ABSTRACT
Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ABSTRACT
COVID-19 made significant health, economic, and social impact across the world. The situation urgently needs to strengthen disaster risk reduction strategies to reduce risks and enhance resilience. Nevertheless, many instances have evidenced disaster risk governance-related issues. This study examined the United Kingdom's present disaster risk governance system since the country has been hit significantly by the pandemic. The study evaluates the risk governance system in the United Kingdom across the key elements of the International Risk Governance Framework. The study conducted a systematic literature review following a literature review protocol. Documents were selected from the Science Direct, Emerald, and Google Scholar databases. Across the framework elements, several challenges were found within the UK's pandemic risk governance system. The study highlights the strength of the well-developed legal and policy supported the country's risk governance system. Even though the study was conducted at the early stage of the pandemic, the early findings will benefit policymakers and practitioners shaping the pandemic risk governance system in the country for a resilient society. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
COVID-19 pandemic has given insights into the systemic risks of a hazard, demonstrating the potency of biological hazards to not only render one sector dysfunctional but also fail the entire system. The grave and devastating impacts of the current COVID-19 call for the need to assess the state of global and national preparedness for future pandemics. This chapter provides an outline of Sri Lanka's response to the COVID-19 pandemic while delving into the current status and gaps concerning preparedness for pandemics in the country. The analysis is aimed at providing key recommendations for policymakers to improve national-level preparedness for anticipated pandemic threats. This chapter has drawn on a review of secondary literature and primary data gathered through in-depth interviews conducted with key informants in the disaster management and public health sectors in the country. Findings show that while preparedness planning for biological hazards is predominantly a responsibility of the health sector in the country, there is a pressing need to strengthen such preparedness through a unified legal framework and system of governance that allow for the transfer of relevant expertise, infrastructure, and lessons learned from previous hazards contexts to situations of pandemics;the incorporation of pandemic preparedness into national-level DRR efforts and subnational-level DRR planning;intensifying national focus on building economic and social resilience;emulating a multisectoral approach, enhancing private sector participation, and establishing a national framework to foster preparedness for parallel hazards. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Without any doubt, the outbreak of novel coronavirus;mostly known as COVID-19 has divided the recent timeline of world into three periods namely, before COVID-19, during COVID-19 and after COVID-19. The devastating impacts that occurred during COVID-19 have already been a wake-up call towards how the existing systems should be strengthened for the period after COVID-19 to mitigate the risk of future pandemics. During the pandemic, functionality of healthcare facilities started to fail in a cascading manner highlighting the need for addressing the systemic nature of risks with novel approaches. Architects, engineers, healthcare professionals, and policymakers have started to plan on how the future healthcare facilities have to be altered for the new normal, COVID-19. This paper delves into the challenges rendered on healthcare facilities during COVID-19, immediate actions taken to mitigate the impacts, and new approaches suggested for the period after COVID-19. The study has drawn on a review of recently published scholarly articles, reports, international and national policy and frameworks, news items, magazine articles, etc. pertaining to the behavior of healthcare facilities during the crisis and future hospital designs. Apart from the challenges and immediate actions in mitigating the negative impacts, this paper has summarized new approaches for future hospital designs under two categories namely, hospital design and built environment, and hospital management and operation. It is evident that pandemic has highlighted the paramount importance of sustainable Disaster Risk Reduction (DRR) strategies towards more resilient healthcare facilities in the future. But still, these new approaches have to be further validated through multi-sectoral approaches since the crisis is not still over. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.