Majid Ezzati and colleagues report the findings of a systematic review and meta-analysis that probes the association between environmental exposure to secondhand smoke and the epidemiology of pediatric invasive bacterial disease.

Moderate changes in consumption of sugar-sweetened soda over a 2-year period were associated with corresponding changes in weight and waist circumference among Mexican women.

Outbreaks of wound botulism are rare, but clinicians and health departments should maintain suspicion for signs, symptoms, and risk factors of wound botulism among persons who inject drugs in order to initiate treatment quickly. This report describes an outbreak of three wound botulism cases among persons in two adjacent counties who injected drugs. Provisional information about these cases was previously published in the CDC National Botulism Surveillance Summary. All three cases in this outbreak were laboratory-confirmed, including one case with detection of botulinum toxin type A in a wound culture sample taken 43 days after last possible heroin exposure. Findings highlight the delay in diagnosis which led to prolonged hospitalization and the persistence of botulinum toxin in one patient.

Background:RA is more responsive to treatment in the early stages of disease, and early treatment may lead to better long-term outcomes.1,2 Data on the effectiveness of specific drugs as first or later lines of therapy will help inform treatment sequencing.Objectives:Data from patients enrolled in the Corrona RA Registry were used to compare the effectiveness of abatacept across lines of therapy overall (primary cohort) and in a subset of patients who were anti-citrullinated protein antibody positive (ACPA+).Methods:Patients with RA who initiated abatacept (January 2006 to October 2020), had 6 months’ follow-up (within 4−9 months of starting abatacept), had baseline (BL) and follow-up CDAI scores available, and had BL CDAI >2.8 were included. Outcomes were compared for first-, second- and third or higher-line therapy: 0, 1 or ≥2 prior biologic DMARDs or Janus kinase inhibitors, respectively. Continuous outcomes included change from BL to 6 months in mean CDAI and patient-reported pain, fatigue, and HAQ. Binary outcomes included rate of achieving minimal clinically important difference (MCID) in CDAI or modified ACR20/50/70 at 6 months. Continuous and binary outcomes were analysed using multiple linear and logistic regression, respectively. The models included line of therapy, age, sex, disease duration, work status, SC nodules, history of hypertension and depression, BL CDAI, BL patient-reported pain and BL fatigue. Additional subgroup analyses were carried out in patients with moderate/high disease activity (CDAI >10) at BL.Results:In total, 2876 patients (2327 with BL CDAI >10; 890 ACPA+) were included; 442, 911, and 1523 patients initiated first-, second- or third/higher-line abatacept, respectively. Compared with patients on second/third/higher-line abatacept therapy, those on first-line abatacept were significantly older, had shorter disease duration, and had lower BL CDAI, pain and fatigue (all p<0.001). In adjusted analyses, patients receiving abatacept as earlier lines of therapy had significantly greater improvement from BL in mean CDAI and in patient-reported fatigue and HAQ (Table 1). There was no significant difference between lines of therapy in change in patient-reported pain. Patients receiving first-line abatacept had significantly higher odds of achieving a MCID in CDAI or modified ACR20/50/70 response (Figure 1). Similar patterns were seen when the sample was limited to patients with moderate/high disease activity or in patients who were ACPA+.Conclusion:There were significant differences in improvement in clinical disease activity and patient-reported outcomes across lines of therapy. Better treatment responses were observed with earlier lines of abatacept therapy in the overall population, in patients who were ACPA+ and in those with moderate/high BL disease activity.References:[1]Harrold LR, et al. Clin Rheumatol 2017;36:1215−1220.[2]Monti S, et al. RMD Open 2015;1(Suppl 1):e000057.Table 1.Adjusted mean change in CDAI and patient-reported outcomes from BL to 6 months after initiation of abatacept by line of therapy (primary cohort)Adjusted outcome, mean change (SE)First-line (n=440)Second-line (n=898)Third/higher-line (n=1515)p valueaCDAI−7.96 (0.33)−7.49 (0.27)−5.74 (0.19)<0.001Patient-reported pain (VAS 0–100)−9.43 (0.69)−7.98 (0.47)−7.70 (0.35)0.074Patient-reported fatigue (VAS 0–100)−7.49 (0.71)−5.87 (0.51)−4.81 (0.36)0.002Patient-reported HAQ−0.16 (0.01)−0.12 (0.01)−0.08 (0.01)<0.001aEstimated by multiple linear regression model adjusted for age, sex, disease duration, work status, SC nodules, history of hypertension and depression, BL CDAI, BL patient-reported pain and BL fatigue (factors that were identified a priori based on clinical experience or that differed significantly by line of therapy); p values reflect ANOVA overall test of differences across lines of therapy.VAS=visual analogue scale.Acknowledgements:Professional medical writing and editorial assistance was provided by Claire Line, PhD, at Caudex and was funded by Bristol Myers Squibb. The poster was a collaborative effort between Corrona and Bristol Myers Squibb, with financial support provided by Bristol Myers Squibb. This study was sponsored by Corrona, LLC. Corrona is supported through contracted subscriptions with multiple pharmaceutical companies.Disclosure of Interests:Leslie Harrold Consultant of: AbbVie, Bristol Myers Squibb, Genentech/Roche, Grant/research support from: Pfizer, Keith Wittstock Employee of: Bristol Myers Squibb, Sheila Kelly Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sang Hee Park Employee of: Bristol Myers Squibb, Xue Han Employee of: Bristol Myers Squibb, Ying Shan: None declared, Carla Roberts-Toler: None declared, Nicole Middaugh: None declared, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb