Clinical factors associated with discontinuation of ts/bDMARDs in rheumatic patients from the BIOBADASER III registry.

Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug's overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan-Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan-Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99-1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54-0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00-1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15-1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05-1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00-1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12-1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.

Tratamiento con linezolid oral en osteomielitis postraumáticas / Treatment of posttraumatic osteomyelitis with oral linezolid

Objetivo. Valorar la eficacia y seguridad de linezolid oral asociado a cirugía en el tratamiento de las osteomielitis postraumáticas. Material y método. Estudio prospectivo monitorizado de todos los pacientes ingresados en la unidad de infecciones óseas y articulares del hospital con osteomielitis postraumática por cocos grampositivos meticilín resistentes tratados con cirugía programada y linezolid, 600 mg cada doce horas, desde junio de 2002 hasta diciembre de 2004. Resultados. Hemos tratado con linezolid a nueve pacientes con osteomielitis postraumática. Los microorganismos aislados han sido: un Staphylococcus aureus meticilín resistente, un estafilococo coagulasa negativo meticilín resistente, siete Staphylococcus epidermidis meticilín resistentes. Dos pacientes han tenido infección asociada con Pseudomonas aeruginosa. La duración media del tratamiento ha sido de 9,5 semanas (rango 6-12). En el seguimiento realizado ocho pacientes están clínicamente curados con estabilización de la fractura y sin signos de infección. Un paciente está en situación de pseudoartrosis infectada. El linezolid ha sido tolerado de manera excelente y no ha habido necesidad de suspender la medicación por toxicidad en ningún caso. Conclusiones. En nuestra experiencia, linezolid oral asociado a cirugía puede ser una excelente opción de tratamiento en osteomielitis postraumática causada por bacterias grampositivas resistentes a meticilina que no respondan a la administración de otros antimicrobianos o que no toleren éstos

Purpose. To assess the efficacy and safety of oral linezolid associated with surgery in the treatment of posttraumatic osteomyelitis. Materials and methods. Monitored prospective study of all patients suffering from posttraumatic osteomyelitis caused by Methicillin-resistant Gram positive cocci treated with elective surgery and linezolid 600 mg every 12 hours from June 2002 to December 2004. Results. We have used linezolid to treat 9 patients with posttraumatic osteomyelitis. The microorganisms isolated were: Methicillin-resistant Staphylococcus aureus, 1; Methicillin-resistant Staphylococcus epidermidis, 7. Two patients had an associated infection caused by Pseudomonas aeruginosa. Mean duration of treatment was 9.5 weeks (range 6-12). During follow-up 8 patients were found to be clinically cured with fracture stabilization and with no sign of infection. One patient had an infected mal-union. Linezolid was excellently tolerated and in none of the cases it was necessary to discontinue administration due to toxicity. Conclusions. In our experience oral linezolid associated with surgery can be an excellent option for the treatment of posttraumatic osteomyelitis caused by Methicillin-resistant Gram positive bacteria that do not respond to other antimicrobials or if these are not well tolerated (AU)