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- 2026-05-02 14:55:44
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- KMA ‘non-face-to-face Wegovy prescriptions cause harm'
- by Kang, Shin-Kook Oct 30, 2024 05:53am
- A Korean doctor's association has called for an immediate halt to the government's plan to allow non-face-to-face medical treatment. The Korean Medical Association (Chairman Hyun-Taek Lim) issued a statement on the 28th claiming, “The government should immediately stop allowing all non-face-to-face medical treatment as its pilot project and ensure that the non-face-to-face treatment pilot project is operated only as a supplementary means for returning patients, under the principle of face-to-face treatment.” The Ministry of Health and Welfare implemented a pilot project for non-face-to-face treatment in June last year, focusing on clinic-level medical institutions and returning patients who have received face-to-face medical treatment, and then allowed overall non-face-to-face treatment as a pilot project in February this year. In response, the Korean Medical Association pointed out, “With the full permit of non-face-to-face treatment, online platforms are encouraging patients to use non-face-to-face treatment platforms through various advertisements, SNS, influencers, and other promotional activities. Rather than providing essential medical treatment services for returning patients that have received face-to-face treatment, patients are being seriously induced to receive non-reimbursed initial medical treatment related to beauty such as hair loss, diet, and acne through online medical platforms.” “In the case of Wegovy, an injectable obesity drug that has been controversially overprescribed through non-face-to-face online platforms, the manufacturer suggests gallstones, hair loss, and indigestion as common side effects, and in rare cases, fatal side effects such as pancreatitis can occur, so it is a specialty drug that should be prescribed through BMI criteria. However, due to the full allowance of non-face-to-face medical treatment, consumers, not patients, can easily acquire and abuse specialty drugs, and we would like to question whether this is in line to allow non-face-to-face treatment,’ said KMA. It added, “To prevent the distortion of the medical market and indiscriminate prescriptions caused by non-face-to-face treatment and the damage to public health, we need to restrict prescription of non-face-to-face treatment for drugs that should be prescribed after strictly identifying the patient's condition. As such, the government should strengthen the monitoring system for online platform companies and prepare measures against factors that may disrupt the medical market.”
- Opinion
- [Reporter's View] Super precision medicine
- by Eo, Yun-Ho Oct 30, 2024 05:53am
- Super Precision medicine. New drugs have been developed to selectively target with more significant efficacy than before. Lately, news articles related to anticancer agents have frequently covered keywords related to genetic mutations, including MET, RET, ALK, EGFR, and ROS1. Customized treatments are becoming available, where effective treatments can be provided depending on the patient's particular genetic mutations. Pharmaceuticals targeting HER2, ALK, and EGFR have been developed, and they show superior effects in patients with particular conditions. Lately, pharmaceuticals have been developed selectively targeting difficult-to-develop gene mutations, such as ROS, NTRK, and RET. Such development of super precision medicines suggests that prescription criteria will likely change from 'disease' to 'genes'. A customizable healthcare era has arrived. However, it is still unfamiliar. Will the South Korea successfully incorporate these drugs that show efficacy regardless of cancer type once gene mutations in patients are confirmed? Previously listed targeted anticancer drugs and immune checkpoint inhibitors have faced difficulties in expanding reimbursement. One such difficulty is the high costs. However, when a drug's new use is discovered, the values and the volume of usage must be re-assessed. The process is required by the National Health Insurance system in South Korea. However, recently developed new drugs target very few patients; in other words, the number of identified gene mutations cases is few. This means that not many patients are likely to be prescribed for these new drugs. In South Korea, patients with rare diseases comprise below 1% of overall solid cancer cases. Less than 200 patients are diagnosed. Experts explain that these types of patients do not respond well to standard therapies (conventional drugs). The problem is reimbursement. Anticancer agents targeting gene mutations mentioned earlier have already been approved domestically. However, most of these drugs are still non-reimbursable. Pharmaceutical companies have continued to apply for coverage, but their attempts 'failed.' It is time to consider a reimbursement track for super precision medicine. Rather than going against the current system, we must establish different reimbursement review criteria for drugs that can be used in patients regardless of their cancer types.
