Effect of alirocumab on lipids and lipoproteins in individuals with metabolic syndrome without diabetes: Pooled data from 10 phase 3 trials.

AimsThis analysis assessed the efficacy and safety of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in patients with or without metabolic syndrome (MetS) using pooled data from 10 phase 3 ODYSSEY trials.Materials and methodsData from 4983 randomized patients (1940 with MetS; 1642 with diabetes excluded) were assessed in subgroups by MetS status. Efficacy data were analysed in 4 pools per study design: 2 placebo-controlled pools (1 using alirocumab 150 mg every 2 weeks [Q2W], 1 using 75/150 mg Q2W) with background statin, and 2 ezetimibe-controlled pools (both alirocumab 75/150 mg Q2W), 1 with and 1 without background statin. Alirocumab 75/150 mg indicates possible dose increase from 75 to 150 mg at Week 12 based on Week 8 LDL-C.ResultsLDL-C percentage reduction from baseline at Week 24 with alirocumab was 63.9% (MetS) and 56.8% (non-MetS) in the pool of alirocumab 150 mg Q2W, and 42.2% to 52.2% (MetS) and 45.0% to 52.6% (non-MetS) in 3 pools using 75/150 mg Q2W. Levels of other lipid and lipoprotein parameters were also improved with alirocumab treatment, including apolipoprotein B, non-high-density lipoprotein cholesterol (non-HDL-C), lipoprotein(a) and HDL-C. Overall, the percentage change at Week 24 in LDL-C and other lipids and lipoproteins did not vary by MetS status. Adverse event rates were generally similar between treatment groups, regardless of MetS status; injection-site reactions occurred more frequently in alirocumab vs control groups.ConclusionsAcross study pools, alirocumab-associated reductions in LDL-C, apolipoprotein B, and non-HDL-C were significant vs control, and did not vary by MetS status

Bacterial Biofilms in Drinking Water Systems: Protecting Patient Health at the Alberta Children’s Hospital

When we hear of bacterial contaminated drinking water, we generally think of microscopic organisms swimming freely throughout the system. Although bacteria are found in this free living form, or planktonically, the majority of microorganisms in natural environments are in fact found growing on a surface. These surface adhered bacteria are called biofilms and can be found anywhere, ranging from implanted medical devices to drinking water pipes. Drinking water system operators use the multiple barrier approach to ensure the microbiological safety of the water. The approach includes primary treatment of the source water with chlorine or UV light; secondary chlorine treatment throughout distribution systems; and routine testing for indicator organisms, such as Escherichia coli. Thus, the presence of indicator organisms signifies that there has been a failure in the treatment process or a contamination in the water system. Regardless of chemical or irradiation treatment, normal flora biofilms continue to grow in these systems. It is theorized that these resident flora biofilms may incorporate and shield pathogenic organisms from chlorine disinfection. The Alberta Children’s Hospital (ACH) water system has a unique design, engineered to reduce bacterial contamination and biofilm growth. This project, done in collaboration with Alberta Health Services and the ACH, aims to evaluate bacterial survival after exposure to low levels of chlorine. It is hypothesized that the chlorine levels maintained in our water systems for secondary treatment may be insufficient to disinfect biofilm growth. Eight isolates were obtained directly from chlorinated water systems, including the ACH. These isolates were tested both planktonically and as biofilms, grown using the Calgary Biofilm Device, under a range of chlorine concentrations. Minimum inhibitory concentration (MIC) and minimum biofilm eradication concentration (MBEC) assays have shown that biofilms can be 2-20 times more resistant to chlorine disinfection when compared to their more vulnerable planktonic counterparts