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infection risk following biological therapy

Insa Joost, Johannes Steinfurt, Philipp T Meyer, Winfried V Kern, Siegbert Rieg
BACKGROUND: Ustekinumab (Stelara®), a human monoclonal antibody targeting the p40-subunit of interleukin (IL)-12 and IL-23, is indicated for moderate to severe plaque psoriasis and psoriatic arthritis. In large multicenter, prospective trials assessing efficacy and safety of ustekinumab increased rates of severe infections have not been observed so far. CASE PRESENTATION: Here, we report the case of a 64-year old woman presenting with chills, pain and swelling of her right foot with dark maculae at the sole, and elevated inflammatory markers...
October 20, 2016: BMC Infectious Diseases
D L Fink, L Hedley, R F Miller
Biologic therapies are injectable immunomodulatory agents directed against specific immune cell or chemical targets. They have transformed the lives of HIV-uninfected individuals with severe inflammatory conditions including psoriasis, rheumatoid arthritis, and ulcerative colitis. The perceived increased infection risk associated with these agents means that HIV-infected individuals have not been included in randomised control trials of these drugs. The literature for use of biologic therapies in HIV-infected populations is limited to case reports and case series...
October 12, 2016: International Journal of STD & AIDS
Yesim Ozguler, Gulen Hatemi, Serdal Ugurlu, Emire Seyahi, Melike Melikoglu, Sermin Borekci, Ersan Atahan, Gul Ongen, Vedat Hamuryudan
The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %)...
October 3, 2016: Rheumatology International
Lídia Teixeira, Ana Rita Fonseca, Gisela Eugénio, Marília Rodrigues, Nikita Khmelinskii, Sílvia Fernandes, Sofia Serra, Tiago Costa, Maria José Santos
INTRODUCTION: Infections are a major cause of morbidity and mortality in systemic inflammatory rheumatic diseases and the management of infectious complications in patients under biological therapies deserves particular attention. OBJECTIVE: Develop evidence-based recommendations for the management of infections in rheumatic patients receiving biological therapies. METHODS: A search in PubMed (until 10 November 2014) and EMBASE (until 20 December 2014) databases was performed...
August 6, 2016: Acta Reumatológica Portuguesa
Paula Dávila-Seijo, Esteban Dauden, M A Descalzo, Gregorio Carretero, José-Manuel Carrascosa, Francisco Vanaclocha, Francisco-José Gómez-García, Pablo De la Cueva-Dobao, Enrique Herrera-Ceballos, Isabel Belinchón, José-Luis López-Estebaranz, Merce Alsina, José-Luis Sánchez-Carazo, Marta Ferrán, Rosa Torrado, Carlos Ferrandiz, Raquel Rivera, Mar Llamas, Rafael Jiménez-Puya, Ignacio García-Doval
Information regarding the safety of biological drugs prescribed to psoriasis patients on daily and long-term bases is insufficient. We used data from the BIOBADADERM registry (Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases) to generate crude rates of infection during therapy with systemic drugs, including biological drugs (infliximab, etanercept, adalimumab, and ustekinumab) and non-biological drugs (acitretin, cyclosporine, and methotrexate). We also calculated unadjusted and adjusted risk ratios (RR) (with propensity score adjustment) of infection, serious infections, and recurrent infections of systemic therapies compared with methotrexate, using Poisson regression...
September 24, 2016: Journal of Investigative Dermatology
L Stratton, G R Caddy
Patients with Crohn's disease often require the use of immunosuppressant drugs to control disease activity. Such medication includes steroids, azathioprine, and biologic therapy. These suppress the immune response, and the patient is more susceptible to infection. We present a case of a 69-year-old gentleman with a history of Crohn's colitis who had ongoing symptoms of diarrhoea in spite of standard treatment. Biologic therapy was considered to be the next step, and screening for infection was undertaken prior to use...
2016: Case Reports in Gastrointestinal Medicine
Marta Olejárová
UNLABELLED: The biological treatment which is the most effective type of therapy for inflammatory rheumatic diseases, has become part of a standard clinical rheumatology practice in recent years. Thousands of patients in the Czech Republic with rheumatoid arthritis, different forms of spondyloarthritides and with psoriatic arthritis are now successfully treated in this way. The following medications are registered in the Czech Republic for the treatment of rheumatic diseases: infliximab, adalimumab, golimumab, certolizumab pegol, etanercept, abatacept, rituximab, tocilizumab and belimumab, newly also secukinumab...