- Company
- "Early intervention" needed for treating multiple myeloma
- by Whang, byung-woo Oct 29, 2024 05:49am
- The survival rate of patients with multiple myeloma increased following new drug development. However, concerns have been raised that South Korea's survival rate is still far from that of advanced countries. Expert opinions indicate that the Korean medical treatment field changes with new drug approvals and reimbursement listings, yet patient access remains restricted. Dr. Chang Ki Min, a Professor of Hematology at Seoul St. MaryDuring the conference commenced by Janssen on October 28th, Dr. Chang Ki Min, a Professor of Hematology at Seoul St. Mary's Hospital, emphasized the need for early treatments customized to the nature of multiple myeloma. According to the Health Insurance Review and Assessment Service (HIRA), the number of Korean patients with multiple myeloma is on the rise due to the aging population. Multiple myeloma patients were 7,063 in 2017, and the number increased to 11,219 patients in 2023. "The average multiple myeloma onset is 60 years or higher. As the aging population continues to increase, the number of multiple myeloma patients will likely increase as well," Dr. Min explained. The problem is that remission of multiple myeloma is difficult to achieve. Despite undergoing treatments, patients are likely to experience relapse. Therefore, treatment focuses on selecting effective treatments in each stage and extending the progression-free survival period. Typically, treatment duration shortens as the number of treatments increases. For example, 95% of patients undergoing first-line treatment relapse, 15% of patients undergoing fourth-line treatment relapse, and the percentage drops to 1% by the time patients receive fifth-line treatment. "When multiple myelomas relapse after several years following treatment at an early stage, the disease becomes chronic. It is important to undergo effective treatment at early stage so that the disease does not advance to secondary, tertiary, etc," said Dr. Min. As new drugs are being developed for treating multiple myeloma, a variety of treatment options are available. Originally starting from simple chemotherapy, the treatment evolved to combination therapies, including proteasome inhibitors, immune modulators, and high-dosage steroids. Recently, new treatments, such as anti-CD38 monoclonal antibodies and BCMA-targeted immune therapy, became available. The survival rate following the development of treatments for multiple myeloma (based on a document presented by Dr. Chang Ki Min) In South Korea, new treatment options are emerging as new drugs for treating multiple myeloma receive the Ministry of Food and Drug Safety (MFDS) approvals: elranatamab in May and Talvey in June. However, the limitation to utilizing such treatments is that the National Health Insurance reimbursement is limited. A 'DVTd combination therapy (Darzalex+bortezomib+thalidomide+dexamethasone),' containing Darzalex (daratumumab), recently received an appropriateness decision from the Drug Reimbursement Evaluation Committee (DREC) for expanding reimbursement as the first-line treatment of multiple myeloma. However, analysis suggests that the medical field still needs overall improvement. "Within the limited government fund, many pharmaceuticals are covered by reimbursement. Yet, there still needs improvement based on the global standard," Dr. Min said. "Despite having good treatment options, including existing medications and new drugs, patient access is limited. Thus, it requires improvement." The survival rate of patients with multiple myeloma in South Korea and several advanced countries (based on a document presented by Dr. Chang Ki Min) The survival rate of Korean patients with multiple myeloma is 51%, showing a 10% difference compared to that of advanced countries, 61% in the United States and 62% in Germany. Consequently, the Korean medical field is changing due to new drug approvals and reimbursement listings. Various approaches may be needed to improve treatment outcomes, such as considering treating the disease at an early stage and optimizing the order of treatments. Dr. Min has suggested an improvement plan as ▲Early use of the monoclonal antibody combination therapy ▲Triple combination drug that can be used in patients who are non-responsive to Lenalidomide ▲A new class treatment for patients relapse or refractory to over third-line therapies. It suggests that administering a new drug that would significantly improve the survival rate at an early stage could achieve both the treatment effects and the National Health Insurance finance. "We understand the problem of limited National Health Insurance finance, but we expect that early administration of an effective treatment method would reduce relapse rate and increase the survival rate, thereby potentially reducing the treatment cost," Dr. Min said. "Most patients currently undergo 6th and 7th treatments. Using effective treatments at an early stage will, in turn, be effective for the National Health Insurance." Lastly, Dr. Min added, "It would be difficult for patients to fully experience the treatment effects when effective medications are used in patients with poor conditions after the 3rd and 4th treatments. By administering treatments early, we expect to see the global standard therapy results."
- Company
- Will the third time be the charm for Mylotarg?
