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한국인 중등증 및 중증 건선 환자에서 Secukinumab과 Guselkumab 치료의 임상적 경험

A Real-life Experience of Secukinumab and Guselkumab in Korean Patients with Moderate to Severe Psoriasis

대한건선학회지 2020년 17권 2호 p.32 ~ 37
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Abstract


Background: The use of biologics to treat psoriasis has been increased dramatically. A considerable disease period often precedes the initiation of biologics and patients are treated with variable modalities during this period. However, there is a lack of nationwide studies examining treatment patterns before starting biologics.

Objective: We investigated treatment patterns until the initiation of biologics in psoriasis patients.

Methods: We conducted a retrospective cohort study using the National Health Insurance System Claims Database of Korean from January 1, 2008 to December 31, 2017, including psoriasis patients who were naive to biologic agents [ustekinumab (UST), TNF-α inhibitor (TNFi): adalimumab, etanercept, infliximab]. We analyzed the systemic agents (acitretin, cyclosporine, methotrexate) and phototherapy prescription patterns until the initiation of biologics.

Results: Among 527 patients, 6.1% (n=32) had psoriatic arthritis [UST: n=9(3.3%), TNFi: n=23(9.1%)]. In UST users (n=295), cyclosporine was prescribed more than methotrexate(76.4%, 41.3% in ever users, p<0.05), while in TNFi users (n=252), methotrexate was prescribed more than cyclosporine (77.4%, 48.4% in ever users, p<0.05). Medication patterns were as follows: monotherapy (50.5%), dual-therapy (32.6%), and triple-therapy (16.9%). TNFi users had higher median cumulative dose (0.33g) and longer duration (31 weeks) of methotrexate than UST users (0.17g, 19 weeks). The cumulative doses of methotrexate were as follows: <1 g (88.4%), 1~2 g (8.5%), 2~3 g (2.1%), and ≥3 g (0.9%). The durations of cyclosporine were as follows: <6 months (52.5%), 6~12 months (22.9%), 1~2 years (13.7%) and ≥2 years (10.8%). Ninety-two patients (17.5%) underwent phototherapy and all of them had used systemic agents. The median duration of total treatment including systemic agents and phototherapy before starting biologics was 41.5 weeks.

Conclusion: Most were treated with appropriate doses and durations of systemic agents and phototherapy, but some were treated with more than those of recommended guidelines. There is no consensus about the appropriate treatment duration before starting biologics. Therefore, it is needed to consider the proper transition period for the severe patients who require rapid disease control.

키워드

Guselkumab; Psoriasis; Safety; Secukinumab

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