A new study has established guselkumab (Tremfya) as both a safe and effective treatment option for psoriatic arthritis (PsA) in patients who had previously responded poorly to tumor necrosis factor inhibitors (TNFis).

“While the positive guselkumab benefit-risk profile observed through week 24 was maintained through 1 year, real-world evidence will further inform long-term guselkumab persistence in TNFi-inadequate response patients,” writes Laura C. Coates, MBChB, PhD, of the University of Oxford (England), and her coauthors. The study was published in the Annals of the Rheumatic Diseases.

Previous studies indicated that the anti–interleukin-23p19 monoclonal antibody improved outcomes in patients with PsA, even after 1 year, but some uncertainty remained regarding the surprisingly similar level of effectiveness in biologic-naive and TNFi-treated patients. Guselkumab is approved for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and adults with active psoriatic arthritis.

Clarity on guselkumab’s effectiveness in certain patients

“In previous studies that cemented guselkumab as a treatment option for PsA, what was odd was that the results were pretty comparable,” Eric M. Ruderman, MD, professor of medicine and associate chief for clinical affairs in the division of rheumatology at Northwestern University in Chicago, Illinois, said in an interview. “We didn’t really have a sense of how well it worked in patients who had failed other biologics, which is where you might expect a drug with a new mechanism to be used when it comes into a particular disease category.

“Not surprisingly, in this study, the overall response rate was a little less than the response rate in the other two trials,” said Dr. Ruderman, who was not involved in the study. “You can’t really compare across studies, but it does fit with what we might expect: People who’ve previously failed a TNF inhibitor might be a little less likely to respond to guselkumab, compared to someone who hasn’t seen a TNF inhibitor.”

When asked about potential follow-up studies, Dr. Ruderman noted that “the missing piece of the puzzle is that we still really have no way to compare this to other biologics. The next step would be to ask, in a single trial, what happens if you give some people TNF inhibitors and some people guselkumab? Just to try to give us context. Is this equivalent? Is it less effective? More effective? Where does it fit? Without that information, rheumatologists may struggle to figure out who is the right person for this drug and how often should they use it.”

Study details

To assess the efficacy and safety of guselkumab in patients who had previously taken TNFis but stopped because of inefficacy or intolerance, the researchers launched a randomized, double-blind study called COSMOS at 84 European sites from March 2019 to November 2020. The study’s 285 patients – 52% of whom were women, with an average overall age of 49 – were assigned to two groups: guselkumab (n = 189) or placebo (n = 96). A total of 88% of all patients had used one TNFi prior; 12% had used two.

The guselkumab group received 100-mg injections at week 0, week 4, and then every 8 weeks through week 44; the placebo group received injections at weeks 0, 4, 12, and 20, followed by 100 mg of guselkumab at weeks 24, 28, 36, and 44. Patients with less than 5% improvement from baseline in both tender and swollen joint counts at week 16 qualified for early escape to “initiate or increase the dose of one permitted concomitant medication up to the maximum allowed dose at the physician’s discretion.” Ultimately, 88% of patients in the guselkumab arm and 83% of the placebo arm completed the study.

At 24 weeks, more than 44% of the guselkumab group achieved a 20% or greater improvement in American College of Rheumatology criteria (ACR20), compared with just under 20% of the placebo group, a difference of nearly 25% (95% confidence interval, 14.1%-35.2%; multiplicity-adjusted P < .001). At 48 weeks, nearly 58% of the guselkumab group had achieved ACR20; of the 51 patients in the placebo arm who started taking guselkumab at week 24, 55% achieved ACR20 by week 48.

Through 24 weeks, 80 patients in the guselkumab group (42%) and 46 patients in the placebo group (48%) experienced adverse events; only 3.7% and 3.1% developed serious adverse events, respectively. The most common adverse events in the guselkumab group at that point included nasopharyngitis (5%) and upper respiratory tract infection (4%), which occurred at a similar frequency (5% and 3%) in the placebo group.