- by Eo, Yun-Ho Oct 29, 2024 05:49am
- The industry’s attention is focused on whether the insurance reimbursement discussions for the acute myeloid leukemia drug ‘Mylotarg’ will make progress this time. According to the industry sources, Pfizer Korea’s acute myeloid leukemia (AML) drug ‘Mylotarg (gemtuzumab ozogamicin)’ is set to be submitted to the Health Insurance Review and Assessment Service’s Drug Reimbursement Evaluation Committee. However, it is not yet confirmed whether the agenda it will be presented in November. Mylotarg’s reimbursement agenda was deliberated by HIRA’s Cancer Disease Review Committee in May 2022 but was unable to set reimbursement standards then. It passed the CDDC review in October last year, but subsequent discussions had collapsed. Pfizer resubmitted the application for its reimbursement in June, which passed the Pharmacoeconomic Evaluation Subcommittee. Mylotarg is an antibody-drug conjugate (ADC) indicated for the first-line treatment of newly diagnosed acute myeloid leukemia whose tumors express the CD33 antigen (CD33-positive AML) . The drug, which received marketing authorization in Korea in December 2021, is an ADC composed of a CD33-targeting monoclonal antibody linked to calicheamicin, a potent cytotoxic agent. The drug works on cells that express the CD33 antigen, which is expressed in more than 90% of AML patients. This blocks cancer cell growth and induces apoptosis. Mylotarg’s approval was based on a clinical trial (ALFA-0701) conducted on 271 patients aged between 50 to 70 with newly diagnosed AML with no prior treatment experience. The ALFA-0701 trial was an open-label, randomly assigned, multicenter Phase III study that compared the existing standard front-line chemotherapy, daunorubicin+cytarabine combination therapy, with Mylotarg+ daunorubicin+ cytarabine combination therapy. Results showed that the median event-free survival (EFS) in the Mylotarg+daunorubicin+cytarabine combination therapy group was 17.3 months, a 7.8 month extension compared to the 9.5 months in the daunorubicin+cytarabine combination therapy group. Also, the Mylotarg combination therapy reduced the risk of induction failure, relapse, or death by 44% compared to chemotherapy alone. The median relapse-free survival (RFS) was 28.0 months in the Mylotarg+daunorubicin+cytarabine combination therapy group and 11.4 months in the daunorubicin+cytarabine combination therapy group, showing a significant 16.6-month difference with the addition ofMylotarg. In the case of median overall survival (OS), the median OS was 27.5 months in the Mylotarg+daunorubicin+cytarabine combination therapy group and 21.8 months in the daunorubicin+cytarabine combination therapy group, but there was no statistically significant difference between treatment arms in OS. Meanwhile, Mylotarg is administered intravenously under close monitoring over 2 hours at the recommended dose with dilution depending on the treatment regimen, including remission induction therapy and remission maintenance therapy. Mylotax was approved by the U.S. FDA in September 2017 and by the European Medicines Agency (EMA) in April 2018.
- Company
- ABL Bio receives ₩7B as milestone payment from Sanofi
- by Kim, Jin-Gu Oct 29, 2024 05:49am
- ABL Bio has received additional milestone payments from Sanofi for its degenerative brain disease treatment candidate ‘ABL301’. Including the upfront payment., ABL Bio will receive a total of KRW 170 billion, which includes the upfront payment. On 28 February, ABL Bio announced the completion of the manufacturing technology transfer of ABL301 to Sanofi and the receipt of USD 5 million (KRW 7 billion) as a milestone payment. ABL Bio signed a licensing-out agreement with Genzyme for ABL301, a bispecific antibody candidate for the treatment of Parkinson's disease and other neurodegenerative diseases. Genzyme is a fully-owned subsidiary of Sanofi. The total value of the agreement was estimated to be approximately $1.06 billion. As part of the agreement, ABL Bio received a non-refundable upfront payment of USD 75 million (KRW 100 billion). In September of the same year, the company received an additional USD 20 million of the USD 45 million in milestone payments for completing preclinical studies. In January last year, the company received an additional USD 25 million as a milestone (KRW 35 billion) for administering the first dose in the Phase I clinical trial. This, coupled with an additional USD 5 million (KRW 7 billion) in milestone payments for the transfer of manufacturing technology, brings the cumulative amount received from Sanofi to more than $125 million (KRW 170 billion). ABL Bio is eligible to receive up to an additional USD 940 million in other milestone payments based on further clinical, regulatory, and commercial achievements. In addition, upon successful commercialization of ABL301, the company may receive an agreed-upon percentage of net sales as an ongoing technology fee (annual fee). ABL301 is currently in a Phase I clinical trial in the U.S. led by ABL Bio. Upon completion of Phase 1 trials, Sanofi will be responsible for initiating Phase II trials. Sanofi retains global development and commercialization rights from Phase II trials. ABL301 is a bispecific antibody that uses ABL Bio’s Grabody-B platform technology to effectively deliver antibodies that inhibit the build-up of alpha-synuclein, the protein that causes Parkinson's disease, into the brain for improved treatment effect. The company's Grabody-B platform leverages the IGF1R (Insulin-like Growth Factor 1 Receptor) to maximize the blood-brain barrier (BBB) penetration of therapeutic candidates for various central nervous system diseases.
