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( Dong Hyek Jang ),( Seok Jae Heo ),( Hyung Don Kook ),( Dong Heon Lee ),( Hye Jung Jung ),( Mi Yeon Park ),( Jiyoung Ahn ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.-
Background: In a previous study, we reported short term effectiveness and safety of dupilumab in Korean atopic patients Objectives: To report the long-term effectiveness and safety of dupilumab in Korea Methods: Ninety-nine patients with moderate to severe AD treated with dupilumab for 52 weeks were included and analyzed. They were evaluated using Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) at baseline, week 16, 32 and 52. Laboratory assessments were also performed at same visits. Results: Efficacy outcomes showed higher improvement at 52 weeks compared with 16 weeks; with high percentual reductions in EASI (88.1 %), peak pruritus NRS (65.6 %), POEM (67.2 %), and DLQI (69.0 %) compared to baseline. Proportion of patients achieving EASI 75 and 90 were 90.2 % and 53.7 %. There was a significant decrease in immunoglobulin E (IgE), total eosinophil count and Lactate dehydrogenase (LDH) levels. POEM and DLQI had a high correlation with clinical measured outcomes. In the analysis for the factors affecting the response of treatment about achieving EASI 90, female gender (OR 2.5), eosinophilia (OR 0.2) and elevated LDH (OR 0.07) were significantly associated. Most frequent adverse events included facial erythema (19.2 %) and conjunctivitis (17.2 %). Conclusion: Dupilumab treatment for 52 weeks in Korean patients with moderate-to-severe AD confirmed long term effectiveness and safety in real-world.
A case of discoid lupus erythematosus showing the clinical features of lupus erythematosus tumidus
( Dong Hyek Jang ),( Jae In Lee ),( Joo Yoon Bae ),( Hong Lim Kim ),( Ji Young Ahn ),( Mi Youn Park ),( Hye Jung Jung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Discoid Lupus Erythematosus(DLE) shows well demarcated, erythematous macules or indurated plaques. Its early active lesion is erythematous, but this will change atrophic and scarring. On the other hand, Lupus Erythematosus Tumidus(LET) shows edematous and urticarial-like plaques on the face or trunk. It tends to resolve completely without either scarring or atrophy. Most patients with LET have a negative ANA and histologically, there is no basement membrane thickening and epidermal change in LET. These are different from that of DLE. A 45-year-old male visited our clinic because of multiple edematous or depressed erythematous round plaques on face, neck and upper chest. These lesions started 6-7 years ago, and have relapsed wax and wane. He had no symptoms such as pain and pruritus. Laboratory tests showed positive ANA(1:40). Histologic examination revealed hyperkeratosis and marked vaculolar degeneration in epidermal basal layer and perivascular periadnexal lymphohistiocytic infiltration. Mucin deposition was observed by alcian blue stain. It was proper to diagnose DLE because this case showed some scarring or atrophic lesions, positive ANA in laboratory tests, and changes at the dermal-epidermal junction in histologic finding. Herein we report an unusual case of DLE showing the clinical features of LET.
( Dong Hyek Jang ),( Seok Jae Heo ),( Hyung Don Kook ),( Dong Heon Lee ),( Hye Jung Jung ),( Mi Yeon Park ),( Jiyoung Ahn ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.1
Background: In a previous study, we reported short term effectiveness and safety of dupilumab in Korean atopic patients Objectives: To report the long-term effectiveness and safety of dupilumab in Korea Methods: Ninety-nine patients with moderate to severe AD treated with dupilumab for 52 weeks were included and analyzed. They were evaluated using Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) at baseline, week 16, 32 and 52. Laboratory assessments were also performed at same visits. Results: Efficacy outcomes showed higher improvement at 52 weeks compared with 16 weeks; with high percentual reductions in EASI (88.1 %), peak pruritus NRS (65.6 %), POEM (67.2 %), and DLQI (69.0 %) compared to baseline. Proportion of patients achieving EASI 75 and 90 were 90.2 % and 53.7 %. There was a significant decrease in immunoglobulin E (IgE), total eosinophil count and Lactate dehydrogenase (LDH) levels. POEM and DLQI had a high correlation with clinical measured outcomes. In the analysis for the factors affecting the response of treatment about achieving EASI 90, female gender (OR 2.5), eosinophilia (OR 0.2) and elevated LDH (OR 0.07) were significantly associated. Most frequent adverse events included facial erythema (19.2 %) and conjunctivitis (17.2 %). Conclusion: Dupilumab treatment for 52 weeks in Korean patients with moderate-to-severe AD confirmed long term effectiveness and safety in real-world.
