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항 Tumor Necrosis Factor 제제 사용 전 잠복결핵 진단 전략에 따른 결핵 발생률
성윤경 ( Yoon Kyoung Sung ),조수경 ( Soo Kyung Cho ),원소영 ( Soyoung Won ),최찬범 ( Chan Bum Choi ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.4
Objective. To compare the incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients using tumor necrosis factor (TNF) inhibitors following two strategies for latent tuberculosis infection (LTBI) screening: Tuberculin skin test (TST) only vs. TST plus Qauntiferron-TB gold in tube (QFT-GIT). Methods. Data was extracted from a retrospective cohort of Korean RA patients who used biologic agents. Of the 406 RA patients who underwent TST before starting TNF inhibitor, we selected 355 patients who strictly followed LTBI screening and treatment strategies. Two hundred and twenty-two patients were classified as TST only group and the remaining 133 patients as TST plus QFT-GIT group. We calculated the standardized incidence ratio of TB in the entire sample and compared the TB incidence between groups. Results. Among the patients who received the TST only strategy (n=222, 538.6 person-year [PY]), two patients developed TB during anti-TNF therapy, while of those who followed the TST plus QFT-GIT strategy, none developed TB (n=133, 108.8 PY). The overall crude incidence of TB in RA patients using TNF inhibitors was 314 per 100,000 PY. Compared with the general population, the overall age standardized incidence of TB in TNF inhibitor users who followed management guideline for LTBI was 3.9. Conclusion. Despite following screening and management guidelines for LTBI, TB incidence for RA patients during anti-TNF therapy is higher than in the general population. Combining QFT-GIT with TST as a screening for LTBI might be reduce the risk of TB. (J Rheum Dis 2015;22:223- 230)
한국인 류마티스 관절염 환자에 대한 에토리콕시브 90 mg 안전성 및 유효성
성윤경 ( Yoon Kyoung Sung ),고은미 ( Eun Mi Koh ),박원 ( Won Park ),이수곤 ( So Kon Lee ),이지수 ( Ji Soo Lee ),김철준 ( Chul Joon Kim ),박영주 ( Young Joo Park ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4
Objective: To assess the efficacy and the safety of etoricoxib 90 mg daily administered to Korean patients for the treatment of rheumatoid arthritis over a 12-week period. Methods: Eighty-nine patients diagnosed with rheumatoid arthritis were administered Etoricoxib 90 mg for 12 weeks. Tender Joint Count (total 68 joints), Swollen Joint Count (total 66 joints), Patient Global Assessment of Disease Activity, and Investigator Global Assessment of Disease Activity were assessed as primary endpoints. Patient Global Assessment of Pain, Health Assessment of Questionnaire (HAQ: disability scales), Patient Global Assessment of Response to Therapy, Investigator Global Assessment of Response to Therapy, and Duration of Morning Stiffness were assessed as secondary endpoints. Those endpoints were assessed at week 2, 4, 8, and 12. Safety was evaluated by physical examination, serum chemistry, blood count, urinalysis, and occurrence of adverse events. Results: Etoricoxib 90 mg showed significant effects compared to baseline, thus the result indicated etoricoxib was clinically effective. Etoricoxib 90 mg showed significant improvement in all efficacy endpoints (primary endpoints and secondary endpoints). Treatment effects for etoricoxib 90 mg were approximately a 7.3 (95% CI 5.8 8.9, P<0.0001) joint reduction in the number of tender joints, 4.8 (95% CI 3.6 6.0, P<0.0001) joint reduction in the number of swollen joints, a 15.4 (95% Cl 12.1 18.7, p<0.0001) mm improvement in the patient global assessment (100 mm VAS) and 1.3 (95% Cl 1.1 1.6, p<0.0001) unit improvement in the investigator global assessment (0 to 4 Likert scale). Treatment effects were observed at the earliest time point of measurement and were maintained over time during the 12-week period. Drug-related clinical adverse events were reported by 22 (24.7%) of 89 safety evaluable subjects. Eight patients discontinued the drug due to clinical adverse events. Frequency of drug-related laboratory abnormalities was low with 2 (2.2%). Nobody discontinued due to laboratory abnormalities. Conclusion: (1) Etoricoxib 90 mg once daily was clinically effective for the treatment of rheumatoid arthritis in Korea patients. (2) Etoricoxib 90 mg once daily administered to patients with rheumatoid arthritis was generally safe and well tolerated.
한국인에서 EQ-5D를 이용한 건강 관련 삶의 질 측정
성상석 ( Sang Seokg Seong ),최찬범 ( Chan Bum Choi ),성윤경 ( Yoon Kyoung Sung ),박용욱 ( Yong Wook Park ),이혜순 ( Hae Soon Lee ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Whan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),이오 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3
Objective: There has been no data on health related quality of life (HRQOL) in general Korean population. Assessing factors affecting HRQOL in Koreans is fundamental in HRQOL research. The objective of this study is to assess HRQOL in Korean using Korean version of EQ-5D (KEQ-5D). Methods: HRQOL was assessed using KEQ-5D from 1,044 randomly selected population representing general Korean population with telephone interview Result: The mean KEQ-5D utility score in Korean was 0.88 (range: -0.59∼1.00). Sociodemographic data showed relatively higher score in male, younger, well educated, higher income, and white color people. Among a variety of diseases, gastric ulcer/gastritis, arthritis, hypertension diabetes, low back pain were common in Korea. The most significant chronic diseases influencing Koreans were gastrointestinal disorder and arthritis. Conclusion: This paper suggests basic information on HRQOL in Korean and can be a useful parameter in comparison in the future research.
