Over five-year analysis of ustekinumab therapy for moderate to severe psoriasis in Korea

( Yeona Kim ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jung-soo Lee ),( Kihyuk Shin ),( Kyunghyung Seo ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Bong Seok Shin ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Ustekinumab is a humanized monoclonal antibody that targets the interleukin (IL)-12 and IL-23. Although this drug is widely used, data on long-term efficacy and safety in Korean patients with psoriasis have been limited. Objectives: To evaluate the long-term efficacy and safety of ustekinumab in Korean patients with psoriasis. Methods: A retrospective study of patients with moderate to severe psoriasis, who have been treated with ustekinumab for at least 5 years was conducted. All patients’ sex, age, body mass index (BMI), medical records, previous psoriasis therapy, Psoriasis Area and Severity Index (PASI) score and adverse event were evaluated. Results: Twenty-five patients (median age 47.0) had been treated with ustekinumab for over 5 years. Among them, the mean duration of psoriasis was 19.12 ± 8.45 years. The treatment duration of ustekinumab was 285.12 ± 8.48 weeks. Baseline PASI was 17.52 ± 7.37. PASI 75 was achieved by 92% of patients at week 28 and 96% of patients maintained PASI 75 during 5-year follow up period. Further, 64% of patients reached PASI 90 at 28 weeks, and 48% of patients maintained PASI 90 for 5 years. No unexpected adverse events were reported other than herpes zoster, herpes simplex, and elevated liver enzyme. Conclusion: Ustekinumab demonstrated long-lasting efficacy with an acceptable safety profile in Korean patients with moderate to severe psoriasis.

Is there a change in the usage of complementary and alternative medicine among Koreans with psoriasis after development of biologics?

( Yeona Kim ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jung-soo Lee ),( Kihyuk Shin ),( Kyunghyung Seo ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Jun Young Kim ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Patients with long standing psoriasis who have failed with conventional medicine seek for complementary and alternative medicine (CAM). Biologic revolution in the field of psoriasis since late 2000s has progressed expecting 90%-100% clearance of disease. The frequency and type associated with usage of CAM may have changed after these advances. Objectives: To investigate the change with the use of CAM in Korean psoriasis patients before and after the development of biologics. Methods: From March to June 2020, patients with psoriasis who visited the Pusan National University Hospitals (Busan and Yangsan) filled out a face-to-face structured questionnaire. These results were compared with the results from our previous study done approximately 10 years ago. Results: A total 207 patients were included. Compared with the previous result, the frequency of using of CAM (67.63%) were increased (p<0.0001). Oriental medicine (45.41%) was still been most commonly used, followed by health supplements and bath therapy. The biggest reason for using of CAM was 'to try all potential treatments'. Meanwhile, negative concern about the conventional medicine (13.53%) was significantly decreased (p<0.0001). Conclusion: Although the efficacy of conventional therapies has been increased after the development biologics, CAM usage tends to be more prevalent among Korean psoriasis patients. Therefore dermatologist should recognize the use of CAM to better empathize with their psoriasis patients.

Real world data on efficacy and safety of ixekizumab for the treatment of moderate to severe psoriasis in Korea

( Sang-hyeon Won ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jungsoo Lee ),( Kihyuk Shin ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Kyunghyung Seo ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Ixekizumab is a humanized IgG4 monoclonal antibody that selectively binds to the IL-17A cytokine and inhibits its interaction with the IL-17 receptor. It has emerged as an effective treatment for moderate to severe psoriasis. However, to date, there are no real-world data for the use of ixekizumab in the treatment of psoriasis in Korean patients. Objectives: To evaluate the effectiveness and safety of ixekizumab in the treatment of moderate to severe psoriasis in Korean patients. Methods: Thirty patients who were treated with ixekizumab were analyzed. All patients’ medical records, Psoriasis Area and Severity Index (PASI) score, body surface area (BSA), Physicians’ Global Assessment (PGA), and adverse events were investigated. Results: A significant reduction in mean baseline PASI score (14.1±2.6) was detected at 4 weeks of ixekizumab therapy (3.8±2.7), with a further improvement at weeks 12 and 24 (0.9±0.7 and 0.5±0.5, respectively). Our analysis showed that 100%, 87.5%, and 50% of patients achieved PASI 75, 90, and 100 responses, respectively, after 48 weeks of therapy. However, nine patients (30%) experienced a mild adverse event such as injection site reaction, urticaria, upper respiratory tract infection, and stomatitis. Conclusion: This study provides evidence for the use of ixekizumab in real-world clinical practice and confirm that it is effective and safe in treating Korean patients with moderate to severe psoriasis.

Switching biologics for the treatment of psoriasis : A retrospective case review

( Jun-oh Shin ),( Bong Seok Shin ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jungsoo Lee ),( Kihyuk Shin ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Kyunghyung Seo ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: It has become common in clinical practice to switch to subsequent biologics in patients with poor response or adverse events to the first biologics. Objectives: To assess the reasons and effectiveness of switching biologic agents during the treatment of psoriasis. Methods: We retrospectively reviewed all psoriasis patients who were treated with biologics in Pusan National University Hospital (Busan and Yangsan) and Chosun University Hospital from March 2012 to June 2020. Demographics and treatment characteristics (reasons for switching biologics and efficacy of the first and second biologics) were assessed for the study. Results: Of 162 psoriatic patients treated with biologic agents for more than 52 weeks, 35 patients required a switch to another biologic agent. First-line biologic agents were ustekinumab (n=91), secukinumab (n=59), adalimumab (n=12), and second-line agents were secukinumab (n=12), ixekizumab (n=9), guselkumab (n=14). The reasons for switching biologic agents were inefficacy (n=29), adverse events (n=2), and others (n=4). The mean Psoriasis Area and Severity Index (PASI) score was 12.0 at the start of the second biologics, and 3.0 at 14-16 weeks after the start of the second biologics. Conclusion: The most common reason to discontinue biologics was inefficacy. Switching to a different biologic agent may improve clinical outcomes for patients who do not sufficiently respond to the first one.

Biologic-resistant areas in Korean patients with moderate to severe psoriasis

( Sang-hyeon Won ),( Bong Seok Shin ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jungsoo Lee ),( Kihyuk Shin ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Kyunghyung Seo ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Psoriasis in certain body sites such as palmoplantar, nail, scalp and intertriginous areas has been known to be difficult to treat. However, to date, there have been no studies for biologic-resistant areas in patients with moderate to severe psoriasis in Korea. Objectives: To investigate the body location of treatment-resistant psoriasis in Korean patients treated with biologic agents. Methods: We included fifty biologic-resistant patients with moderate to severe psoriasis treated for > 6 months in Pusan National University Hospitals(Busan and Yangsan) and Chosun University Hospital. All patients’ medical records, Psoriasis Area and Severity Index (PASI) score, the location of treatment-resistant psoriasis were investigated. Results: The mean age of the patients was 47.8±11 years, and 32 patients (64%) were male. The median PASI score (interquartile range) at treatment initiation was 15 (12.2-18.1), and current PASI score was 1.8 (1.4-2.8). The median PASI reduction from treatment initiation was 87.9% (81.3-92). The most common site of recalcitrant psoriasis was the anterior lower leg (56%) followed by the knee (48%), posterior lower leg (42%), scalp (38%), and back (34%). Conclusion: In real-world clinical practice, the most common sites of recalcitrant psoriasis in Korean patients treated with biologic agents are the anterior lower leg, knee, and posterior lower leg.