The authors acknowledge their study’s limitations, including imbalances in baseline characteristics such as gender and weight, as well as the COSMOS study being restricted to European patients and thus potentially limiting diversity. In addition, while the COVID-19 pandemic may have increased major protocol deviations near the end of the study, the authors note that “most were related to timing of study visits and did not impact efficacy.”

The study was funded by Janssen, and six authors reported being employees of the company. The authors also acknowledge numerous potential conflicts of interest, including receiving consulting fees and research grants from various pharmaceutical companies, including Janssen. Dr. Ruderman is a consultant for AbbVie, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer, and Janssen and served on the data safety monitoring committee for two other phase 3 guselkumab trials.

A version of this article first appeared on Medscape.com.

A new study has established guselkumab (Tremfya) as both a safe and effective treatment option for psoriatic arthritis (PsA) in patients who had previously responded poorly to tumor necrosis factor inhibitors (TNFis).

“While the positive guselkumab benefit-risk profile observed through week 24 was maintained through 1 year, real-world evidence will further inform long-term guselkumab persistence in TNFi-inadequate response patients,” writes Laura C. Coates, MBChB, PhD, of the University of Oxford (England), and her coauthors. The study was published in the Annals of the Rheumatic Diseases.

Previous studies indicated that the anti–interleukin-23p19 monoclonal antibody improved outcomes in patients with PsA, even after 1 year, but some uncertainty remained regarding the surprisingly similar level of effectiveness in biologic-naive and TNFi-treated patients. Guselkumab is approved for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and adults with active psoriatic arthritis.

Clarity on guselkumab’s effectiveness in certain patients

“In previous studies that cemented guselkumab as a treatment option for PsA, what was odd was that the results were pretty comparable,” Eric M. Ruderman, MD, professor of medicine and associate chief for clinical affairs in the division of rheumatology at Northwestern University in Chicago, Illinois, said in an interview. “We didn’t really have a sense of how well it worked in patients who had failed other biologics, which is where you might expect a drug with a new mechanism to be used when it comes into a particular disease category.

“Not surprisingly, in this study, the overall response rate was a little less than the response rate in the other two trials,” said Dr. Ruderman, who was not involved in the study. “You can’t really compare across studies, but it does fit with what we might expect: People who’ve previously failed a TNF inhibitor might be a little less likely to respond to guselkumab, compared to someone who hasn’t seen a TNF inhibitor.”

When asked about potential follow-up studies, Dr. Ruderman noted that “the missing piece of the puzzle is that we still really have no way to compare this to other biologics. The next step would be to ask, in a single trial, what happens if you give some people TNF inhibitors and some people guselkumab? Just to try to give us context. Is this equivalent? Is it less effective? More effective? Where does it fit? Without that information, rheumatologists may struggle to figure out who is the right person for this drug and how often should they use it.”

Study details

To assess the efficacy and safety of guselkumab in patients who had previously taken TNFis but stopped because of inefficacy or intolerance, the researchers launched a randomized, double-blind study called COSMOS at 84 European sites from March 2019 to November 2020. The study’s 285 patients – 52% of whom were women, with an average overall age of 49 – were assigned to two groups: guselkumab (n = 189) or placebo (n = 96). A total of 88% of all patients had used one TNFi prior; 12% had used two.

The guselkumab group received 100-mg injections at week 0, week 4, and then every 8 weeks through week 44; the placebo group received injections at weeks 0, 4, 12, and 20, followed by 100 mg of guselkumab at weeks 24, 28, 36, and 44. Patients with less than 5% improvement from baseline in both tender and swollen joint counts at week 16 qualified for early escape to “initiate or increase the dose of one permitted concomitant medication up to the maximum allowed dose at the physician’s discretion.” Ultimately, 88% of patients in the guselkumab arm and 83% of the placebo arm completed the study.

At 24 weeks, more than 44% of the guselkumab group achieved a 20% or greater improvement in American College of Rheumatology criteria (ACR20), compared with just under 20% of the placebo group, a difference of nearly 25% (95% confidence interval, 14.1%-35.2%; multiplicity-adjusted P < .001). At 48 weeks, nearly 58% of the guselkumab group had achieved ACR20; of the 51 patients in the placebo arm who started taking guselkumab at week 24, 55% achieved ACR20 by week 48.

