ACRレポート2008
10月24日~29日,San Francisco
京都大学大学院医学研究科 内科学講座臨床免疫学
村上孝作
2008年の演題数
• Plenary session: 2演題
• Current Abstract Session: 17演題
• Poster Session: 135演題(日本から11演題)
Plenary SessionⅠ
(638)Fra2-Tg mouse
• Fra2: AP-1ファミリーに属する転写因子
PDGFがFra2の発現を促す
• Transgenic mouse
fibrosis (肺,皮膚),肺動脈の閉塞
TUNEL/Caspase (+)細胞が増加
血管内皮にFra2 siRNA→血管形成改善
自己抗体形成は無かった.
• ヒトSScの皮膚でもFra2の発現増加
Plenary SessionⅠ
(639)Tadarafil for Raynaud’s phenomenon (RP)
• PDE5 阻害薬(sildenafilより半減期が長い)
• RP+指尖潰瘍例にTadarafil or Placebo 6 week
→ washout →症例を入れ替えて6 week (全24症例)
• 結果(Baseline/ Placebo / Tadarafil)
daily duration (時間): 3.4 / 3.3 / 2.2
投与前後の潰瘍指の総計 Placebo
13→10
Tadarafil 24→0
・Adverse effectに明確な差は無かった.
Clinical Symposium: The great debate
CyclophosphamideはSScの病態を改善させるか?
1) Do you believe that CY is an effective therapy for SSc
lung disease after it is stopped?
Y: 60% N: 40%
2) Do you believe that CY is an effective Tx for extrapulmonary SSc in the long term (greater than 2 years) ?
Y: 22% N: 78%
3) Is CY’s risk/ benefit profile in SSc acceptable or not in the
long term (greater than 2 years) ?
Y: 45% N: 55%
4) Should CY be considered a “disease modifying” agent in
scleroderma?
Y: 55% N: 45%
Clinical Symposium: The great debate
CyclophosphamideはSScの病態を改善させるか?
Pro perspective and discussion--- Daniel E. Furst; UCLA
1) Yes.
(Lung)
SLS study→%FVCの変化が有意に改善.
2) Yes.
(extrapulmonary)
For function, QOL and Skin score
3) Yes.
(risk/benefit)
SLS studyでは,severe AEに明らかな差は無かった. 長
期使用による副作用の頻度は不明.
4) Yes.
(disease modifying drug?)
Ann Intern Med: alveolitis→CY使用群で生命予後改善.
Clinical Symposium: The great debate
CyclophosphamideはSScの病態を改善させるか?
Con perspective and discussion---James R. Seibold; Univ. of Michigan
Nannini C et al. (ART 2008)
Based on available data (380 subjects), CY DOES NOT
appear to result in clinically significant improvement of
pulmonary function.
(SLEで)CY使用による子宮頚癌の発症率が有意に増加.
Should CY be used? …..MAYBE SOMETIMES
Clinical Symposium: The great debate
CyclophosphamideはSScの病態を改善させるか?
1) Do you believe that CY is an effective therapy for SSc
lung disease after it is stopped?
Y: 60% N: 40%
→ Y: 53% N: 47%
2) Do you believe that CY is an effective Tx for extrapulmonary SSc in the long term (greater than 2 years) ?
Y: 22% N: 78%
→ Y: 33% N: 67%
3) Is CY’s risk/ benefit profile in SSc acceptable or not in the
long term (greater than 2 years) ?
Y: 45% N: 55%
→ Y: 50% N: 50%
4) Should CY be considered a “disease modifying” agent in
scleroderma?
Y: 55% N: 45%
→ Y: 48% N: 52%
Concurrent Abstract Session
(1221)Imatinibの治療実験
• Imatinib mesylate (IM, Gleevec): selective tyrosine kinase
inhibitor (Abl and PDGF)
• Bleomycin誘導性皮膚硬化に対する予防実験はすでに報
告あり→一旦生じた線維化を修復する効果はあるのか?
• Model for treatment of pre-established fibros:
local injections of bleomycin every other day.
• Bleomycin injection前との,skin thicknessの変化:
3w Ble.
→148 ± 14%
3w Ble. + 3w Ble.
→168 ± 10%
3w Ble. + (3w Ble. + IM 150mg/kg/d)
→124 ± 12%
(上記2者どちらの比較ともp <0.05)
Concurrent Abstract Session
(1222)Imatinib: Phase IIa Trial(中間報告)
Single center, Open label, IM 400mg/d for diffuse SSc
Target recruitment
20 Pts with < 4 years of disease
10 Pts with 4 to 10 years
evaluation :
histories, physical exam., SF-36s, sHAQs,
Lab data, skin biopsies, chest X-ray, PFTs,
ECG, mRSS
・18 例で治療開始.
・3M後の評価が10例で,6M後の評価が5例で可能であった.
・15例にAEを認めた;CK elevations (n=7), edema (n=7),
nausea (n=7)
・2例にsevere AEを認めたが,いずれもIMとの関連性は否定
的であった.
Change in mRSS.
Disease
Total time on
Duration
1.5 years
3 years
<4 years
<3 years
6 years
<1 year
7 years
<1 year
3.5 years
<1 year
Gleevec
7 months
7 months
3 months
7 months
6 months
5 months
1 month
3 months
3 months
3 months
Baseline
mRSS
Month 3
mRSS
Month 6
mRSS
21
30
26
24
20
43
31
25
46
41
26
29
20
24
15
40
27
21
45
46
28
27
24
24
10
MEAN (S.D.) at 3 months (G1 - G10)
30.7 (9.4)
29.3 (10.8)
MEAN (S.D.) at 6 months (G1 - G5)
24.2 (4.0)
22.8 (5.4)
Patient Id
G1
G2
G3
G4
G5
G6
G7
G8
G9
G10
22.6 (7.3)
(Abstractより改変)
Conclusion: Imatinibは,安全性・認容性のある
SScの治療薬として期待される.
Concurrent Abstract Session
(1223)Autologous stem cell transplantation
• Update on ASTIS-trial
• High dose immunosuppressive therapy (HDIT) +
hematopoietic stem cell transplantation (HSCT)
• 移植群: Mobilization with CY 2×2 g/m2, conditioning
with CY 200 mg/kg, rbATG 7.5 mg/kg, followed by
reinfusion of CD34+ selected autologous HSCT
• 対照群:12x monthly i.v. bolus CY 750 mg/m2
• Primary endpoint = event free survival during 2 years
follow-up.
Concurrent Abstract Session
(1223)Autologous stem cell transplantation
•
•
•
•
Results
2008年4月で,10カ国25施設118症例がenrolled.
Mean disease duration: 1.8 yr.
6 か月目のfollowとして,91例(43:移植群,48:対照群)の
安全性情報を回収.
平均29か月(1-72)の観察で,Grade 3 or 4の毒性は移植群
15例(/43),対照群13例(/48)で認められた→両群間に有
意差は認められず.
Concurrent Abstract Session
(1225)Bosentan (TRUST 3-year data)
• 53 例のPAH-CTD (WHO Functional Class Ⅲ)
(42 例: SSc, 5例: SLE, 6例: Overlap CTD)
• ボセンタン投与量 4 週間: 62.5mg twice a day
→44週間: 125mg twice a day
• Kaplan-Meier法を用いた生存率
1年目:92.3%→2年目:78.7%→3年目:69.9%
• Functional Class の改善を認めた症例:55.9%
(95%CI: 37.9 – 72.8)
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ACRレポート2008 10月24日~29日,San Francisco