Aims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Methods: Time-to-event analysis for mean treatment duration (estimated as the Restricted Mean Survival Time), b/tsDMARD failure, and b/tsDMARDs switching was performed for 230 patients (n = 147 RA, 46 PsA, 37 AS) who commenced their first b/tsDMARD between 2008 and 2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of b/tsDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. Treatment retention data was compared to a historical analysis (2002–2008).Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third b/tsDMARDs across all patients (p = 0.46). When compared to RA patients, the risk of b/tsDMARD failure was halved in PsA patients [Hazard Ratio (HR) = 0.50], but no different in AS patients (HR = 1.0). The respective restricted mean (95%CI) treatment durations, estimated at 5 years of follow-up, were 3.1 (2.9, 3.4), 4.1 (3.7, 4.6), and 3.3 (2.8, 3.9) years, for RA, PsA, and AS, respectively. Age, gender, disease duration, smoking status and the use of concomitant csDMARDS were not associated with the risk of bDMARD failure. The most common reasons for switching in the first and subsequent years were secondary (n = 62) and primary (n = 35) failure. Comparison with historical data indicated no substantive differences in switching of the first biologic for RA and PsA.Conclusion: Similar retention rates of the second and third compared to the first b/tsDMARD in RA, PsA, and AS support a strategy of differential b/tsDMARDs use informed by patient presentation. Despite greater availability of b/tsDMARDs with differing mechanisms of action, retention rates of the first b/tsDMARD remain similar to previous years.

Purpose: The world health organization (WHO) in 2009 in their consensus recommendation on hand hygiene has suggested two formulations of hand sanitizers which are also the basis of main components of most commercial and medical grade hand sanitizers today.We evaluated the in vitro antimicrobial efficacy of ten different hand sanitizers (seven commercial including herbal (sanitizer 1, 2, 3, 4, 5, 9, and 10) and three of medical grade (sanitizers 6, 7 and 8). Method: The efficacy of hand sanitizers was checked against five ATCC strains: Staphylococcus aureus, Staphylococcus hemolyticus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis. Experiment was performed in three parts. The first part was performed in triplicate to see the zone of inhibition for each sanitizer. The second part was performed to see the duration of action of each hand sanitizer and third part (in triplicates) was performed to see the efficacy of active components individually (alcohol and disinfectant in different dilutions).Results: Sanitizers with ethanol and chlorhexidine as main ingredients (6 and 8) showed zone of inhibition for all tested gram positive and negative bacteria. Sanitizer 7 (propanol and mecetronium ethyl sulphate as main components) showed zone of inhibition for all tested bacteria except Pseudomonas aeruginosa. Other hand sanitizers did not show any zone of inhibition after incubation for 24 hours at 37oC. For second part hand sanitizer 6inhibited growth for all bacteria at all-time points (15, 30, 45 and60 seconds) and Sanitizer 8(ethanol and chlorhexidine as main components) showed growth inhibition only after 15seconds. Other hand sanitizers did not show any growth inhibition. For the third part, all dilutions of ethanol and propanol (60%, 70% and 80%) were unable to inhibit growth of any ATCC strain. Disinfectant 2.5v/v chlorhexidine was able to inhibit all five bacteria.0.2 gm mecetronium ethyl sulphate showed inhibition for all except Pseudomonas aeruginosa. Conclusion: Hand sanitizers with alcohol only as their main ingredient were unable to inhibit growth of ATCC strains. Hand sanitizers with both alcohol and disinfectant performed better .These findings preludes for further in vivo studies to validate 2009-WHO hand sanitizer preparations and suggest modifications.