ABSTRACT
Background/Aims The use of Janus Kinase Inhibitors (JAKi) has been gradually increasing overtime in the management of rheumatoid arthritis (RA) and other inflammatory arthritis and these appeal to patients. being oral agents. Nevertheless, rheumatologists have become cautious about their use since recent trials have shown safety concerns about VTEs, MACE and malignancies. Methods We decided to study use of JAKi at our centre in Princess of Wales Hospital Bridgend. The aim was to assess whether appropriate patients were selected (considering cautions about MACE, VTEs and malignancies). We also wanted to see whether all patients had required pretreatment safety testing and post-treatment monitoring performed. Results These were 70 patients;59 were females and 11 were males. All of them were diagnosed as RA. Average age was 61.1 years (20-85), average duration of disease 129.9 months (16-340) and average duration of treatment was 58.1 weeks. The most common JAKi being used was baricitinib (84%) followed by tofacitinib (12%) and upadacitinib (4%). 50% patient were on concomitant csDMARDs among whom two-thirds were on methotrexate. Looking at previous biologic use, 9 patients were biologic naive, 22 had one biologic, 15 had two biologics used in the past. All patients were appropriately selected (severe RA and no significant risk factors for MACE, VTEs and malignancies). All patients had pre-treatment Hepatitis B, Hepatitis C, latent TB, FBC and LFTs checked. All patients had FBC and LFTs monitored post treatment. No patient developed VTE, MACE or cancer on treatment. 84.2% patients had lipids tested before starting JAKi. 22.8% patients had abnormal lipids before Rx initiation and 62.5% of these were on lipid lowering Rx. All patients had lipids tested post treatment, but the timing was quite variable and only 62.5% of patients had lipids tested on the recommended time. There were 2 deaths recorded in this cohort. One of those was an 80-year-old RA patient on baricitinib 2mg OD, who died due to chest infection on the background of ILD. He was not on steroids or csDMARDs. The second patient was 63 years' old (on baricitinib 4mg OD), and died due to respiratory sepsis, and was also on azathioprine. She had RA with advanced ILD. The reasons for discontinuing JAKi were inefficacy (46%), side effects (39%) and both inefficacy and side effects (15%). 41.4%of patient experienced side effects due to JAKi. These included infection 28%, deranged lipids 17%, cytopenia 14%, deranged LFTs 14%, GI side effects 10%, skin rash 7% and varicella zoster 3%. Conclusion There has been steady increase in the use of tsDMARDs for RA and other rheumatic conditions. Due to short half-life, these drugs became a popular choice during COVID-19 pandemic but on the other hand safety monitoring became extremely challenging during this time.
ABSTRACT
Background: The impact of COVID-19 mitigation measures on STI transmission and racial disparities remains unknown. The objectives were to examine trends in sex and drug risk behaviors, access to sexual health services and STI positivity overall and by race during-compared to pre-pandemic among urban sexual minorities (MSM). Methods: Sexually-active MSM aged 18-45 years were administered a behavioral survey and STI testing at three-month intervals. Participants completing > one during-pandemic (April-December 2020) and one pre-pandemic study visit (before March 13, 2020) occurring < six months apart were included. Generalized estimating equations with modified Poisson regression models compared outcomes during-compared to pre-pandemic visits. Results: Among 231 MSM, reports of > three sex partners declined [adjusted Prevalence Ratio (aPR): pandemic-1(p1) 0.68, 95% CI (0.54-0.86);pandemic-2(p2) 0.65 (0.51-0.84);pandemic-3(p3) 0.57 (0.43-0.75)];similar findings were observed among Black and non-Black MSM. Black, but not non-Black MSM, reported sustained decreases in substance use (aPR: p1 0.90 (0.79-1.03);p2 0.74 (0.62-0.89);p3 0.82 (0.67-0.99)], and increased HIV/PrEP care engagement [aPR: p1 1.20 (1.07-1.34);p2 1.24 (1.11-1.39);p3 1.30 (1.16-1.47)]. Reported STI testing (overall and by race) decreased [aPR: p1 0.68 (0.57-0.81);p2 0.78 (0.67-0.92)], then rebounded [aPR: p3 1.01 (0.87-1.18)]. Overall, neither chlamydia [aPR: p2 1.62 (0.75-3.46);p3 1.13 (0.24-1.27)] nor gonorrhea [aPR: p2 0.87 (0.46-1.62) p3 0.56 (0.24-1.27)] positivity significantly changed during vs. pre-pandemic. Conclusion: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared to pre-pandemic. Findings underscore the urgent need for novel strategies to deliver STI prevention services without in-person interactions among MSM.
ABSTRACT
BackgroundCOVID-19 mitigation measures may indirectly impact sexually transmitted infection (STI) transmission. Social distancing may impact number/type of sex partnerships and access to STI testing and treatment. The objective was to compare the number of reported sex partnerships and gonorrhea and chlamydia prevalence pre- and during-pandemic among a cohort of gay, bisexual and other men-who-have-sex-with-men (MSM) in Baltimore, Maryland, a U.S. city with sustained STI epidemics.MethodsThis study was nested in a cohort study of sexually active MSM aged 18–45, and included participants who had at least one study visit after March 13, 2020 (during-pandemic) and ≤ six months between their first during-pandemic and last pre-pandemic visit. Wilcoxon and McNemar tests for paired data were used for statistical testing.ResultsAmong 417 MSM enrolled in the cohort, 220 (52.8%) were included. 213 (96.8%) had a visit between April 6-June 30, 2020 (during-pandemic1);185 (84.1%) had a visit between July 1-September 30, 2020 (during-pandemic2), including seven who missed the during-pandemic1 visit. The majority were Black (73.2%) and aged 24–35 (56.4%);42% were living with HIV. Compared to pre-pandemic, the median number of total and casual male sex partners (past three months) significantly declined during-pandemic1 and during-pandemic2 (Total partners: pre-pandemic: 2.0 (range: 0–75);during-pandemic1: 1.0 (0–25), p<0.0001;during-pandemic2: 1.0 (0–20) p<0.0001;Casual partners: pre-pandemic: 1.0 (0–75);during-pandemic1: 0.0 (0–25) p<0.0001, during-pandemic2: 1.0 (0–20), p=0.004). Among those tested both pre- and during-pandemic2, (n=96) STI prevalence was similar (gonorrhea: 14.1% vs. 15.8%, p=0.847;chlamydia: 7.0% vs. 9.5%, p=0.527).ConclusionsAlthough overall and casual sex partnerships declined significantly during- compared to pre-pandemic, STI prevalence was similar. The observed decreased sex partnerships may not have substantially altered transmission dynamics or were offset by increased prevalence due to limited access to testing/treatment. Improved understanding of how COVID-19 mitigation measures alter STI transmission dynamics is needed.