2016: Vnitr̆ní Lékar̆ství
Claudio Bonifati, Viviana Lora, Dario Graceffa, Lorenzo Nosotti
The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV)...
July 28, 2016: World Journal of Gastroenterology: WJG
Cristina Costa, Francesca Sidoti, Samantha Mantovani, Gabriella Gregori, Alex Proietti, Valeria Ghisetti, Rossana Cavallo
In immunosuppressed patients, pre-emptive therapy and a strict follow-up of CMV infection are the standard of care for the prevention of CMV disease. Several real-time PCR assays for CMV DNA quantification on whole blood (WB) and plasma (PL) are commercially available. This study compared and correlated CMV viral loads obtained by the Cobas AmpliPrep/Cobas TaqMan (CAP/CTM) platform on plasma specimens with those obtained on corresponding whole blood specimens by the real-time PCR assay (ELITe MGB-CMV) in 185 sequential samples from 41 immunosuppressed patients...
September 2016: New Microbiologica
Caitlin W Hicks, Katherine E Poruk, Pablo A Baltodano, Kevin C Soares, Said C Azoury, Carisa M Cooney, Peter Cornell, Frederic E Eckhauser
BACKGROUND: Sandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure. METHODS: We conducted a 4-y retrospective review of all complex SVHRs (biologic mesh underlay and synthetic mesh overlay) with HVAC closure performed at our institution by a single surgeon...
August 2016: Journal of Surgical Research
L Peyrin-Biroulet, A Germain, A S Patel, J O Lindsay
BACKGROUND: Colectomy for ulcerative colitis is associated with short- and long-term complications. Estimates of the frequency of such complications are variable and may have changed since the introduction of biological therapy. Understanding the true burden of surgical complications is important to clinicians in assessing risks and benefits of colectomy vs. continued medical therapy. AIM: To ascertain the outcomes of colectomy and ileal pouch surgery in patients with ulcerative colitis in the biologics era...
October 2016: Alimentary Pharmacology & Therapeutics
Ursula Wiedermann, Harald H Sitte, Heinz Burgmann, Alexander Eser, Petra Falb, Heidemarie Holzmann, Maria Kitchen, Marcus Köller, Herwig Kollaritsch, Michael Kundi, Hans Lassmann, Ingomar Mutz, Winfried F Pickl, Elisabeth Riedl, Maria Sibilia, Florian Thalhammer, Barbara Tucek, Werner Zenz, Karl Zwiauer
Immunosuppression of various origins is associated with an increased risk of infection; therefore the prevention of infectious diseases by vaccination is especially important in immunocompromised patients. However, the response to vaccinations is often reduced in these risk groups and the application of live vaccines is contraindicated during immunosuppression.In the following expert statement, recommendations for vaccination were created on the basis of current evidence and theoretical/immunological considerations...
August 2016: Wiener Klinische Wochenschrift
April W Armstrong, Michael Bukhalo, Andrew Blauvelt
Many of the molecular pathways associated with psoriasis pathogenesis are also involved in host defense mechanisms that protect against common pathogens. Candida can stimulate the production of cytokines that trigger or exacerbate psoriasis, and many systemic psoriasis treatments may put patients at increased risk for developing oral, cutaneous, and genitourinary candidiasis. Therefore, dermatologists should regularly screen patients with psoriasis for signs of Candida infection, and take steps to effectively treat these infections to prevent worsening of psoriasis symptoms...
August 2016: American Journal of Clinical Dermatology
Lucas Otieno, Martina Oneko, Walter Otieno, Joseph Abuodha, Emmanuel Owino, Chris Odero, Yolanda Guerra Mendoza, Ben Andagalu, Norbert Awino, Karen Ivinson, Dirk Heerwegh, Nekoye Otsyula, Maria Oziemkowska, Effua Abigail Usuf, Allan Otieno, Kephas Otieno, Didier Leboulleux, Amanda Leach, Janet Oyieko, Laurence Slutsker, Marc Lievens, Jessica Cowden, Didier Lapierre, Simon Kariuki, Bernhards Ogutu, Johan Vekemans, Mary J Hamel
BACKGROUND: Malaria remains a major global public health concern, especially in sub-Saharan Africa. The RTS,S/AS01 malaria candidate vaccine was reviewed by the European Medicines Agency and received a positive scientific opinion; WHO subsequently recommended pilot implementation in sub-Saharan African countries. Because malaria and HIV overlap geographically, HIV-infected children should be considered for RTS,S/AS01 vaccination. We therefore aimed to assess the safety of RTS,S/AS01 in HIV-infected children at two sites in western Kenya...
