Optimizing treatment strategies in psoriasis: targeting the IL-23/12 pathway

( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Psoriasis is an immune-mediated inflammatory disease that affects 0.5%-4% of the population according to ethnicity. Over the past decade, research into the immunopathogenesis of psoriasis, including investigations into the role of tumor necrosis factor-alpha and more recently interleukins (IL) 12/23, has led to the advent of targeted biologic therapies based on the central role of a new subset of T cells, Th17. Because of their increased specificity, biologic agents have revolutionized short- to medium-term treatment outcomes and safety profiles for moderate to severe disease over previously gold standard systemic agents. The immunopathogenesis of the disease is still a focus for researchers and novel targets for future agents are being discovered and investigated in clinical trials. In particular, specifically targeting the IL-23/Th17 pathway has given rise to IL-23p19 and IL-17 antagonists, both of which have shown significant promise in clinical trials. Interleukin (IL)-23 is a heterodimeric cytokine composed of a distinct p19 subunit and a p40 subunit, which it shares with IL-12. The aim of this presentation is to bring to light new data demonstrating clinical efficacy of targeting IL-23/12 pathway. Although current IL-12/23p40 inhibitors have shown good efficacy and safety, data regarding the functional role of IL-12 in immune defense suggest that preserving this cytokine would be beneficial. To date, evidence from mouse models and preliminary data in human beings show that specifically targeting IL-23p19 may be a safer but equally efficacious treatment option.

Symposium 7: Photomedicine

( Yong Beom Choe ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Best time to Leave and time to stay with topical therapy

( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.1

Usefulness of the Psoriatic Arthritis Screening and Evaluation Questionnaire to Monitor Disease Activity in Management of Patients with Psoriasis: Findings from the EPI-PSODE Study

( Yong Beom Choe ),( Chul Jong Park ),( Dae Young Yu ),( Youngdoe Kim ),( Hyun Jeong Ju ),( Sang Woong Youn ),( Joo-Heung Lee ),( Byung Soo Kim ),( Seong Jun Seo ),( Seok-Kweon Yun ),( Joonsoo Park ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.1

Background: Psoriasis and psoriatic arthritis (PsA) are included in the group of immune-mediated inflammatory diseases (IMIDs) caused by systemic inflammation; however, indicators for monitoring inflammatory activity in patients with psoriasis, such as the Psoriasis Area and Severity Index (PASI), are limited. Objective: To determine whether the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire can be used to monitor disease activity in patients with psoriasis. Methods: This was a multicenter, noninterventional, cross-sectional study. Demographic factors and PASI and PASE scores were collected to investigate associations between each. Results: PASE data were available for 1,255 patients, of whom 498 (39.7%) had a score of ≥37. Compared with the group with PASE score <37, the group with score ≥37 had a higher proportion of women (34.9% vs. 48.8%, p<0.0001), older mean age at diagnosis (36.4 vs. 41.7 years, p<0.0001), more severe disease activity using PASI and body surface area measures (p=0.0021 and p=0.0008, respectively), and higher mean body mass index (23.7 vs. 24.1, p=0.0411). In a multiple linear regression model, PASE score was positively associated with cutaneous disease activity (p<0.0001). Conclusion: After risk-adjustment, PASE was positively associated with PASI, which suggests that PASE can be sensitive to disease activity. Since psoriasis is regarded as one of the IMIDs, PASE may be utilized as a tool not only to screen PsA but also to monitor disease activity. (Ann Dermatol 31(1) 29∼36, 2019)

Sun protection -Dermatologists` perspective

( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.1

Calcipotriol-PUVA 복합요법에 의한 건선의 치료

최용범(Yong Beom Choe),박석범(Seok Beom Park),윤재일(Jai Il Youn) 대한피부과학회 2000 대한피부과학회지 Vol.38 No.6

