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From articles published in Kosin Medical Journal (2020 ~ ).

Original articles
Comparison of the radiation dose between dual-acquisition coronary computed tomography angiography and coronary angiography for coronary spasm
Soo-Jin Kim, Moo Hyun Kim, Eun-Ju Kang
Kosin Med J. 2022;37(1):46-51.   Published online March 16, 2022
DOI: https://doi.org/10.7180/kmj.21.035
Funded: Bayer Co
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Coronary computed tomography angiography (CCTA) is an imaging technique that can be used to evaluate and diagnose coronary artery stenosis. Dual-acquisition CCTA (DA-CCTA) with additional nitrate infusion is a promising alternative noninvasive diagnostic tool, as conventional CCTA has limitations in the diagnosis of variant angina compared to conventional angiographic coronary spasm tests. However, DA-CCTA may pose a potential risk due to radiation exposure. We compared the radiation dose between DA-CCTA and the coronary angiographic spasm provocation test.
Methods
Patients with clinically suspected variant angina at a single hospital between March 2013 and October 2018 were screened and underwent DA-CCTA or a coronary angiographic spasm provocation test. The effective radiation dose required for each approach was compared.
Results
In total, 211 suspected variant angina patients underwent DA-CCTA or the coronary angiographic spasm provocation test. Of these, 49 patients (mean age, 59.8 years; 67.3% men) received DA-CCTA and 162 patients (mean age, 60.5 years; 66.2% men) received a coronary angiographic spasm provocation test. There was a significant difference in the effective radiation dose, with a median dose of 5.1 mSv (interquartile range [IQR], 4.1–9.2 mSv) required for DA-CCTA and a median dose of 10.9 mSv (IQR, 8.4–15.2 mSv) for the coronary angiographic spasm provocation test (p<0.001).
Conclusion
DA-CCTA showed a significantly lower effective radiation dose than the coronary angiographic spasm provocation test required to diagnose variant angina.
Transcriptome analysis of the pathogenic ciliate Miamiensis avidus after hydrogen peroxide treatment
Hyunsu Kim, A-Reum Lee, Kyung-Yoon Jeon, Eun-Ji Ko, Hee-Jae Cha, Mee Sun Ock
Kosin Med J. 2022;37(1):52-60.   Published online March 11, 2022
DOI: https://doi.org/10.7180/kmj.21.040
Funded: National Research Foundation of Korea, Ministry of Education
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
The scuticociliate Miamiensis avidus is a highly pathogenic ciliate responsible for serious damage to various organs of aquaculture fish. In particular, the olive flounder aquaculture industry is suffering massive losses due to M. avidus infection. Hydrogen peroxide (H2O2) is one of the most widely used chemicals for scuticociliate treatment. Despite the superior killing effect of H2O2, studies on transcription levels and gene expression changes after H2O2 treatment are limited. We conducted an mRNA transcriptome analysis to compare the expressed gene (DEG) profiles between the ciliate and cyst-like stages of M. avidus after H2O2 treatment.
Methods
We applied differentially expressed gene profiling to identify DEGs during the ciliate and cyst-like stages of M. avidus.
Results
There were 5,967 DEGs among the 9,075 transcripts identified, and 50 of these DEGs were significantly different (p<0.05). Among these, 21 DEGs were upregulated and 29 were downregulated in the cyst-like stage. The most significantly upregulated genes during the change to the cyst-like stage were cytochrome c oxidase genes. Genes related to the calcium channel were also highly upregulated.
Conclusion
The significant upregulation of cytochrome c gene expression and cytosolic calcium ion channel-related gene expression after H2O2 treatment suggests that ciliate mortality occurred through apoptosis. The formation of the cyst-like stage is considered a temporary form during the process of apoptosis. Information on the gene expression profile of M. avidus in response to H2O2 is expected to contribute to the understanding of the mechanism of action of therapeutic agents against this pathogen.
Case report
Metastatic ameloblastoma with postoperative accelerated tumor growth treated with carboplatin and paclitaxel: a case report
Joo Un Park, Jae Wan Jung
Kosin Med J. 2022;37(1):83-88.   Published online March 23, 2022
DOI: https://doi.org/10.7180/kmj.21.030
Funded: Wonkwang University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Ameloblastoma is a histologically benign odontogenic epithelial tumor that rarely metastasizes. However, metastasis to the lungs can occur, usually years after the development of the primary tumor. Here, we present the case of a 63-year-old woman with metastatic ameloblastoma in the lungs that developed 12 years after surgery for the primary lesion. As is typical for metastatic ameloblastomas, the tumor was incidentally found on radiography and surgically removed. However, the tumor exhibited accelerated progression with pleural metastasis after surgical removal, which is unusual in metastatic ameloblastoma. The patient was successfully treated with carboplatin/paclitaxel and showed a partial response to tumor progression, implying that this approach can be safely used in the absence of a standard treatment regimen.
Original Articles
Observational Study for Adverse Effects and Discontinuation with Long-Term Post-Operative Hormonal Treatment for Endometriosis in Real-World Practice
In Hye Kim, Hyungjoon Yoon, Hyun Joo Lee, Hye Kyung Noh, Jong Kil Joo, Ki Hyung Kim
Kosin Med J. 2021;36(2):116-124.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.116
Funded: Pusan National University Hospital
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

