Risk of adverse events in psoriasis patients receiving classic systemic drugs and biologics in a 5-year observational study of clinical practice: 2008-2013 results of the Biobadaderm registry

BACKGROUND

Biobadaderm is the Spanish registry of psoriasis patients receiving systemic treatment in clinical practice.

OBJECTIVE

To compare the safety of biologics and classic systemic treatment.

METHODS

Prospective cohort of patients receiving biologics and classic systemic therapies between 2008 and 2013 in 12 hospitals are included. We registered demographic data, diagnoses, comorbidities, treatments and adverse events (AE). We obtained raw relative risks (RR) for specific AE. Multivariate analysis consisted of Cox models adjusting for age, gender, chronic hepatic disease and previous cancer.

RESULTS

A total of 1030 patients received biologics (2061 AE in 3681 person-years), 926 patients classic systemic drugs (1015 AE in 1517 person-years). Ninety-three per cent of AE in both groups were non-serious, 6% serious and 0.003% fatal. The age- and gender-adjusted hazard ratio of AE was lower in the biologics group [hazard ratio 0.6 (95% CI: 0.5-0.7)].We found no differences in rates of serious and mortal AE. Some system organ class AE rates differed between both groups. As limitations: Prescription bias might affect the incidence of AE in both groups. Association of drug and AE was based on timing: associations might not be causal.

CONCLUSION

Patients receiving biologics had lower risk of AE. We did not find differences in the risk of serious or fatal AE.

[Culture media for the detection and the identification of Streptococcus agalactiae]

Streptococcus agalactiae, a Group B streptococcus, is the main cause of bacterial perinatal infection and is also an important opportunistic pathogen. Detection and identification of S. agalactiae are straight forward with special culture media, where Group B streptococci show a specific, typical pink or red pigment. To quickly and easily detect the pigment, culture media should contain: (i) starch; (ii) an inhibitor of the folate pathway; (iii) animal serum; (iv) a pepsic proteic hydrolysate; and (v) glucose, together with a high-capacity buffer. When selective antibiotics are added to culture media designed in this way, it is possible to detect S. agalactiae directly from clinical samples by observation of its pigment after less than 12 hours of aerobic incubation.

[Prevalence of antibodies against CMV in Grenada]

The prevalence of anti-CMV antibodies was studied on 1,552 serum samples by means of latex passive haemagglutination method. Of all the sera studied, 1,084 were positive (69.8%). Amongst them, 523 samples came from women and 561 from men, which represent 74.7% and 65.8%, respectively. Regarding to age, 62.3% of the positive samples were from people under 30 years and 91.3% from subjects over that age. The screening of anti-CMV antibodies is especially important in blood and organ donors, where the high percentage of positivity makes it difficult to select negative blood donations. Thus, taking into account the cost-effectiveness, and the results of this study, the search for CMV-negative blood must be exerted preferentially on the group of blood donors under 30 years of age, regardless of sex.

New Granada Medium for detection and identification of group B streptococci

A methotrexate-containing medium for the detection of beta-hemolytic group B streptococci from clinical specimens on the basis of detection of pigment is described. The medium contained peptone, starch, serum, MgSO4, glucose, pyruvate, methotrexate (as pigment enhancer), phosphate-morpholine-propanesulfonic acid buffer, and selective agents. The recovery of beta-hemolytic group B streptococci was comparable to that obtained with selective broth.

[Evaluation of the Vitek system in the identification and biotyping of Streptococcus agalactiae]

Using the Vitek card for identification of gram-positive agents, 244 strains of Streptococcus agalactiae were studied. Twenty five out of these strains were studied during 3 consecutive days. The study also involved 25 pairs of maternal and neonatal strains. The system gave correct identification of only 52 out of 244 strains of S. agalactiae. Due to the low reproducibility of the system it is suggested that the bionumbers used in the codification of a microorganism should be avoided.

[Isolation of Streptococcus agalactiae in adults: serotypes, adhesiveness to epithelial cells]

Serotype distribution and adherence to epithelial cells (HeLa and Hep-2) were studied in 230 strains of Streptococcus agalactiae (GBS) isolated in adult patients with GBS infection or in asymptomatic carriers. In the population investigated, serotypes Ia and III predominated in the strains isolated from both carriers and patients. Adhesivity was significantly greater in strains isolated from the former, regardless of serotype. Thus in adults, serotype cannot be correlated with virulence of a given strain.

Mycoplasma hominis infection in three renal transplant patients

We describe three cases of extragenital infection by Mycoplasma hominis in three patients transplanted with kidneys from cadaver donors. In two patients, the microorganism was isolated in the exudate from the surgical wound after 72 hrs. of culture on blood-agar (Columbia + 5% horse blood) in CO2 and under anaerobic conditions. In the remaining case, M. hominis was isolated in urine from a suprapubic catheter. All three patients responded satisfactorily to treatment with doxycycline. Mycoplasma hominis should be considered as the possible source of infection in patients at risk because of immunosuppressive therapy and manipulation of the urinary tract. Detection and identification of the organism are difficult without the appropriate techniques.