Secukinumab vs. Ustekinumab: How Do These Two Psoriasis Drugs Compare?
Patients with psoriasis may achieve better outcomes with secukinumab compared to ustekinumab, according to a study. The analysis consisted of patients with chronic plaque psoriasis who were aged 18 or older and had at least 1 record of a Psoriasis Area and Severity Index (PASI) of 12 or higher prior to initiating either medication. There were 1,231 patients evaluated: 917 in the ustekinumab group and 314 in the secukinumab group. In almost all analyses, secukinumab outperformed ustekinumab. The only exception was under the nonresponder imputation method when analyzing the proportion of patients who attained a PASI of 2 or lower: RR, 1.28, and RD, 11.9%.
When Admitted to the ICU, These Factors in Patients with Rheumatoid Arthritis May Increase Mortality Risk
A study examined factors that may be associated with poorer intensive care unit (ICU) outcomes among patients with rheumatoid arthritis (RA).
The median age at the time of admission was 70 years, and RA duration was 10 years. The five-year survival rate after ICU admission was 47%. The 30-day mortality rate was 22%, 90-day rate was 27%, and one-year rate was 37%. Two-thirds of the 30-day mortality patients died as a result of infection; factors associated with mortality were a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. According to laboratory data collected at admission, factors predictive of a significantly poorer prognosis were lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR). Upon multivariate analysis, factors that increased mortality risk following ICU admission were nonuse of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), high updated CCI, increased APACHE II score, and prolonged PT-INR.
Which Patients With Rheumatoid Arthritis Are More Likely to Experience Multiple Biologic Failures?
A study examined factors associated with multiple failures to biologic DMARDs (bDMARDs) among patients with RA. Multi-refractory patients (MR-patients) were those who had an insufficient response to at least three bDMARDs or two bDMARDs that had different mechanism of action. Non-refractory patients (NR-patients) were those who attained low disease activity or remission, per the Disease Activity Score in 28 joints (DAS-28), with the first bDMARD and maintained it for at least five years. The following factors were independently correlated with being MR-patients to bDMARDs on multivariate analysis: being younger, presence of erosions, and higher baseline DAS-28 before initiating the first bDMARD, and achieving a delta-DAS-28 <1.2 six months after initiating the first bDMARD.
Orthopedic Trauma Update: These Are The Trends in Fatal and Nonfatal Firearm Injuries in the United States
A study evaluating the incidence of fatal and nonfatal firearm injuries in the United States found that the nation’s most common cause of firearm injury death is suicide, and that the majority of those who die by suicide never reach the hospital. Over the course of the study period (2009-2017), the rate of self-harm deaths increased in all age groups and areas; most of them happened outside the hospital (87.8%), and they were most common in people aged 55 years and older. When looking at trends by location and age, fatal assault injuries were more common in urban areas than rural ones, with rates of 16.6 and 9 per 100,000 per year, respectively, and they were highest in the 15 to 34 years age group, at 38.6 per 100,000 per year. Unintentional injuries were more prevalent in rural areas, with 18.5 per 100,000, compared to urban areas, with 12.4 per 100,000.
In additional orthopedic trauma news, a study that appeared in the Journal of the AAOSfound that managing incomplete femur fracture as a result of a low-velocity gunshot wound may be able to be handled nonoperatively.