Through 24 weeks, 80 patients in the guselkumab group (42%) and 46 patients in the placebo group (48%) experienced adverse events; only 3.7% and 3.1% developed serious adverse events, respectively. The most common adverse events in the guselkumab group at that point included nasopharyngitis (5%) and upper respiratory tract infection (4%), which occurred at a similar frequency (5% and 3%) in the placebo group.

The authors acknowledge their study’s limitations, including imbalances in baseline characteristics such as gender and weight, as well as the COSMOS study being restricted to European patients and thus potentially limiting diversity. In addition, while the COVID-19 pandemic may have increased major protocol deviations near the end of the study, the authors note that “most were related to timing of study visits and did not impact efficacy.”

The study was funded by Janssen, and six authors reported being employees of the company. The authors also acknowledge numerous potential conflicts of interest, including receiving consulting fees and research grants from various pharmaceutical companies, including Janssen. Dr. Ruderman is a consultant for AbbVie, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer, and Janssen and served on the data safety monitoring committee for two other phase 3 guselkumab trials.

A version of this article first appeared on Medscape.com.

A new study has established guselkumab (Tremfya) as both a safe and effective treatment option for psoriatic arthritis (PsA) in patients who had previously responded poorly to tumor necrosis factor inhibitors (TNFis).

“While the positive guselkumab benefit-risk profile observed through week 24 was maintained through 1 year, real-world evidence will further inform long-term guselkumab persistence in TNFi-inadequate response patients,” writes Laura C. Coates, MBChB, PhD, of the University of Oxford (England), and her coauthors. The study was published in the Annals of the Rheumatic Diseases.

Previous studies indicated that the anti–interleukin-23p19 monoclonal antibody improved outcomes in patients with PsA, even after 1 year, but some uncertainty remained regarding the surprisingly similar level of effectiveness in biologic-naive and TNFi-treated patients. Guselkumab is approved for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and adults with active psoriatic arthritis.

Clarity on guselkumab’s effectiveness in certain patients

“In previous studies that cemented guselkumab as a treatment option for PsA, what was odd was that the results were pretty comparable,” Eric M. Ruderman, MD, professor of medicine and associate chief for clinical affairs in the division of rheumatology at Northwestern University in Chicago, Illinois, said in an interview. “We didn’t really have a sense of how well it worked in patients who had failed other biologics, which is where you might expect a drug with a new mechanism to be used when it comes into a particular disease category.

“Not surprisingly, in this study, the overall response rate was a little less than the response rate in the other two trials,” said Dr. Ruderman, who was not involved in the study. “You can’t really compare across studies, but it does fit with what we might expect: People who’ve previously failed a TNF inhibitor might be a little less likely to respond to guselkumab, compared to someone who hasn’t seen a TNF inhibitor.”

When asked about potential follow-up studies, Dr. Ruderman noted that “the missing piece of the puzzle is that we still really have no way to compare this to other biologics. The next step would be to ask, in a single trial, what happens if you give some people TNF inhibitors and some people guselkumab? Just to try to give us context. Is this equivalent? Is it less effective? More effective? Where does it fit? Without that information, rheumatologists may struggle to figure out who is the right person for this drug and how often should they use it.”

Study details

To assess the efficacy and safety of guselkumab in patients who had previously taken TNFis but stopped because of inefficacy or intolerance, the researchers launched a randomized, double-blind study called COSMOS at 84 European sites from March 2019 to November 2020. The study’s 285 patients – 52% of whom were women, with an average overall age of 49 – were assigned to two groups: guselkumab (n = 189) or placebo (n = 96). A total of 88% of all patients had used one TNFi prior; 12% had used two.

The guselkumab group received 100-mg injections at week 0, week 4, and then every 8 weeks through week 44; the placebo group received injections at weeks 0, 4, 12, and 20, followed by 100 mg of guselkumab at weeks 24, 28, 36, and 44. Patients with less than 5% improvement from baseline in both tender and swollen joint counts at week 16 qualified for early escape to “initiate or increase the dose of one permitted concomitant medication up to the maximum allowed dose at the physician’s discretion.” Ultimately, 88% of patients in the guselkumab arm and 83% of the placebo arm completed the study.