October 2016: Lancet Infectious Diseases
J M Carrascosa, M Galán, R de Lucas, A Pérez-Ferriols, M Ribera, I Yanguas
BACKGROUND: There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS: We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method...
June 22, 2016: Actas Dermo-sifiliográficas
Cristina Costa, Francesca Sidoti, Samantha Mantovani, Gabriella Gregori, Alex Proietti, Valeria Ghisetti, Rossana Cavallo
In immunosuppressed patients, pre-emptive therapy and a strict follow-up of CMV infection are the standard of care for the prevention of CMV disease. Several real-time PCR assays for CMV DNA quantification on whole blood (WB) and plasma (PL) are commercially available. This study compared and correlated CMV viral loads obtained by the Cobas AmpliPrep/Cobas TaqMan (CAP/CTM) platform on plasma specimens with those obtained on corresponding whole blood specimens by the real-time PCR assay (ELITe MGB-CMV) in 185 sequential samples from 41 immunosuppressed patients...
June 10, 2016: New Microbiologica
Denise P C Chan, Hsin-Yun Sun, Horas T H Wong, Shui-Shan Lee, Chien-Ching Hung
Sexually acquired hepatitis C virus (HCV) infection remains a public health problem, with significant disease burden primarily in HIV-positive men who have sex with men (MSM). Over the past decades, the epidemic of sexually transmitted HCV infection has continued to expand and the epidemiology of HCV in HIV has changed significantly. In the post-combination antiretroviral therapy era, sexual network characteristics within the specific core group of MSM with increased sexual risk behaviours, including serosorting on the basis of HIV-positive status and intense mucosally traumatic sexual practices, confer increased HCV acquisition and transmission...
August 2016: International Journal of Infectious Diseases: IJID
I García-Doval, M V Hernández, F Vanaclocha, A Sellas, P de la Cueva, D Montero
BACKGROUND: Information on safety of TNF-antagonists frequently arises from their use in rheumatic diseases, their first approved indications, and is later applied to psoriasis. Whether the risk of biological therapy is similar in psoriasis and rheumatoid arthritis has been considered a priority research question. OBJECTIVES: To compare the safety profile of anti-TNF drugs in patients with rheumatoid arthritis and psoriasis. METHODS: We compared two prospective safety cohorts of patients with rheumatoid arthritis and psoriasis that share methods (Biobadaser and Biobadaderm)...
June 3, 2016: British Journal of Dermatology
Donatella Maria Rodio, Elena Anzivino, Monica Mischitelli, Anna Bellizzi, Rossana Scrivo, Daniela Scribano, Gianlorenzo Conte, Carla Prezioso, Maria Trancassini, Guido Valesini, Anna Teresa Palamara, Valeria Pietropaolo
Chronic inflammatory rheumatic diseases (CIRDs) are immune-mediated pathologies involving joints. To date, TNFα-blocking agents administration is the most promising therapy, although these treatments are associated with an increased Polyomavirus JC (JCPyV) reactivation, the etiological agent of the Progressive Multifocal Leukoencephalopathy (PML). The aim of this study was the recruitment and the analysis of a CIRDs cohort in order to investigate a possible correlation between JCPyV presence and the influence of anti-TNF-α agents on viral loads...
2016: Frontiers in Microbiology
Ruth Costello, Kevin L Winthrop, Stephen R Pye, Benjamin Brown, William G Dixon
INTRODUCTION: Guidelines for the management of rheumatoid arthritis (RA) recommend using influenza and pneumococcal vaccinations to mitigate infection risk. The level of adherence to these guidelines is not well known in the UK. The aims of this study were to describe the uptake of influenza and pneumococcal vaccinations in patients with RA in the UK, to compare the characteristics of those vaccinated to those not vaccinated and to compare vaccination rates across regions of the UK. METHODS: A retrospective cohort study of adults diagnosed with incident RA and treated with non-biologic immunosuppressive therapy, using data from a large primary care database...
2016: PloS One
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