- Policy
- Low reimb approval rate hinders Soliris’s use for aHUS
- by Lee, Tak-Sun Oct 29, 2024 05:49am
- The industry’s eyes are on whether the preliminary reimbursement review process for Soliris, a treatment for the rare disease aHUS (atypical hemolytic uremic syndrome), will be eased in Korea. Until now, patients wishing to use Soliris for aHUS with reimbursement had to pass a preliminary review process. However, the problem is its low approval rate. With an approval rate in the 30-40% range every year, it has been a regular topic of discussion in the medical field and at the NA audit. This year, the issue was again raised during the NA audit, and attention has been drawn to the fact that HIRA expressed its intention to conduct a prospective review of the process. According to industry reports on the 27th, Rep Yoon Kim, a member of the Democratic Party of Korea, said to HIRA, “Soliri Inj, a treatment for atypical hemolytic uremic syndrome, has a very low approval rate at the preliminary reimbursement review committee process. If it cannot be used because of too strict standards, the standards need to be improved.” “As it is an acute disease, its use should not be bound by the preliminary review system, but should be started first, and the decision on whether to continue the treatment should be made afterwards.” aHUS is a severe, rare, hereditary disease where 79% of patients die within 3 years of onset, require dialysis, and suffer permanent renal failure. Without Soliris, it can be fatal. However, there are many cases of pre-approval rejections, rendering it difficult to treat patients in the field. However, HIRA has been citing the lack of required application data from long-term care institutions as the reason for the low approval rate, and that there was no problem with the reimbursement standards and review process. However, whether Rep. Yoon Kim’s criticism will improve the system is gaining attention. In its response to the NA’s written inquiry, HIRA said, ‘We will collect opinions from relevant societies on whether first allow the initial treatment with “Soliris Inj,” a drug for atypical hemolytic uremic syndrome, and then conduct preliminary review for further administration of the drug.” However, it seems that the authorities will keep the preliminary review system will be maintained. NA Rep. Jong-Heon Baek pointed out, “It seems inappropriate to operate the pre-review system for aHUS, as it is an acute rare disease. In other countries, considering the characteristics of acute rare diseases, they do not place them in the pre-review system or process the review very quickly. Korea is the only country that does not consider such characteristics of the disease.” To this, HIRA only responded, ‘Considering the nature of the disease, the drug can be administered immediately after submission of the pre-review application if it is an emergency case, and if approval follows, It is retroactively applied.” This suggests that the authorities are not considering plans to convert the preliminary review process to regular review. The implication is that they will consider exempting the initial dose only. In November, the government decided to switch the preliminary review process for the reimbursement of Soliris and Ultomiris for PNH (Paroxysmal nocturnal hemoglobinuria) to regular review. This is because the existing approval rate has remained stable at over 90%. Upon the change in their reimbursement process, there have been growing calls in the medical community for the removal of prior authorization aHUS in addition to PNH.
