitalier, La Rochelle), Olivier Varenne (Hôpital Cochin, Paris), Eric Verbrugge (Centre Hospitalier, Boulogne sur Mer), Marc Villaceque (Cabinet Privé, Nîmes), Fabrice Vine (Cabinet Privé, Paris), Thibaud Violet (Cabinet Privé, Annecy), Bruno Vittecoq (Cabinet Privé, Saint-Michel-sur-Orge), Bernard Charlot Wafo (Centre Hospitalier, Briis sous Forges), Rana Wanly (Centre Hospitalier, Vienne), Michel Wazana (Cabinet Privé, Strasbourg), Michel Weingrod (Cabinet Privé, Plaisir), Steve Werquin (Centre Hospitalier, Dunkerque), Xavier Wuydin (Cabinet Privé, Cappelle en Pévèle), Cossi Virgile Yadouleton (Centre Hospitalier, Brive la Gaillarde), Wael Yafi (Centre Hospitalier, Mulhouse), Gilles Zemmour (Centre Hospitalier, Cannes).

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