RITUXIMAB
Promising biologic treatment for SLE
Rituximab is an anti-CD20 monoclonal antibody that depletes B cells, which play a prominent role in the pathogenesis of systemic lupus erythematosus (SLE). However, research on whether the drug is an effective treatment for SLE has been inconclusive. To explore the drug's short-term effectiveness and infection rates, investigators in the United Kingdom studied 270 patients with SLE being treated with a biologic therapy, most commonly rituximab (n = 261), from September 2010 to September 2015. Over 90% of patients were also taking glucocorticoids at baseline. At 6 months, response rates were available for 68% of patients.
Nearly 50% of patients responded to treatment. Findings also included:
* a reduction in glucocorticoid use at 6 months.
* serious infections in 10% of patients (n = 26), occurring most frequently in the first 3 months.
* a higher proportion of nonrespiratory infections among early infections.
The investigators concluded that rituximab is "safe and is associated with improvement in disease activity in patients with refractory SLE with concomitant reductions in glucocorticoid use." However, they urge vigilance for infection postinfusion to minimize risks and improve benefits. In the United States, rituximab is indicated for various serious disorders, including rheumatoid arthritis, but it isn't currently FDA-approved for treating SLE.
Sources: McCarthy EM, Sutton E, Nesbit S, et al. Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register. Rheumatology (Oxford). 2018;57(3):470-479. Rituxan (rituximab) injection, for intravenous use. Prescribing information. http://www.rituxan.com. Walsh N. A role for rituximab in lupus? Half of refractory patients responded in 6 months. MedPage Today. March 8, 2018.
ANTIBIOTIC RESISTANCE
"Nightmare bacteria" require aggressive action
The CDC is warning clinicians and the public about an alarming increase in the prevalence of so-called "nightmare bacteria"-strains of bacteria that have unusual resistance to all or most antibiotics and are uncommon and/or contain special resistance genes that enable them to pass on their ability to resist antibiotics to other bacteria. In 2017, the CDC reports that lab tests uncovered more than 200 instances of unusual resistance in nightmare bacteria. The good news is that prompt and aggressive action can prevent the spread of unusual resistance in healthcare facilities when even a single case is found. For example, the CDC estimates that an aggressive containment strategy could prevent 1,600 cases of carbapenem-resistant Enterobacteriaceae in one state over 3 years.
The CDC urges state and local health departments to coordinate with healthcare facilities, the new Antibiotic Resistance Lab Network regional labs, and the CDC for every case of unusual resistance. Interventions should include onsite infection control assessments and colonization screenings for anyone who may have been exposed. The CDC notes that in 11% of screening tests, resistant bacteria are found in people with no signs and symptoms of infection.
For more recommendations, resources, and educational poster material, visit the CDC site referenced below.
Source: Centers for Disease Control and Prevention. Vital Signs: containing unusual resistance. April 3, 2018. http://www.cdc.gov/vitalsigns/containing-unusual-resistance/index.html.
GERIATRICS
Polypharmacy has cumulative effects, study shows
In a recent study, polypharmacy was associated with poorer physical and cognitive capability in older adults, even after adjusting for disease burden and other factors. In addition, cumulative exposure to polypharmacy was associated with poorer outcomes. For purposes of the study, polypharmacy was defined as five to eight prescribed medications and excessive polypharmacy was defined as nine or more prescribed medications.
The study was based on a sample of British men and women for whom medication data at ages 60 to 64 and age 69 were available. Polypharmacy was present in over 18% of participants at age 69 and nearly 5% experienced excessive polypharmacy.
About 2,700 of these older adults were invited to participate in tests conducted in their homes at age 69. Study results were based on 2,149 home visits in which research nurses conducted standardized tests for cognitive and physical functioning, such as chair rise speed and walking speed.
Results showed that both polypharmacy and excessive polypharmacy were correlated with poorer cognitive and physical capability at age 69, and that excessive polypharmacy was associated with poorer physical and cognitive capability than polypharmacy alone. In addition, associations were stronger in subjects exposed to polypharmacy at least twice, suggesting "dose-dependent, cumulative negative associations between polypharmacy and cognitive and physical capability."
The authors call for more research to determine whether "reducing polypharmacy earlier in the course of its development, in addition to optimizing disease control, might avoid potential cumulative detrimental effects on physical and cognitive capability noted here in early old age."
Source: Rawle MJ, Cooper R, Kuh D, Richards M. Associations between polypharmacy and cognitive and physical capability: a British birth cohort study. J Am Geriatr Soc. [e-pub March 24, 2018].
OPIOID EPIDEMIC
New playbook for opioid stewardship
The National Quality Forum (NQF) National Quality Partners (NQP) has issued a guide entitled National Quality Partners Playbook: Opioid Stewardship to help healthcare organizations and clinicians safely manage patient's pain in all care settings and specialties of care. The guide is a response to the rising tide of opioid misuse and addiction in the United States, described by the NQF as an urgent public health crisis. According to the CDC, nearly two million Americans have a prescription-related opioid use disorder and more than 46 Americans die each day from an overdose related to prescription opioids.
Providing concrete examples and strategies for implementation, the NQF Playbook identifies fundamental actions to support sustainable opioid stewardship, including:
* promoting healthcare leadership in implementing policies that support opioid stewardship, tracking data on opioid use and outcomes, and establishing a culture of opioid stewardship.
* advancing clinical knowledge and expertise in pain management and opioid prescribing behavior.
* educating patients and family caregivers about the risks and benefits of pain management strategies, especially opioid use.
A summary of the NQP Playbook is available on the NQF website: http://www.qualityforum.org. The entire document can be downloaded for a fee.
Source: National Quality Forum. Managing the nation's pain: NQF issues essential guidance on opioid stewardship. http://www.qualityforum.org/Managing_the_Nations_Pain.aspx.