- Policy
- COVID-19 treatments 'Paxlovid·Veklury' reimb begins today
- by Lee, Jeong-Hwan Oct 28, 2024 05:54am
- Beginning today (October 25th), the National Health Insurance is applied to COVID-19 treatments, Paxlovid Tab (Pfizer Korea) and Veklury Inj (Gilead Sciences Korea). The patient copay will be maintained at the current cost of about KRW 50,000: KRW 47,090 for a single package of Paxlovid Tab (30 tablets) and KRW 49,920 (6 bottles) for Veklury Inj. The government expects that the National Health Insurance reimbursement will enable a stable supply of the COVID-19 treatments on a needs basis. Previously, the Korea Disease Control and Prevention Agency (KDCA) had purchased the drugs from pharmaceutical companies and distributed them to pharmacies at no cost. It will transition to commercial distribution system where pharmacies and medical centers purchase medications from pharmaceutical companies. However, the KDCA will temporarily maintain the government supply with commercial distribution to minimize disruption in the medical field during the transition and to efficiently utilize the purchased stock. Most of the criteria for the government-funded drugs, including prescription criteria and copays, will change to criteria for the National Health Insurance. For Veklury, individuals eligible for government-funded medications will be limited to high-risk individuals with mild·moderate symptoms and have not received reimbursement previously. The patient copay will be maintained at the current cost of about KRW 50,000: KRW 47,090 for a single package of Paxlovid Tab (30 tablets) and KRW 49,920 (6 bottles) for Veklury Inj. The previous policy required prescribing and dispensing COVID-19 medications from 'designated centers for COVID-19 medications.' Starting October 25th, pharmacies and medical centers nationwide can prescribe and dispense COVID-19 medications for National Health Insurance recipients. The exception is that prescriptions for high-risk individuals with mild‧moderate symptoms require a prescription and must be dispensed from 'designated centers for COVID-19 medications.' "With the National Health Insurance reimbursement of COVID-19 treatments, patients are expected to stably use the treatments in response to changes to COVID-19 spread," Lee Joongkyu, Director of the National Health Policy at the Ministry of Health and Welfare (MOHW), said. "We will continue to strive to expand the health insurance reimbursement for medications needed in the medical field."
- Company
- 'Aquipta,' new oral migraine drug, can be prescribed
- by Eo, Yun-Ho Oct 28, 2024 05:53am
- Product photo of AbbVie Korea AbbVie Korea's new drug 'Aquipta,' an oral drug used to treat migranes, is expanding the number of hospitals where it can be prescribed. According to industry sources, Aquipta (atogepant), an oral calcitonin gene-related peptide (GRRP) receptor antagonist for migraine treatment, has passed the drug committee (DC) of tertiary general hospitals, including Samsung Medical Center, Seoul National University, Asan Medical Center in Seoul, and Sinchon Severance Hospital, as well as other medical centers including, Kangbuk Samsung Hospital, Hallym University Dongtan Sacred Heart Hospital, and Inha University Hospital. Since its official launch in June, it has quickly become available for prescription. Aquipta is drawing attention as the first and only oral treatment option within the same class. In 2021, the U.S. Food and Drug Administration (FDA) approved Aquipta for the prophylaxis of episodic and chronic migraine in adults. In August, it received European approval for the prophylaxis of migraine in adults who have four or more migraine days per month. The basis for the approval in South Korea was the PROGRESS, ADVANCE, and ELEVATE Phase 3 studies. In the PROGRESS study, the efficacy and safety of Aquipta in preventing chronic migraine was compared to those of placebo. In the study, 521 adult patients with a diagnosis of chronic migraine for at least a year (greater or equal to 15 headache days and at least 8 migraine days) were randomized 1:1 to the Aquipta treatment or placebo treatment. The primary endpoint was changes from baseline in monthly mean headache days across a 12-week treatment period. The results demonstrated that the Aquipta treatment group had a reduction in monthly mean headache days by 6.9 days from baseline, compared to 5.1 days for the placebo group. The ADVANCE study compared the efficacy of Aquipta in preventing episodic migraines to that of placebo. The study involved 458 patients with a history of chronic migraine 4 to 14 days per month. The results demonstrated that the Aquipta treatment group had a reduction of monthly mean migraine days from baseline by 4.2 days, compared to a reduction of 2.5 days for placebo. In the ELEVATE study, which evaluated the preventative effect of chronic migraine in patients who previously failed prophylaxis, Aquipta treatment showed more significant reduction in monthly mean migraine days compared to placebo. "CGRP treatment is significantly effective in preventing migraines. Previously released injectables required monthly hospital visits, whereas oral treatment provides patients with more treatment options," Byung-Kun Kim, Professor of Nowon Eulji Hospital, said.