To evaluate the side effects and causes of discontinuation of either combined oral contraceptives or dienogest (DNG) used to prevent recurrence in patients with surgically confirmed endometriosis.

Methods

We retrospectively analyzed the medical records of 213 women with endometriosis who had been treated with combined oral contraceptives (ethinyl estradiol 0.02 mg/drospirenone 3 mg [EE/DRSP]) or DNG 2 mg for 12 months or more. The side effects reported by the patients, laboratory parameters, causes of discontinuation of medication, and recurrence rates were evaluated one, two, three, four, and five years after starting medication (Y1, Y2, Y3, Y4, and Y5).

Results

EE/DRSP were administered to 59 patients, while DNG was administered to 154 patients. The mean durations of postoperative use of EE/DRSP and DNG were 44.5 ± 22.6 months and 23.6 ± 13.5 months, respectively. The prevalence of side effects was 27.1%, 19.0%, 10.0%, 10.5%, and 7.4% in the EE/DRSP group and 29.2%, 15.7%, 14.0%, 23.1%, and 0.0% in the DNG group at Y1, Y2, Y3, Y4, and Y5, respectively. The discontinuation rates were 1.7%, 1.7%, 4.0%, 0.0%, and 7.4% at Y1, Y2, Y3, Y4, and Y5, respectively, in the EE/DRSP group and 10.4%, 3.3%, 4.0%, 3.8%, and 0.0% at the same times in the DNG group. The recurrence rates were less than 4% in both the groups.

Conclusions

The side effects of commonly prescribed postoperative hormone treatments were relatively mild, and the occurrence of side effects decreased with continuous administration. Further, the long-term use of postoperative hormone treatments is likely to prevent recurrence of endometriosis after surgery.

Association of Weight Change and Physical Activity with Knee Pain and Health-Related Quality of Life in East Asian Women Aged 50 Years and Older with Knee Osteoarthritis: A Population-Based Study
Chong Bum Chang, Young Choi, Seung Baik Kang, Chin Youb Chung, Moon Seok Park, Kyoung Min Lee
Kosin Med J. 2021;36(2):125-135.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.125
Funded: Seoul National University Hospital
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data.

Methods

A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five-dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m2).

Results

In the whole group, the level of knee pain was significantly associated with K-L grade (P < 0.001), and EQ-5D was negatively associated with age (P < 0.001), the level of knee pain (P < 0.001), and weekly hours of vigorous-intensity activity (P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m2 < BMI ≤ 27.5 kg/m2 (P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m2 (P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m2.

Conclusions

The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.

Case Reports
Spontaneous Disappearance of Unruptured Intracranial Aneurysm: A Case Report
Sang Hoon Jeong, Jung Hwan Lee, Tae Hong Lee, Chang Hwa Choi
Kosin Med J. 2021;36(2):148-152.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.148
Funded: Pusan National University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Spontaneous resolution or thrombosis of giant or ruptured intracranial aneurysms is occasionally reported. However, spontaneous resolution of unruptured aneurysms without any intervention is extremely rare. Recently, we encountered a case of spontaneous resolution of a small unruptured aneurysm of the anterior communicating artery. We describe this rare case and discuss the mechanism of resolution with a review of the related literature.

The Importance of Lamina Size Measurement and Proper Implants Selection before Laminoplasty : Two Case Reports
Dong Hwan Kim, Su Hun Lee, Dong Ha Kim, Kyoung Hyup Nam, In Ho Han, Byung Kwan Choi
Kosin Med J. 2021;36(2):169-174.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.169
Funded: Pusan National University Hospital
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Open door laminoplasty using plates is a safe and effective procedure for multi-level cord compression. To achieve stable laminar arch, various types of plate have been developed and used. Now, we introduce two rare complications related to the laminar shelf of plate.

In the first case, we used the wider laminar shelf plate because the elevated lamina did not fit well into the usual laminar shelf. During follow-up, cord compression due to laminar shelf was observed.