At 24 weeks, more than 44% of the guselkumab group achieved a 20% or greater improvement in American College of Rheumatology criteria (ACR20), compared with just under 20% of the placebo group, a difference of nearly 25% (95% confidence interval, 14.1%-35.2%; multiplicity-adjusted P < .001). At 48 weeks, nearly 58% of the guselkumab group had achieved ACR20; of the 51 patients in the placebo arm who started taking guselkumab at week 24, 55% achieved ACR20 by week 48.

Through 24 weeks, 80 patients in the guselkumab group (42%) and 46 patients in the placebo group (48%) experienced adverse events; only 3.7% and 3.1% developed serious adverse events, respectively. The most common adverse events in the guselkumab group at that point included nasopharyngitis (5%) and upper respiratory tract infection (4%), which occurred at a similar frequency (5% and 3%) in the placebo group.

The authors acknowledge their study’s limitations, including imbalances in baseline characteristics such as gender and weight, as well as the COSMOS study being restricted to European patients and thus potentially limiting diversity. In addition, while the COVID-19 pandemic may have increased major protocol deviations near the end of the study, the authors note that “most were related to timing of study visits and did not impact efficacy.”

The study was funded by Janssen, and six authors reported being employees of the company. The authors also acknowledge numerous potential conflicts of interest, including receiving consulting fees and research grants from various pharmaceutical companies, including Janssen. Dr. Ruderman is a consultant for AbbVie, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer, and Janssen and served on the data safety monitoring committee for two other phase 3 guselkumab trials.

A version of this article first appeared on Medscape.com.

Key clinical point: Development of bacteremia in immunocompetent adult patients managed in the ICU for severe pneumococcal community-acquired pneumonia (CAP) had no effect on mortality.

Main finding: In-hospital mortality (21.5% vs. 16.9%; P = .11) or baseline variables associated with in-hospital death, such as the age ≥65 years (P interaction = .45) and bilateral pulmonary infection (P interaction = .77), were not significantly different between patients with and without bacteremia.

Study details: This was a post hoc analysis of the prospective STREPTOGENE study including 614 immunocompetent adult white patients admitted to an ICU for severe pneumococcal CAP. Of these, 270 patients had a positive blood culture for Streptococcus pneumoniae at admission.

Disclosures: The study was sponsored by 2 public health care and research agencies: the Assistance Publique Hôpitaux de Paris and Délégation à la Recherche Clinique et au Développement. None of the authors declared any conflict of interests.

Source: Bellut H et al. Ann Intensive Care. 2021;11:148 (Oct 24). Doi: 10.1186/s13613-021-00936-z.

Key clinical point: Development of bacteremia in immunocompetent adult patients managed in the ICU for severe pneumococcal community-acquired pneumonia (CAP) had no effect on mortality.

Main finding: In-hospital mortality (21.5% vs. 16.9%; P = .11) or baseline variables associated with in-hospital death, such as the age ≥65 years (P interaction = .45) and bilateral pulmonary infection (P interaction = .77), were not significantly different between patients with and without bacteremia.

Study details: This was a post hoc analysis of the prospective STREPTOGENE study including 614 immunocompetent adult white patients admitted to an ICU for severe pneumococcal CAP. Of these, 270 patients had a positive blood culture for Streptococcus pneumoniae at admission.

Disclosures: The study was sponsored by 2 public health care and research agencies: the Assistance Publique Hôpitaux de Paris and Délégation à la Recherche Clinique et au Développement. None of the authors declared any conflict of interests.

Source: Bellut H et al. Ann Intensive Care. 2021;11:148 (Oct 24). Doi: 10.1186/s13613-021-00936-z.

Key clinical point: Development of bacteremia in immunocompetent adult patients managed in the ICU for severe pneumococcal community-acquired pneumonia (CAP) had no effect on mortality.

Main finding: In-hospital mortality (21.5% vs. 16.9%; P = .11) or baseline variables associated with in-hospital death, such as the age ≥65 years (P interaction = .45) and bilateral pulmonary infection (P interaction = .77), were not significantly different between patients with and without bacteremia.