- Company
- Will Roche’s lymphoma drug Columvi be discussed for reimb?
- by Eo, Yun-Ho Oct 28, 2024 05:53am
- Will Columvi, the first bispecific antibody treatment option for lymphoma, enter the first step to its reimbursement within the year? Roche Korea’s CD20-CD3 bispecific antibody for diffuse large B-cell lymphoma (DLBCL), Columvi (glofitamab), may likely be redeliberated by the Health Insurance Review and Assessment Service's Cancer Disease Deliberation Committee meeting set to be held in November. Originally, there were hopes for its discussions in October, supported by strong requests from patient groups. The agenda was reviewed by CDDC in July but failed to set reimbursement standards at the time. Therefore, industry eyes are on whether Columvi can break through the barrier this time. Columvi was approved in Korea last December for the treatment of adult patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL), after two or more lines of systemic therapy. The drug is a third-line treatment option for DLBCL, like Novartis’s chimeric antigen receptor (CAR)-T-cell therapy Kymriah (tisagenlecleucel). The two drugs have different benefits; therefore the choice will likely be based on each patient's condition and circumstance. Columvi demonstrated efficacy in the Phase I/II NP30179 trial in 155 patients with relapsed or refractory DLBCL after two or more prior systemic therapies. Results showed that Columvi achieved a complete response (CR) of 40% and an overall response rate(ORR) of 52%. The efficacy was also consistent across all subgroups. The most common adverse event was cytokine release syndrome (CRS). Adding to the encouraging data presented at the 2024 Congress of the European Hematology Association (EHA 2024), the company unveiled the results of the Phase III STARGLO study, which demonstrated an improvement in overall survival (OS) with Columvi. The STARGLO study enrolled patients with relapsed or refractory (R/R) diffuse DLBCL who were not eligible to receive an autologous stem cell transplant after one or more prior systemic therapies, or who had received two or more prior systemic therapies. In the primary analysis (median follow-up 11.3 months), Columvi and gemcitabine+oxaliplatin (GemOx) combination significantly improved the primary endpoint of OS with a 41% lower risk of death compared to rituximab+GemOx. Meanwhile, the Korea Leukemia Patients Organization had continuously requested the CDDC review for Columvi review in October and has also requested that Roche, the manufacturer, provide a financial sharing plan to expedite its reimbursement listing.
- Company
- "We have clinically proven Stelara for Koreans"
- by Moon, sung-ho Oct 28, 2024 05:53am
- Due to its wide variety of conditions, Crohn's disease requires customized long-term treatment depending on the disease type and inflammatory region. When treating patients with Crohn's disease, the location of the disease is challenging because the intestinal tract of the ileum (lower part of the small intestine) is narrow. Recently, the research results of the K-STAR study, the Real-World Evidence (RWE) study of Stelara, a drug containing the original ingredient ustekinumab, was conducted for the first time in Korean patients, were published in 'IBD (Inflammatory Bowel Diseases) Journal.' The K-STAR study followed the effects and safety of Stelara in Korean patients with Crohn's disease over a year. Discussion with Dr. Byong Duk Ye and Dr. Chang Kyun Lee who have presented the first RWE study conducted in South Korea.This research confirmed clinically and endoscopically improved effects and drug tolerance profile regardless of the disease-affected regions or disease type.다. On October 14th, Daily Pharm met with the research authors, Dr. Byong Duk Ye, a Professor at Asan Medical Center (Gastroenterology), and Dr. Chang Kyun Lee, a Professor at Kyunghee University (Gastroenterology), and heard about potential changes to the treatment strategy for Crohn's disease after the K-STAR research. ▶ We have heard that the study is the first study to use the Real-World Data collected from Korean patients with Crohn's disease. Ye: The K-STAR study is a RWE study conducted from April 2018 to April 2022. It enrolled 464 patients with Crohn's disease who have started the Stelara treatment in 44 medical centers. The study evaluated the results of all adverse reactions and the efficacy over the year after the Stelara treatment. The study was significant because it was the first Stelara RWE to involve Korean patients with Crohn's disease and a multi-agency Post-Marketing Survey (PMS) study where clinical response rate·remission rate, endoscopic remission rate, and improvements to biomarker index were comprehensively evaluated. Furthermore, 60% of the patients enrolled in the study already had complications, including stenosis and fistulas. After the Stelara treatment, these patients had no further advancement in Crohn's disease and remained stable for up to 1 year. Lee: The study is meaningful because it is an RWE that shows the distribution of disease types and