Background:PUVA photochemotherapy has been accepted as an effective treatment modality in the treatment of psoriasis. Many combination therapies have been tried to reduce the long-term side effects of UV radiation. Objective:We performed conventional PUVA and calcipotriol-PUVA combination therapy to compare the effectiveness between two treatment modalities. Methods:We treated 38 Korean patients with conventional PUVA and 54 with D-PUVA. We compared the total number, duration and total UVA dose of PUVA therapy to reach grade 4 between two groups. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, and evaluated PASI score at patient`s visits. Results:The irradiation number and total cumulative dose of D-PUVA phototherapy to achieve grade 4 were significantly smaller than PUVA phototherapy. Conclusion:Combining PUVA with a vitamin D analogue, calcipotriol, in the treatment of psoriasis may lead to lowering the risk of long-term exposure to UV radiation with higher efficacy. (Korean J Dermatol 2000;38(6):772~776)

IFN-alpha and plasmacytoid dendritic cells in psoriasis(초)

최용범 ( Yong Beom Choe ) 대한피부과학회 2010 초록집 Vol.48 No.10

Integrating phototherapy in clinic-based practice

최용범 ( Yong Beom Choe ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). A variety of protocols for BB-UVB, NB-UVB, and PUVA have been used in clinical trials. Nothing to say, NB-UVB is more effective than BB-UVB and safer than PUVA. That`s why NB-UVB phototherapy is considered the first-line treatment for plaque type psoriasis. In this topic, we will discuss mainly NB-UVB phototherapy. NB-UVB phototherapy at a wavelength of 311 nm was first proven effective, safe, and cost beneficial in the early-1990`s and became available in Korea in the late 1990`s. Typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months. Treatment must be independently developed to suit each participant`s needs. NB-UVB phototherapy is equivalent or nearly equivalent to PUVA without the inconvenience and toxicity of psoralen. An increased skin cancer risk occurs after prolonged phototherapy with PUVA; however, the same risk of carcinogenesis has not been established with either BB-UVB or NB-UVB. Moreover, many studies have demonstrated the superiority of NB-UVB to BB-UVB including studies with right- and left-sided controls on the same individual. NB-UVB may be used in almost any patient regardless of comorbidity, including children and pregnant women. NB-UVB is particularly effective in the treatment of psoriasis because the wavelength of treatment (311 nm) falls within the optimal treatment range for psoriasis, as originally determined by Parrish and Jaenicke. The variables of treatment, including starting dose, increments of treatment, and irradiation frequency, have been much debated, with various combinations making up specific NB-UVB treatment regimens. NBUVB has been used in combination with topical or systemic anti-psoriatic agents as well as biological agents. Presumably, combination therapy has practical benefits: rapid response to treatment and cumulative dose of either drug used in combination is reduced thus effectively reducing the side-effects of both. However, combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety. The purpose of this lecture is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for psoriasis care.

UV and its practical use in the clinics

최용범 ( Yong-beom Choe ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Phototherapy is a mainstay in the treatment of various dermatoses such as psoriasis, atopic dermatitis, vitiligo, progressive macular hypomelanosis, pruritus and chronic eczematous diseases. NBUVB has been found to be a comparatively effective and relatively safer alternative to PUVA in more than two decades of use in the management of psoriasis and vitiligo. As a result PUVA is not popular and replaced with NBUVB in most dermatologic clinics. Following is focused on NBUVB phototherapy in real clinical practice. The optimum phototherapy regimen is to achieve a complete cure of disease with a minimum number of exposures, a low cumulative UV dose and with least possible acute as well as chronic side effects. What should be the initial dose of exposure, how frequently should a patient be exposed to phototherapy, what should be the percentage increase in the UV dose in every subsequent visit, what should be the maximum dose a patient should be subjected to and what if somebody develops adverse effects of NBUVB? Although answers to these riddles are still evolving over the years, these aspects of NBUVB phototherapy have largely been addressed. We are well aware of the difference of erythema and pigmentary response after ultraviolet irradiation according to skin color and expect that optimal protocol is different depending on skin phototype. Unfortunately, these studies have been performed mainly on fair-skinned people. However, field experience for more than 15 years and some data on the skin reaction caused by ultraviolet radiation from dark skinned people, we could barely discuss optimal regimen for NBUVB phototherapy with dark skinned people. The purpose of this talk is to provide some practical guidance to general dermatologists on the specifics of using phototherapy which remains one of our most safe and effective treatment strategies for various dermatoses.

Phototherapy in clinic

최용범 ( Yong Beom Choe ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2