Higher levels of response on clinical atopic dermatitis severity measures are associated with meaningful improvements in patient-reported symptom and quality of life measures: Integrated analysis of three Upadacitinib phase 3 trials.

BACKGROUND: It is not fully understood how different degrees of improvements in atopic dermatitis (AD) clinical outcome measures translate to improvements in patient-reported outcome (PRO) measures, such as those assessing itch, symptoms, sleep, anxiety, depression, quality of life (QoL), and work productivity. OBJECTIVES: This post hoc analysis of three clinical studies assessed how more robust improvements in clinical responses are associated with improvements in PROs and QoL. METHODS: Data from three randomized, double-blind, placebo-controlled, phase 3 trials in adults and adolescents with moderate to severe atopic dermatitis (Measure Up 1, Measure Up 2, and AD Up) were included. Patients were randomly assigned (1:1:1) to upadacitinib (15 or 30 mg) or placebo once daily (alone or in combination with topical corticosteroids). The mean percentage improvement from baseline to week 16 and percentage of patients achieving responses at week 16 were summarized by the Eczema Area and Severity Index (EASI) and validated Investigator Global Assessment of Atopic Dermatitis (vIGA-AD) response level categories. RESULTS: A total of 2392 patients from the three trials were included in the analysis. Increasingly greater mean percentage improvement and proportion of patients achieving response was observed at higher clinical response levels (i.e., stepwise pattern). Mean percentage improvement and proportion of patients achieving response exceeded 69% and 70% at EASI ≥ 90 and vIGA-AD 0/1, respectively, for most PROs including Worst Pruritus Numeric Rating Scale, Patient Oriented Eczema Measure, and Dermatology Life Quality Index. CONCLUSIONS: Greater degrees of clinical responses are related to more robust improvements across multiple dimensions impacted by AD, including itch, skin pain, sleep, anxiety, depression, and QoL.

Attitudes toward directly administered antiretroviral therapy (DAART) among HIV-positive inpatients in an inner city public hospital.

Directly administered antiretroviral therapy (DAART) is one approach to improve adherence among HIV-positive individuals. DAART has been assessed for confined participants such as prisoners and for patients enrolled in methadone clinics but community-based voluntary DAART programs are not well studied. We examined the attitudes toward DAART among 47 HIV-positive inpatients in an inner city public hospital, a population difficult to engage in conventional self-administered highly active antiretroviral therapy (HAART). This study found that 83% of participants prefer self-administered therapy (SAT) and only 17% elect for DAART. A significant proportion of participants think the approach is intrusive or impractical and few are willing to meet with providers daily. A proportion of our patients, however, struggle with medication non-adherence and fragmented medical care, evident in the high rates of missed clinic appointments, frequent emergency department visits and repeated hospitalizations. These data can inform the development of DAART programs and suggest that considerable effort is needed to 'sell' the idea of DAART to this patient population. It is likely that such patients will greatly benefit from a clinic that can provide intensive counseling, frequent follow-up, home visits and DAART. Patient education regarding the merits of such an approach will be key to success.

Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by health care workers after patient care.

Gloving reduces acquisition of vancomycin-resistant Enterococcus species (VRE) on the hands, and it should be considered for routine inpatient care, even for contact with the intact skin of patients who may be colonized with VRE. However, gloving does not completely prevent contamination of the hands, and hand washing is necessary after glove removal.