conditions among Koreans undergoing treatments. Unlike previously presented real-world data (RWD)-based studies were retrospective, the K-START study is significant because it collected data over a year, following pre-planned criteria from the beginning of the study. ▶ Stelara monotherapy's clinical remission rate was similar to that of the concomitant use of the drug with immune modulators. What does it entail? Ye: Patients using immune modulators often report pain during treatment due to a variety of side effects. Because of this, using the drugs in combination was uneasy. The current research showed that the clinical remission rate of Stelara monotherapy was not significantly different from that of using Stelara in combination with the immune modulator. It lowered the occurrence of side effects due to the immune modulators and provided a medical cost-saving effect ▶ We would like to hear about the report on differences in the treatment outcomes of patients previously treated with a biological agent or not. Ye: In the research, higher treatment effects were observed in patients with no prior experience with a biological agent than patients with experience of such experience. At 16-20 weeks of treatment, combined effectiveness was 50.3% for patients with no prior experience with a biological agent and 30.7% for patients with prior experience. At 52-66 weeks of treatment, 47.7% and 36.0% of combined effectiveness were observed, respectively. Both follow-up periods showed significant differences. Based on these results, greater effects can be expected when Stelara, a biological agent, is used as the first-line treatment. In my opinion, the study's importance lies in having Korean patients with Crohn's disease as study participants and in using Stelara monotherapy as the first-line treatment of a biological agent without using the drug in combination with an immune modulator. Lee: Many patients registered to the previous RWD-based studies already have prior experiences with medication, so they have undergone drug switching. This study is particularly significant because the percentages of patients with prior biological agent treatment (53.4%) and without one (46.6%) are nearly similar. ▶ In the K-STAR study, what treatment effects of Stelara were observed in the regions affected by the disease? Ye: In this research, the clinical response rate was higher in patients with the disease affecting the ileum (L1) than in patients who have the disease spread to the colon (L2) or ileocolon (L3). Typically, Anti-Tumor Necrosis Factor (TNF) agents, which show strong anti-inflammatory effects, were considered for patients with terminal ileal Crohn's disease. However, this research demonstrated that Stelara could effectively treat terminal ileal Crohn's disease. ▶How would you think the Stelara-treatable patient group would change following this research? Lee: In Korean patients with Crohn's disease, the ileum is the most affected region. Through this research, Stelara was found to effectively treat terminal ileal Crohn's disease, and the treatable patient group has expanded. We could expect to achieve treatment effects when providing Stelaral monotherapy at an early stage in patients aged 65 years and older with terminal ileal Crohn's disease who were hesitant about undergoing immune modulators. Also, Stelara was proven effective in treating patients who initially attempted anti-TNF agents and then experienced diminishing effects. We can now consider various treatment methods in the clinical setting. Ye: Regardless of disease type, over 50% of all patient groups reached clinical response, clinical remission, and clinical remission without steroids when treated with Stelara. In other words, patients with Crohn's disease with accompanying complications who were not subject to surgeries had anti-TNF agents as a treatment option. Now, Stelara can be considered depending on clinical conditions. ▶Recently, drug prescription sequence is often discussed when treating IBD, such as Croh's disease. We are curious what drugs are primarily prescribed in treating Crohn's disease. Ye: Patient-customized prescriptions are important when prescribing drugs. Safety is foremost considered when prescribing to patients who are likely to have a high risk of side effects. Administration methods are important depending on patient lifestyles. We primarily consider treatment effects for patients with poor prognosis and need to modulate inflammation quickly. Lee: Drug prescription sequence differ depending on patient profiles, so nothing is absolute. Drugs with high safety profiles are primarily used in patients who are prone to having drug-associated side effects, and drugs with superior effects are used for patients who need to treat the inflammation quickly on top of safety. Additionally, the drug prescription order is selected after a comprehensive assessment of cost issues, insurance policies, and lifestyles. In conclusion, we think that the goal of the sequence is to aim for the long-term maintenance of the treatment by considering such treatment decisions.
