ABSTRACT
Pembrolizumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death (PD)-1 receptor. Although it has a dramatic effect on the treatment of advanced malignancies, instability of immune tolerance may cause immune-related adverse events in the skin. A 62-year-old male with a history of metastatic urothelial carcinoma was referred to the dermatology department and presented with a widespread mucocutaneous rash. Itching appeared 7 days after the first administration of pembrolizumab, and on the third day after the second administration, an erythematous maculopapular rash that coalesced into large flaccid bullae on the whole body with a positive Nikolsky’s sign developed. A biopsy revealed a subepidermal bulla with basal keratinocyte necrosis. Pembrolizumab was discontinued due to the diagnosis of toxic epidermal necrolysis (TEN), and intravenous methylprednisolone was started. Herein, we report a case of TEN induced by pembrolizumab to highlight immune-related cutaneous adverse events in patients receiving anti-PD-1 therapy.
ABSTRACT
Background@#Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. @*Objective@#We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. @*Methods@#This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. @*Results@#Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). @*Conclusion@#This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.
ABSTRACT
Background@#Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. @*Objective@#We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. @*Methods@#This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. @*Results@#Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). @*Conclusion@#This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.
ABSTRACT
The purpose of this study was to measure the transmittance change of composites during light curing in real time according to different shades and thicknesses. An instrument using pulse width modulation-curing light was developed to measure the transmittance of composites in real time. A micro-hybrid composite, Filtek Z250, was used for %transmittance measurement with five different shades (A1, A2, A3, A3.5, A4) and 4 different thicknesses (0.16, 0.5, 1.0, 1.5 mm). The maximum value of d(%Transmittance)/dt and peak time were used to observe polymerization kinetics. Attenuation coefficient was also compared between pre and post cured specimens. The transmittance increased in all specimens after polymerization. A2 showed the highest and A1 showed the lowest transmittance in both pre and post curing. The transmittance change and maximum rate of change were highest in A2 and lowest in A3.5, and the peak time, which ranged in 3.10 to 4.07, was not significantly different among shades. As the specimen became thinner, both the transmittance and rate of change increased, and the peak time was maximum at 1.5 mm thickness. The absolute value of attenuation coefficient decreased after polymerization in all specimens. In conclusion, the transmittance of composite increased after polymerization. Each shade showed different transmittance value for both pre and post curing state, and thinner specimen showed higher transmittance value. Polymerization kinetics could also be observed through the rate of transmittance change over time.
ABSTRACT
The purpose of this study was to measure the transmittance change of composites during light curing in real time according to different shades and thicknesses. An instrument using pulse width modulation-curing light was developed to measure the transmittance of composites in real time. A micro-hybrid composite, Filtek Z250, was used for %transmittance measurement with five different shades (A1, A2, A3, A3.5, A4) and 4 different thicknesses (0.16, 0.5, 1.0, 1.5 mm). The maximum value of d(%Transmittance)/dt and peak time were used to observe polymerization kinetics. Attenuation coefficient was also compared between pre and post cured specimens. The transmittance increased in all specimens after polymerization. A2 showed the highest and A1 showed the lowest transmittance in both pre and post curing. The transmittance change and maximum rate of change were highest in A2 and lowest in A3.5, and the peak time, which ranged in 3.10 to 4.07, was not significantly different among shades. As the specimen became thinner, both the transmittance and rate of change increased, and the peak time was maximum at 1.5 mm thickness. The absolute value of attenuation coefficient decreased after polymerization in all specimens. In conclusion, the transmittance of composite increased after polymerization. Each shade showed different transmittance value for both pre and post curing state, and thinner specimen showed higher transmittance value. Polymerization kinetics could also be observed through the rate of transmittance change over time.