Treatment Recommendations

Introduction

The getAlternatives request retrieves valid therapeutic alternatives for an indication.

Entry Point

post/aort/v1/graphql

HTTP Headers

Name	Value
`Content-Type`	`application/json`
`Authorization`	`Bearer <token>`

Variables

To enter the indication, use the autocomplete with entity_type=CLINICAL_INDICATION.
To enter drugs, use the autocomplete with entity_type=DRUG.
To enter conditions, use autocomplete with entity_type=CONTRAINDICATION_TERRAIN.
To enter adverse effects to avoid, use autocomplete with entity_type=ADVERSE_EFFECT.

Variable	Input field	Type	Description
`target`	`drug`	`DrugInput`	Drug for which to find an alternative to exclude from the results
`target`	`indication`	`IndicationInput`	Indication for which to find a therapeutic alternative
`target`	`level`	`Level`	Risk level of the alternatives; alternatives will only be proposed for indications without alerts of an equivalent level
`target`	`adverseEffectsToAvoid`	`CodingInputWithLabel[]`	List of codes for adverse effects to avoid for the alternatives
`target`	`pathways`	`CodingInputWithLabel[]`	List of codes for forms for the alternatives
`target`	`forms`	`CodingInputWithLabel[]`	List of codes for routes for the alternatives
`target`	`therapeuticBooklet`	`TherapeuticBooklet`	Therapeutic booklet configuration to include only the specialties (packaged drugs) present in the booklet
`target`	`outOfStock`	`Boolean`	Filter for out-of-stock items (not yet implemented)
`target`	`marketed`	`Boolean`	Filter for drugs with market authorization
`patient`	`conditions`	`ConditionInput[]`	Patient’s pathologies and conditions (SNOMED)
`patient`	`sex`	`Gender`	Patient’s biological gender
`patient`	`ageGroups`	`AgeGroup[]`	Patient’s age group
`patient`	`birthDate`	`Date`	Patient’s date of birth
`patient`	`continuousCriteria`	`ContinuousCriterionInput[]`	Patient’s biological parameters
`patient`	`concurrentTreatments`	`AlternativeTreatmentInput`	Patient’s pre-existing treatments
`snomedInferrence`	`indication`	`Boolean`	Parameter to search for alternatives on similar indications via inferences allowed by SNOMED.
`snomedInferrence`	`alerts`	`Boolean`	Parameter to search for alerts on similar conditions via inferences allowed by SNOMED.
`snomedInferrence`	`adverseEffects`	`Boolean`	Parameter to search for adverse effects via inferences allowed by SNOMED.

ContinuousCriterionInput

Input field	Type	Description
`type`	`String`	Biological parameter type
`unit`	`String`	Biological parameter unit
`min`	`Float`	Lower bound of the biological parameter
`max`	`Float`	Upper bound of the biological parameter
`value`	`Float`	Absolute value of the biological parameter

ConcurrentTreatments

Input field	Type	Description
`ingredients`	`String[]`	Ingredients of pre-existing drugs in the patient
`procedures`	`String[]`	Procedures and operations in the patient’s history
`therapeuticClasses`	`String[]`	Therapeutic classes of treatments taken by the patient

Result

The API returns an object of type AlternativeResult.

Alternative Result

Attributes	Type	Description
`drug`	`AlternativeDrug`	Description of each drug in an alternative
`alerts`	`AlertResult[]`	List of remaining contraindications for each alternative
`interactions`	`InteractionResult[]`	List of remaining interactions for each alternative
`adverseEffects`	`AdverseEffect[]`	List of remaining adverse effects for each alternative
`indications`	`IndicationResult`	Details about the indication to fill the filters

AlternativeDrug

Attributes	Type	Description
`clinicalDrug`	`ClinicalDrug`	Details about the proposed virtual drug as an alternative
`brandedDrugs`	`BrandedDrug[]`	List of brand names of the drugs
`ingredients`	`String[]`	List of ingredient designations

ClinicalDrug

Attributes	Type	Description
`codings`	`Coding[]`	Additional codes to describe the drug
`form`	`Coding`	Drug form
`pathways`	`Coding[]`	Possible administration routes for the drug
`inn`	`String`	International Nonproprietary Name
`marketed`	`Boolean`	Indicates if the drug is marketed
`historicalSales`	`HistoricalSales`	Sales history of the drug

