BackgroundUstekinumab is a fully human monoclonal antibody approved for the treatment of chronic moderate-to-severe plaque psoriasis in adults. However, factors including efficacy, tolerability, ease of use, and cost burden may affect ustekinumab utilization. Noncompliance may, in turn, affect treatment response.ObjectiveTo evaluate ustekinumab utilization in the real-world setting in Asia-Pacific countries.MethodsIn this phase 4 observational study conducted in Indonesia, Malaysia, Singapore, Korea, and Taiwan, adults with plaque psoriasis receiving ustekinumab were followed for up to 52 weeks. Study endpoints were the proportion of all patients using ustekinumab according to label-recommended intervals and the proportion of Korean patients who achieved a psoriasis area severity index 75 response at week 16. Safety was assessed by monitoring adverse events.ResultsOverall, 169 patients received ustekinumab (Korea, n=102; other countries, n=67). Just over half (56.2%) of patients used ustekinumab with the label-recommended interval from baseline to week 40; the proportion was higher in Korea (73.5%) than in other countries (29.9%), probably because ustekinumab was provided without charge for Korean patients up to week 40. Noncompliance increased after week 40 in Korea and from week 28 in other Asia-Pacific countries, with cost cited as the most common reason. At week 16, 56.9% of Korean patients achieved a Psoriasis Area Severity Index 75 response. Safety results were in line with those seen in previous studies.ConclusionMore than half of all patients in Asia-Pacific countries used ustekinumab as per the label-recommended dose interval, but reimbursement variations between countries may have confounded overall results.
The route of transmission of leprosy is still unclear. Multiple opinions exist regarding the environmental dissemination of Mycobacterium leprae (M. leprae). This research aims to identify the positive proportion of M. leprae deoxyribonucleic acid (DNA) on skin lesion surface of untreated multibacillary leprosy patients by polymerase chain reaction (PCR), and its association with the examination result of acid-fast bacilli (AFB) in epidermis, pilosebaceous unit, and sweat glands. The M. leprae DNA sample was taken from smears of the skin lesion surface by using PCR and the skin biopsy test was done to detect AFB in epidermis, pilosebaceous unit, and sweat glands. From 28 subjects, there was 82.1% positive proportion of M. leprae DNA on the skin lesion surface of untreated multibacillary leprosy patients, where all were found in the lepromatous leprosy and borderline leprosy type. The result of AFB was positive in epidermis (71.4%), pilosebaceous unit (46.4%) and sweat glands (53.6%). We found M. leprae by using PCR technique on skin lesion surface of untreated multibacillary leprosy patients, and its route which most likely was through the epidermis.
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