Study details: This was a post hoc analysis of the prospective STREPTOGENE study including 614 immunocompetent adult white patients admitted to an ICU for severe pneumococcal CAP. Of these, 270 patients had a positive blood culture for Streptococcus pneumoniae at admission.

Disclosures: The study was sponsored by 2 public health care and research agencies: the Assistance Publique Hôpitaux de Paris and Délégation à la Recherche Clinique et au Développement. None of the authors declared any conflict of interests.

Source: Bellut H et al. Ann Intensive Care. 2021;11:148 (Oct 24). Doi: 10.1186/s13613-021-00936-z.

Key clinical point: Pneumococcal urinary antigen testing (PUAT) effectuated early de-escalation of broad-spectrum antibiotics among positive patients with community-acquired pneumonia (CAP) and thus should be widely performed to substantiate antimicrobial stewardship interventions.

Main finding: PUAT-positive patients showed a significantly shorter median (interquartile range) time to de-escalation vs. PUAT-negative patients (1 [0-2] days vs. 1 [1-2] days; P = .01) and a higher atypical (azithromycin or doxycycline) coverage discontinuation rate within 24 hours of PUAT (61.3% vs. 47.2%; P = .026), with no significant difference in methicillin-resistant Staphylococcus aureus agent discontinuation (P = .610) or antipseudomonal de-escalation (P = .895).

Study details: The data come from a retrospective chart review study including 910 adult patients who were hospitalized for CAP and, as part of the diagnostic procedure, underwent PUAT, which returned a positive result in 121 patients.

Disclosures: The authors reported no financial support or conflict of interests.

Source: Greenfield A et al. Open Forum Infect Dis. 2021;ofab522 (Oct 22). Doi: 10.1093/ofid/ofab522.

Key clinical point: Pneumococcal urinary antigen testing (PUAT) effectuated early de-escalation of broad-spectrum antibiotics among positive patients with community-acquired pneumonia (CAP) and thus should be widely performed to substantiate antimicrobial stewardship interventions.

Main finding: PUAT-positive patients showed a significantly shorter median (interquartile range) time to de-escalation vs. PUAT-negative patients (1 [0-2] days vs. 1 [1-2] days; P = .01) and a higher atypical (azithromycin or doxycycline) coverage discontinuation rate within 24 hours of PUAT (61.3% vs. 47.2%; P = .026), with no significant difference in methicillin-resistant Staphylococcus aureus agent discontinuation (P = .610) or antipseudomonal de-escalation (P = .895).

Study details: The data come from a retrospective chart review study including 910 adult patients who were hospitalized for CAP and, as part of the diagnostic procedure, underwent PUAT, which returned a positive result in 121 patients.

Disclosures: The authors reported no financial support or conflict of interests.

Source: Greenfield A et al. Open Forum Infect Dis. 2021;ofab522 (Oct 22). Doi: 10.1093/ofid/ofab522.

Key clinical point: Pneumococcal urinary antigen testing (PUAT) effectuated early de-escalation of broad-spectrum antibiotics among positive patients with community-acquired pneumonia (CAP) and thus should be widely performed to substantiate antimicrobial stewardship interventions.

Main finding: PUAT-positive patients showed a significantly shorter median (interquartile range) time to de-escalation vs. PUAT-negative patients (1 [0-2] days vs. 1 [1-2] days; P = .01) and a higher atypical (azithromycin or doxycycline) coverage discontinuation rate within 24 hours of PUAT (61.3% vs. 47.2%; P = .026), with no significant difference in methicillin-resistant Staphylococcus aureus agent discontinuation (P = .610) or antipseudomonal de-escalation (P = .895).

Study details: The data come from a retrospective chart review study including 910 adult patients who were hospitalized for CAP and, as part of the diagnostic procedure, underwent PUAT, which returned a positive result in 121 patients.

Disclosures: The authors reported no financial support or conflict of interests.

Source: Greenfield A et al. Open Forum Infect Dis. 2021;ofab522 (Oct 22). Doi: 10.1093/ofid/ofab522.

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.