Incidence of Psoriatic Arthritis Among Patients Receiving Biologic Treatments for Psoriasis: A Nested Case-Control Study.

OBJECTIVE: To investigate the effect of biologic treatments for psoriasis on the incidence of psoriatic arthritis (PsA). METHODS: This retrospective cohort study was conducted using electronic medical records from a large health maintenance organization. Patients who received biologic treatment for psoriasis and were not diagnosed as having PsA before or at the time of biologic treatment initiation were included. Control psoriasis patients who did not receive biologic treatment were matched by age at time of diagnosis, sex, time from psoriasis diagnosis until treatment initiation, maximum body mass index, and smoking status. The groups were different in most characteristics. Therefore, propensity score matching was implemented. Log rank test and multivariable Cox proportional hazards regression were used to compare the groups. RESULTS: Overall, 1,326 patients were included, of whom 663 had received biologic treatment and 663 had not. The Kaplan-Meier curve for the propensity score-matched groups reflected a statistically significant increased risk for PsA among the control group compared to the biologic treatment group. The results of the multivariable Cox regression showed that the control group had a significantly higher risk for PsA compared to the biologic treatment group within 10 years of follow-up (adjusted hazard ratio 1.39 [95% confidence interval 1.03-1.87]). CONCLUSION: Our findings show a statistically and clinically significant decreased risk for developing PsA among patients with psoriasis who receive biologic treatments. The results suggest that biologic medications should be considered for patients who present with significant risk factors for PsA at an earlier stage of treatment.

The impact of breast augmentation on breast feeding in primigravida women - A cohort study.

OBJECTIVE: Breast augmentations are among the most common interventional cosmetic procedures performed nowadays, but scarcity of data exists on its effects on breastfeeding. Our aim was to evaluate whether breast augmentation adversely affects breastfeeding. STUDY DESIGN: A retrospective cohort study using database of a 2.3-million-member state mandate health maintenance organization (HMO). We identified primigravida women with a singleton pregnancy who delivered between the years 1998-2016, at gestational age of >34 weeks of gestation. Study group included women with breast augmentation surgery, which compared to control group of women who did not undergo breast augmentation. The primary outcome was documentation of any breastfeeding during the first three months postpartum. RESULTS: Overall, 14,919 women were included, of them, 3913 and 11,006 women with and without breast augmentation, respectively. Women with breasts augmentation were younger (29.8 ± 3.6 years vs. 30.9 ± 4.0 years, p < 0.001), had lower pre-pregnancy BMI (25.2 ± 5.0 vs. 26.36 ± 5.0 Kg/m2, p < 0.001), belong to higher socioeconomic status level and less religious communities. Breastfeeding rates in the study group were lower as compared to controls (70.7% VS 85.1%; p < 0.0001), with an adjusted odds ratio of 0.42(95% CI: 0.38-0.461). Maternal diabetes mellitus and advanced maternal age were associated with a lower likelihood of breastfeeding (95% CI:0.45-0.78, p-value < 0.0001), while belonging to religious communities were associated with higher breastfeeding rates (95% CI: 1.34-1.99, p-value < 0.0001). CONCLUSION: Women with breast augmentation tend to breastfeed less than women without breast augmentation, during the first three month of postpartum.

Association between oral contraceptives and serious infections: A population-based cohort study.

AIMS: Oral contraceptives (OC)s are commonly used worldwide. In a recent study, we showed that the use of OCs is associated with an increased risk for neutropenia. We aimed to investigate the clinical implications of this finding by examining the infection rates of 4 serious infections before, during and after OCs. METHODS: A retrospective cohort study using the electronic medical records of a large health organization. We selected 2 retrospective cohorts of women aged 16-40 between years 2005 and 2019. The first cohort examined infection rates during 2 years before OC use and 2 consecutive years of adherent OC use. The second cohort included women who consumed OCs adherently for 2 years and then discontinued their use for 2 consecutive years. Women's infection rates were compared by χ2 test, results were stratified by OC type and age. RESULTS: Overall, 21 595 and 20 728 women were included in Cohorts 1 and 2 respectively. We found a statistically significant higher relative risk for infection while using OCs; the overall risk ratios (95% confidence intervals) for infection in Cohorts 1 and 2 were 1.35 (1.32-1.38) and 1.27 (1.24-1.31), respectively. The overall infection risk remained statistically significant when stratified by age. CONCLUSIONS: This study demonstrates a high statistically and clinically significant risk for all infections followed during OC consumption, which is likely to have major clinical and economic implications. These findings may have implications to millions of women worldwide and should lead to more research on the safety of the pill.

Oral Contraceptives and Neutropenia: A Population-Based Cohort Study.

BACKGROUND: Oral contraceptives (OCs) are one of the most commonly used classes of drugs worldwide. A case of neutropenia and associated infections in a young woman using OCs that settled after discontinuation and reappeared upon re-challenge, has led us to investigate a potential association between oral contraceptives and neutropenia. OBJECTIVES: To compare rates of neutropenia among women receiving OCs to a matched control group of women not exposed to the "pill". PATIENTS AND METHODS: In this population-based cohort study we used a large computerized database of a health fund, comparing women prescribed OCs and a control group not using the pill. We selected a cohort of 51,394 OC users aged 16-40 years who purchased their first monthly pack of OCs between 2010 and 2018. Controls included all non-pregnant women aged 16-40 years for whom OC was not dispensed (n = 140,932). Neutrophil count before and during OC were compared. RESULTS: Prior to OC exposure, 1.3% of the women were neutropenic, compared to 1.6% after exposure to OC (RR 1.22; 95% CI 1.1-1.35). Mean neutrophil count changed from 3.87 × 103 to 3.82 × 103 mm3 (p < 0.001). In the control group (n = 140,932) no difference was seen in the proportion of neutropenic women between the first complete blood count (1.7%) compared to the second (1.8%) count (p = 0.305). In all severity levels, neutropenia was significantly more common in the OC group. The relative risk was higher for severe (RR 1.63) than for mild neutropenia (RR 1.13) (p = 0.034 for trend). CONCLUSIONS: There is a significant increase in the proportion of neutropenic women after initiating OCs. More research is needed in order to evaluate the effect of neutropenia in this group of women.