And in the second case, the laminar shelf of plate did not fit into the elevated lamina, so we inserted it with a little bit of force. But the patient’s symptom was not improved. On CT image, the inner cortical bone of the lamina was fractured.

To prevent these complications, surgeons need to consider the thickness of the lamina and the size of the laminar shelf before surgery.

Removal of Large Urinary Stone Using Percutaneous Nephrolithotomy in a Patient with Crohn’s Disease
Young Joo Park, Dong Hoon Baek, Young Min Kwak, Yong Bo Park, Dong Chan Joo, Tae Kyung Ha, Da Mi Kim, Geun Am Song
Kosin Med J. 2021;36(2):180-186.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.180
Funded: Pusan National University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD) is approximately 36%. Of genitourinary complications as an EIM of Crohn’s disease (CD), nephrolithiasis is the most common urinary complication in patients with CD. CD patients have been shown to have decreased urinary volume, pH, magnesium, and excretion of citrate, all of which are significant risk factors for nephrolithiasis. Genitourinary complications often occur in case of a severe longstanding disease and are associated with, the activity of bowel disease, especially in those who have undergone bowel surgery. As uncontrolled nephrolithiasis could impair renal function as well as adversely affect quality of life, proper monitoring, early detection, and prevention of the occurrence of urologic complications in CD is crucial. Few data are available about urolithiasis in patients with CD. Herein we report a case of a successful removal of a 2.7 cm calcium oxalate stone using percutaneous nephrolithotomy from a patient with long-standing CD with a previous surgery for small intestinal and colonic stricture.

Review Article
The Roles of Human Endogenous Retroviruses (HERVs) in Inflammation
Eun-Ji Ko, Hee-Jae Cha
Kosin Med J. 2021;36(2):69-78.   Published online December 31, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.2.69
Funded: National Research Foundation of Korea
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Human endogenous retroviruses (HERVs) are ancient, currently inactive, and non-infectious due to recombination, deletions, and mutations in the host genome. However, HERV-derived elements are involved in physiological phenomena including inflammatory response. In recent studies, HERV-derived elements were involved directly in various inflammatory diseases including autoimmune diseases such as rheumatoid arthritis (RA), multiple sclerosis, amyotrophic lateral sclerosis (ALS), and Sjogren’s syndrome. Regarding the involvement of HERV-derived elements in inflammation, two possible mechanisms have been proposed. First, HERV-derived elements cause nonspecific innate immune processes. Second, HERV-derived RNA or proteins might stimulate selective signaling mechanisms. However, it is unknown how silent HERV elements are activated in the inflammatory response and what factors and signaling mechanisms are involved with HERV-derived elements. In this review, we introduce HERV-related autoimmune diseases and propose the possible action mechanisms of HERV-derived elements in the inflammatory response at the molecular level.

Original Articles
Antinociceptive Effect of BPC-157 in the Formalin-induced Pain Model
Sang Yoong Park, So Ron Choi, Jeong Ho Kim, Seung Cheol Lee, Seong Yeop Jeong, Joon Ho Jeong, Tae Young Lee
Kosin Med J. 2021;36(1):1-13.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.1
Funded: Dong-A University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry.

Methods

Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining.

Results

BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues.

Conclusions

BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.

Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes
Ki Hyun Kim, Yoon Hong Kim, Kyung Won Seo, Ki Young Yoon, Yeon Myeong Shin, Young Sik Choi, Bu Kyung Kim
Kosin Med J. 2021;36(1):25-33.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.25
Funded: Kosin Society of Metabolic and Obesity Surgery
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer.

Methods

A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC).

Results

The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery.

Conclusions

Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Case Reports
Idiopathic Intracranial Hypertension following Ventriculoperitoneal Shunt Malfunction in Infant Hydrocephalus
Sangjun Ahn, Jae Meen Lee, Young Mi Kim, Hyeshin Jeon, Chang Hwa Choi
Kosin Med J. 2021;36(1):44-50.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.44
Funded: Pusan National University Hospital
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial pressure without any abnormal findings. In the present study, we report a rare case of IIH in a patient after ventriculoperitoneal shunt (VPS) due to infant hydrocephalus. A 13-year-old girl with a history of VPS due to infant hydrocephalus was admitted to emergency room with the complaint of severe headache and visual disturbance. Brain computed tomography showed normal findings. However, based on the measurement by lumbar puncture, her cerebrospinal fluid (CSF) pressure was observed to be very high. The shunt function test revealed a VPS malfunction. Thus, we conducted VPS revision in this patient. All symptoms improved immediately after the revision. Thus, it is proposed that IIH should be considered for patients with visual disturbance and severe headache after VPS due to infant hydrocephalus without ventriculomegaly.