이상구 ( Sang Koo Lee ),나영인 ( Young In Na ),장세민 ( Se Min Jang ),백승삼 ( Seung Sam Paik ),성윤경 ( Yoon Kyoung Sung ),전재범 ( Jae Bum Jun ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.2
Objective: To induce a mouse model of scleroderma with repeated bleomycin injections for research into human scleroderma at our research laboratory. Methods: The protocol of Yamamoto et al. was replicated to establish the bleomycin-induced mouse model of scleroderma. Results: A mouse model of scleroderma was induced by repeated subcutaneous injections of bleomycin. The dermal thickness increased with homogeneous and thickened collagen bundles. Semiquantitative measurements of dermal fibrosis were prominent in bleomycin-treated mice. Conclusion: A mouse model of scleroderma was induced with repeated injections of bleomycin at our laboratory.
Health Assessment Questionnaire (HAQ)을 이용한 EuroQol (EQ5D) 추정의 타당성
조수경 ( Soo Kyung Cho ),성윤경 ( Yoon Kyoung Sung ),이혜선 ( Hye Seon Lee ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.3
Objective: Assessment of health-related quality of life in patients with rheumatoid arthritis (RA) has become important in health research. Health economists have used linear regression equations to mathematically transform changes in HAQ scores into EQ5D data, which can be used to calculate quality adjusted life years (QALYs). We aimed to examine whether a given approach is justified. Methods: A total of 223 patients with RA were recruited from the Hospital for Rheumatic Diseases at Hanyang University. They completed the HAQ and EQ5D and a correlation analysis was performed between the two instruments. We compared HAQ and EQ5D score changes for patients who completed the EQ5D and HAQ at first and second visits (n=159). Predicted EQ5D was estimated from the HAQ using the calculating method of Bansnack et al. The mean difference between the predicted EQ5D from the HAQ and observed health utility score at the first visit and change during the study were tested by the paired t-test. Results: In the cross-sectional study, EQ5D scores were moderately inversely correlated with HAQ (r=-0.716, p<0.001). However, the predicted EQ5D from the HAQ was significantly different from the observed EQ5D (p=0.001; 95% confidence interval [CI] 0.020∼0.079). The change in EQ5D was also inversely correlated with the change in the HAQ (r=-0.615, p<0.001), and change in the predicted EQ5D scores corresponded well with changes in observed health utility scores (p=0.155; 95% CI (-0.0873∼0.0140). Conclusion: Changes in predicted EQ5D corresponded with observer changes in EQ5D, suggesting that it may be better to use predicted EQ5D form HAQ to identify change in the quality of life.
치료 불응성 루푸스 신염 환자에 대한 Rituximab 치료
염지연 ( Ji Youn Youm ),성윤경 ( Yoon Kyoung Sung ),엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4
Objective: To determine preliminary evidence for the safety and efficacy of B lymphocyte depletion therapy in refractory systemic lupus erythematosus (SLE). Methods: Four female lupus nephritis patients who had been refractory to steroid and one or more immunosuppressive therapy were treated on an open-label basis. During a 4-week period, each patient received two 500-mg infusions of rituximab and two 750-mg infusions of cyclophosphamide. Results: Patient 1, 2, and 3 were responded with rituximab treatment with improvements in SLEDAI and laboratory parameters such as C3/C4 and 24 hour urine protein. However, patient 4 had not improved with rituximab. The variation in the level of anti-double-stranded DNA antibody was different in individual patients. No significant adverse events were observed during follow-up. Conclusion: This study provides an evidence for the safety and possible efficacy of B lymphocyte depletion therapy in refractory lupus nephritis. However a further randomized trial is needed to confirm the efficacy and durability of remission.
김담 ( Dam Kim ),성윤경 ( Yoon-kyoung Sung ) 대한내과학회 2016 대한내과학회지 Vol.91 No.3
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammation. There are two kinds of NSAID classified according to the selectivity of COX-2 inhibition: non-selective NSAIDs and cyclooxygenase (COX)-2 inhibitors. Non-selective NSAIDs have a high incidence of gastrointestinal and bleeding-associated adverse events, while COX-2 inhibitors are safer in terms of these events. However, COX-2 inhibitors are thought to cause increased cardiovascular events. The COX-2 inhibitors rofecoxib and valdecoxib were withdrawn from the market over safety concerns. Three COX-2 inhibitors are now available in South Korea after the recent approval of etoricoxib and polmacoxib for osteoarthritis patients. After reviewing the history of and recent studies about the safety of COX-2 inhibitors, physicians should find new uses for old drugs. (Korean J Med 2016;91:250-256)
류마티스관절염에서 DAS28에 근거한 보험급여기준 적용시 항 TNF제제 대상 환자 예측
원소영 ( Soyoung Won ),성윤경 ( Yoon-Kyoung Sung ),조수경 ( Soo-Kyung Cho ),최찬범 ( Chan-Bum Choi ),고은미 ( Eun-Mi Koh ),김성규 ( Seong-Kyu Kim ),김진석 ( Jinseok Kim ),김태환 ( Tae-Hwan Kim ),김현아 ( Hyoun Ah Kim ),나성수 ( Se 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.2
Objective. The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria. Methods. Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement. Results. Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP). Conclusion. Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.