HistoricalSales

Attributes	Type	Description
`atc5`	`Int`	Sales history for ATC5
`atc7`	`Int`	Sales history for ATC7

TherapeuticUseResult

Attributes	Type	Description
`intents`	`Intent[]`	Intentions for which the drug is an alternative
`treatmentTypes`	`TreatmentType[]`	Types of treatment for which the drug is an alternative
`therapies`	`Therapy[]`	Types of therapy for which the drug is an alternative

BrandedDrug

Attributes	Type	Description
`code`	`Coding`	Specialty code (branded drug)
`brandname`	`String`	Brand name of the specialty
`therapeuticBooklet`	`Boolean`	If true, filters specialties to only show those present in the booklet
`outOfStock`	`Boolean`	If true, filters specialties to only show those in stock (Not yet implemented)

AdverseEffect

Attributes	Type	Description
`condition`	`Condition`	Description of the adverse effect condition
`incidence`	`Incidence`	Incidence of the adverse effect
`patient`	`Patient`	Patient criteria for which the adverse effect has this incidence
`dosage`	`String`	Drug dose likely to cause the adverse effect
`phase`	`String`	Treatment phase likely to cause the adverse effect
`behaviour`	`String`	Recommended action in case of occurrence of the adverse effect

IndicationResult

Attributes	Type	Description
`condition`	`Condition`	Indication condition description
`therapeuticUse`	`TherapeuticUse`	Details of therapeutic use of the indication

Example

Alternatives

query getAlternatives($target: AlternativeTarget) {
  getAlternatives(target: $target) {
    drug {
      clinicalDrug {
        inn
        codings {
          code
          label
          terminology
        }
        form {
          code
          label
          terminology
        }
        routes {
          code
          label
          terminology
        }
        marketed
        historicalSales {
          atc5
          atc7
        }
      }
      brandedDrugs {
        brandname
        code {
          code
          label
          terminology
        }
        outOfStock
        therapeuticBooklet
      }
      ingredients
    }
    indications {
      condition {
        designation
        codings {
          code
          label
          terminology
        }
        associatedConditions {
          designation
          codings {
            code
            label
            terminology
          }
          
          modifiers
        }
        modifiers
      }
      therapeuticUse {
        intents
        therapies
        treatmentTypes
      }
    }
    alerts {
      designation
      type
      condition {
        designation
        codings {
          code
          label
          terminology
        }
        associatedConditions {
          designation
          codings {
            code
            label
            terminology
          }
          modifiers
        }
        modifiers
      }
      patient {
        ageGroups
        gender
        concurrentTreatments {
          ingredients
          procedures
          therapeuticClasses
        }
        continuousCriteria {
          type
          min
          max
          unit
        }
      }
      warnings {
        risk
        modifiers
        guidelines
      }
      source {
        author
        url
      }
      comment
    }
    interactions {
      designation
      type
      drugs {
        ingredient {
          code
          label
          terminology
        }
        clinicalDrug {
          code
          label
          terminology
        }
        brandedDrug {
          code
          label
          terminology
        }
      }
      comment
      source {
        author
        url
      }
    }
    adverseEffects {
      condition {
        designation
        codings {
          code
          label
          terminology
        }
        associatedConditions {
          designation
          codings {
            code
            label
            terminology
          }
          modifiers
        }
        modifiers
      }
      incidence
      patient {
        ageGroups
        gender
        concurrentTreatments {
          ingredients
          procedures
          therapeuticClasses
        }
        continuousCriteria {
          type
          min
          max
          unit
        }
      }
      phase
      dosage
      behaviour
    }
  }
}