Unusual Magnetic Resonance Imaging Findings Contrast-induced Encephalopathy following Cerebral Angiography
Won Ho Cho, Jung Hwan Lee, Tae Hong Lee, Chang Hwa Choi, Jun Kyeung Ko
Kosin Med J. 2021;36(1):51-55.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.51
Funded: Pusan National University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Contrast-induced encephalopathy (CIE) following cerebral angiography has similar clinical presentations to ischemic complications of cerebral angiography. Neurologic deficits in CIE are mostly transient, but those caused by acute cerebral infarction (ACI) as ischemic complications of cerebral angiography may be permanent. Therefore, distinguishing CIE from ACI is important. Diffusion restriction on magnetic resonance imaging (MRI) implies ACI, while hyperintensity on diffusion weighted imaging (DWI) without correlation on the apparent diffusion coefficient (ADC) map implies CIE. We reported a rare case of CIE with diffusion restriction on MRI following cerebral angiography that mimicked MRI findings of ACI. The mechanism of this phenomenon remains unknown and requires further investigation.

Original Articles
Therapeutic Effects of Prolonged Release Melatonin (Circadin®) in Patients with Overactive Bladder and Chronic Insomnia in More Than 55 Years Old
Min Jung Park, Seon Young Seo, Hyun Jun Park, Jih Hoon Park, Mi Young Lim, Nam Cheol Park
Kosin Med J. 2020;35(2):101-113.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.101
Funded: Pusan National University
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Bladder storage symptoms including nocturia is the most common cause of sleep disturbance in all age groups. Sleep disturbance is also a main cause of nocturia so that sleep recovery can clinically improve nocturia. Melatonin has main action to induce sleep and additional effects of smooth muscle relaxation, free radical scavenging, anti-inflammation, et cetera. This study was evaluated the improvement of sleep quality after administrating prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia.

Methods

This clinical trial was performed with a randomized single open study. Thirty-seven patients with overactive bladder and chronic insomnia were initially enrolled in this study. After 4 or 12 weeks treating with 2 mg of prolonged-release melatonin, clinical outcomes were evaluated with OABSS, IPSS, PSQI and WHO 5 well-being index.

Results

Of the 37 patients, 34 (91.9%) were included in the ITT group and 26 (76.5%) in the PP group. In the primary outcome of PP group, significant improvements were observed in total OABSS and nocturia frequencies at 12 weeks, respectively. Secondary outcome measurement including in voiding, storage symptoms, and total IPSS scores showed the improvement at 4 and 12 weeks and in total and sleep quality PSQI scores at 12 weeks, and in quality of life scores of the WHO 5 well-being index at 12 weeks. Only one (3.8%) adverse event was observed.

Conclusions

These results suggest clearly that prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia has the potential to control concomitant voiding and sleep difficulty.

Efficacy of Evolocumab in Patients with Hypercholesterolemia
Xuan Jin, Moo Hyun Kim, Young-Rak Cho, Jong-Sung Park, Kai Song, Song Lin Yuan
Kosin Med J. 2020;35(2):125-132.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.125
Funded: Amgen
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

The FOURIER trial reported that inhibition of PCSK9 with evolocumab on a background of statin therapy lowered low-density lipoprotein (LDL) cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. Here, we report data from a single center focusing on the effect of a PCSK9 inhibitor antibody on hyperlipidemia.

Methods

We enrolled 29 hypercholesterolemia patients who had LDL cholesterol levels ≥ 70 mg per deciliter or non-HDL cholesterol ≥ 100 mg per deciliter and were divided into two groups (placebo n = 14, evolocumab n = 15), and participated in a 72 – 96 week, randomized, double-blind, placebo-controlled trial with statin therapy. Patients were randomly assigned to receive evolocumab (140 mg every 2 weeks or 420 mg monthly) or matched placebo via subcutaneous injection. Lipid changes during follow-up were analyzed.

Results

The median LDL cholesterol level at baseline was 88 mg per deciliter, and the average LDL cholesterol level was 101.8 ± 20.0 mg per deciliter. At 4 weeks, the median LDL cholesterol level was 39 mg per deciliter, and the average LDL cholesterol level was 34.8 ± 51.8 mg per deciliter. Compared to placebo group, the LDL cholesterol levels were significantly reduced after treatment (P < 0.001), as well as total cholesterol, ApoB, and ApoB/ApoA1 levels. During follow-up, no discomfort was reported at local injection sites, and no cases of abnormal liver function were observed.

Conclusions

Evolocumab significantly reduced LDL cholesterol levels and was well tolerated.


KMJ : Kosin Medical Journal