Improvement of lichen amyloidosis after the treatment of anti-IL-4R alpha monoclonal antibody
( Dong Hyek Jang ),( Jae In Lee ),( Joo Yoon Bae ),( Hye Jung Jung ),( Mi Youn Park ),( Ji Young Ahn ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Lichen Amyloidosis (LA) is primary localized cutaneous amyloidosis, presenting pruritic, hyperkeratotic brown papules on the extensor surface. The association between AD and LA is thought to be close in previous studies. The anti-IL-4R alpha monoclonal antibody (Dupilumab) was approved for use in the treatment of adults with moderate to severe AD in Korea. Dupilumab is an receptor antagonist binding to the alpha subunit of the interleukin-4 receptor (IL-4R alpha). Through binding to IL-4R alpha, dupilumab inhibits signaling of both IL-4 and IL-13, the representative Th2 biomarkers. In addition to the treatment effects for AD during the treatment, we will introduce the unexpected effect of improving Lichen Amyloidosis. A thirty seven-year old male patient presented our clinic with generalized erythema, lichenification and flake as manifestation of AD, evaluated as EASI 16.2 and pruritus NRS 10. In addition to atopic lesions, lichen amyloidosis was observed on the legs. At 2 weeks after the initial administration of Dupilumab, systemic atopic lesions improved attaining EASI 50 and pruritus decreased to NRS 2. Furthermore, lichen amyloidosis lesions seen on the legs also showed marked improvement. Dupilumab is an emerging therapeutic agent for AD, and treatment cases are increasing in Korea. Herein, we report the unexpected effect of improving Lichen Amyloidosis in the treatment of Dupilumab, besides the treatment effect of AD.
( Dong Hyek Jang ),( Jae In Lee ),( Joo Yoon Bae ),( Hye Jung Jung ),( Mi Youn Park ),( Ji Young Ahn ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Dupilumab is an receptor antagonist binding to the alpha subunit of the interleukin-4 receptor (IL-4R alpha). Through binding to IL-4R alpha, dupilumab inhibits signaling of both IL-4 and IL-13, the representative Th2 biomarkers. In addition to the treatment effects for AD during the treatment, we will introduce the case of unexpected effect as a facial erythema. A twenty seven-year old female patient developed erythema and flake on the face and neck after Dupilumab administration, and symptoms gradually improved after a week. She had AD on wholebody before the treatment, and her face and neck were clear at that time. Dupilumab was administered by the intervals of two weeks and atopic lesions of the body have improved from the beginning of the treatment. Meanwhile, the severity of erythema and flake of the face and neck decreased gradually. The blood test results showed elevation of both ANA and anti-phospholipid antibodies. There was no specific findings in patch and interdermal test. A rheumatologist suspected the possibilitiy of SLE. Herein, we report the facial erythema during the treatment of Dupilumab in suspicious of SLE patient.
Treatment of moderate to severe atopic dermatitis with Dupilumab: real world practice in Korea
( Dong Hyek Jang ),( Seok Jae Heo ),( Hye-jung Jung ),( Mi-youn Park ),( Seong-jun Seo ),( Ji Young Ahn ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2
Background: Among biological agents for treatment of Atopic dermatitis (AD), Dupilumab is emerging agent. To date, many studies have been conducted on the real world use of Dupilumab. However, sample size is often small and data on western people are the main ones. Objectives: To investigate efficacy of Dupilumab by the treatment to the patients with moderate to severe AD in Korea Methods: All patients with moderate to severe AD treated with Dupilumab from September 2018 to June 2019 in this institution were included and analyzed by medical records. They were evaluated by the means of EASI, NRS, POEM, and DLQI, respectively on admission, after 2 weeks (only EASI and NRS) and after 16 weeks. Laboratory test were measured before and 16 weeks after treatment. Results: A total of 101 patients were included. EASI, NRS, POEM, and DLQI all showed statistically significant decrease after 16 weeks. In laboratory test, high eosinophil count was related to lower change in EASI and POEM. In correlation analysis, EASI was not correlated to DLQI before treatment. For changes after 16 weeks, POEM showed the highest correlation with DLQI. In additional analysis, female gender was associated with good treatment response. (Odds ratio 5.4, p=0.04) Conclusion: We suggest that POEM is useful tool for identifying the quality of life and high eosinophil count may be related to poor treatment response. Further research will be need for long-term period.
The real world practice of dupilumab in korea
( Dong Hyek Jang ),( Jae In Lee ),( Joo Yoon Bae ),( Hye Jung Jung ),( Mi Youn Park ),( Ji Young Ahn ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Atopic dermatitis has several pathologies, among which immune dysregulation can be caused by mainly T helper 2 type cytokines, IL-4 and IL-13. Dupilumab binds to a common unit of IL-4 and IL-13 receptors, simultaneously suppressing both signaling. The efficacy and characteristics of Dupilumab will be investigated, by the treatment of Dupilumab to the patients with atopic dermatitis in Korea. Patients with moderate to severe atopic dermatitis who visited our clinic, were evaluated by the means of EASI (Eczema Area and Severity Index), NRS (Numerical Rating Scale), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI), respectively on admission, after first injection and after 16 weeks. The mean EASI was 32.2 for the first visit. After first injection of Dupilumab, average of improvement was 42.7% in EASI. At 16 th week after the treatment of Dupilumab, among 23 patients of 55 patients, completed 16 weeks schedule, EASI, NRS, POEM, and DLQI showed 73.4%, 70.6%, 55.2 % and 58.9% of averaged improvement, respectively. Dupilumab showed improvement in all indexes. EASI was most sensitive responder according to the treatment. No specific adverse effects were seen in the treatment of Dupilumab, no conjunctivitis was seen, contrast to existing research. Long term follow up will be needed in real world.