Response

{
  "data": {
    "getAlternatives": [
      {
        "drug": {
          "clinicalDrug": {
            "inn": "glimépiride",
            "codings": [
              {
                "code": "MV00000125",
                "label": "Glimépiride 3 mg comprimé",
                "terminology": "posos"
              },
              {
                "code": "A10B",
                "label": "médicaments hypoglycémiants sauf insulines",
                "terminology": "ATC4"
              },
              {
                "code": "A10BB",
                "label": "sulfonylurées",
                "terminology": "ATC5"
              },
              {
                "code": "A10BB12",
                "label": "glimépiride",
                "terminology": "ATC7"
              }
            ],
            "form": {
              "code": "PDF-10219000",
              "label": "Comprimé",
              "terminology": "EDQM_form"
            },
            "routes": [
              {
                "code": "ROA-20053000",
                "label": "Voie orale",
                "terminology": "EDQM_pathway"
              }
            ],
            "marketed": true,
            "historicalSales": {
              "atc5": 9112677,
              "atc7": 1636144
            }
          },
          "brandedDrugs": [
            {
              "brandname": "glimepiride",
              "code": {
                "code": "61788049",
                "label": "GLIMEPIRIDE ACCORD HEALTHCARE 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "62969440",
                "label": "GLIMEPIRIDE ZYDUS 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "63235360",
                "label": "GLIMEPIRIDE ARROW 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "63422748",
                "label": "GLIMEPIRIDE ARROW GENERIQUES 3 mg, comprimé sécable",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "63718067",
                "label": "GLIMEPIRIDE CRISTERS 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "64816831",
                "label": "GLIMEPIRIDE EG 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "amarel",
              "code": {
                "code": "65035230",
                "label": "AMAREL 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "65546901",
                "label": "GLIMEPIRIDE ZENTIVA 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "65607350",
                "label": "GLIMEPIRIDE SANDOZ 3 mg, comprimé sécable",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "65660794",
                "label": "GLIMEPIRIDE TEVA SANTE 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "67447122",
                "label": "GLIMEPIRIDE EVOLUGEN 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "68427382",
                "label": "GLIMEPIRIDE BGR 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            },
            {
              "brandname": "glimepiride",
              "code": {
                "code": "69977393",
                "label": "GLIMEPIRIDE VIATRIS 3 mg, comprimé",
                "terminology": "cis"
              },
              "outOfStock": false,
              "therapeuticBooklet": false
            }
          ],
          "ingredients": null
        },
        "indications": [
          {
            "condition": {
              "designation": null,
              "codings": [
                {
                  "code": "10022491",
                  "label": "Diabète insulinorésistant",
                  "terminology": "meddra"
                },
                {
                  "code": "44054006",
                  "label": "diabète sucré de type 2",
                  "terminology": "snomed"
                },
                {
                  "code": "E11",
                  "label": "Diabète sucré de type 2",
                  "terminology": "cim10"
                }
              ],
              "associatedConditions": null,
              "modifiers": []
            },
            "therapeuticUse": {
              "intents": [],
              "therapies": [],
              "treatmentTypes": []
            }
          }
        ],
        "alerts": [],
        "interactions": [],
        "adverseEffects": []
      }
    ],
    ...
  }
}

Enum

Gender

Variable	Description
M	Male
F	Female

AgeGroup

Variable	Description
NEWBORN	Newborn
SENIOR	Senior
CHILD	Child
ADOLESCENT	Adolescent
PREMATURE	Premature
INFANT	Infant
ADULT	Adult

Intent

Variable	Description
FIRST_LINE	First intention
SECOND_LINE	Second intention
THIRD_LINE	Third intention

TreatmentType

Variable	Description
ACUTE	Acute treatment
ADJUVANT	Adjuvant treatment
CONTINUATION	Continuation treatment
CURATIVE	Curative treatment
DIAGNOSIS	Diagnostic agent
EMERGENCY	Emergency treatment
ETIOLOGICAL	Etiological treatment
HOMEOPATHY	Homeopathic treatment
IMMUNOMODULATOR	Immunomodulator treatment
INDUCTION	Induction treatment
INITIAL	Initial treatment
LOCAL	Local treatment
LONG_TERM_DISEASE_MODIFYING	Long-term disease-modifying
MAINTENANCE	Maintenance treatment
MANAGEMENT	Management treatment
PALLIATIVE	Palliative treatment
PHYTOTHERAPY	Phytotherapy treatment
PREVENTIVE	Preventive treatment
REPLACEMENT	Replacement treatment
REVERSAL	Reversal treatment
SYMPTOMATIC	Symptomatic treatment
VACCINE	Vaccine

Therapy

Variable	Description
MONOTHERAPY	Monotherapy treatment type
BITHERAPY	Bitherapy treatment type
TRITHERAPY	Tritherapy treatment type
COMBINATION_THERAPY	Combination therapy type

Codes de réponse

Code	Description
`200`	OK
`400`	One of the parameters passed in the request is invalid.

Interactions Drug-Indexed Decision Support Sytem (HAS)