過去の記事: 5月 2011

New Treatments for Hepatitis C  (C型肝炎新治療薬認可)

2011年 05月 29日:  

dr.gif千葉県木更津市 はやさかクリニック 院長 肝臓専門医 早坂章です。米国肝臓学会では、FDAがC型肝炎治療薬、2剤を認可したと発表しました。

使用適応に関する注意がきちんと書かれています。 日本語訳はのちほどで申し訳ありません。

The FDA has just approved two direct-acting antivirals for the treatment of hepatitis C (HCV): boceprevir and telaprevir.

Each of them improves cure rates in selected patients infected with HCV genotype 1 — when used in combination with pegylated interferon and ribavirin. Approved treatment schedules will be complex and different for each of them. AASLD will soon release updated treatment guidelines for hepatitis C that will include specifics of therapy with each of these drugs.

In the meantime, the following are important issues regarding these drugs:

  1. Neither drug can be used alone. Each of them can only be used in combination with pegylated interferon and ribavirin. When used alone, the drug will not be effective and will cause emergence of antiviral-resistant mutants that could be difficult to treat subsequently.
  2. They are only approved for use in patients with HCV genotype 1.
  3. They are not approved for use in post-transplant recurrent HCV.
  4. They are not approved for use in HIV/HCV coinfected patients.
  5. They are not approved for use in children.
  6. The newly approved treatment schedules have more side effects than pegylated interferon and ribavirin, and should be managed carefully.

An announcement will be made as soon as the updated AASLD guidelines are available.

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FDA approves Incivek for hepatitis C (米国FDA C肝炎治療薬telaprevir認可))

2011年 05月 29日:

 

dr.gif千葉県木更津市 はやさかクリニック 院長 肝臓専門医 早坂章です。

米国でC型肝炎治療薬が2剤認可になりましたが、telaprevirについてのFDAの発表です。 まず、英語でひとつ御紹介です。

FDA NEWS RELEASE

For Immediate Release: May 23, 2011
Media Inquiries: Erica Jefferson, 301-796-4988, erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA approves Incivek for hepatitis C

The U.S. Food and Drug Administration today approved Incivek (telaprevir) to treat certain adults with chronic hepatitis C infection. Incivek is used for patients who have either not received interferon-based drug therapy for their infection or who have not responded adequately to prior therapies. Incivek is approved for use with interferon therapy made up of peginterferon alfa and ribavirin.

The current standard of care for patients with chronic hepatitis C infection is peginterferon alfa and ribavirin taken for 48 weeks. Less than 50 percent of patients respond to this therapy.

The safety and effectiveness of Incivek was evaluated in three phase 3 clinical trials with about 2,250 adult patients who were previously untreated, or who had received prior therapy. In all studies patients also received the drug with standard of care. In previously untreated patients, 79 percent of those receiving Incivek experienced a sustained virologic response (i.e. the infection was no longer detected in the blood 24 weeks after stopping treatment) compared to standard treatment alone.

The sustained virologic response for patients treated with Incivek across all studies, and across all patient groups, was between 20 and 45 percent higher than current standard of care.

The studies indicate that treatment with Incivek can be shortened from 48 weeks to 24 weeks in most patients. Sixty percent of previously untreated patients achieved an early response and received only 24 weeks of treatment (compared to the standard of care of 48 weeks). The sustained virologic response for these patients was 90 percent.

When a person achieves a sustained virologic response after completing treatment, this suggests that the hepatitis C infection has been cured.

Sustained virologic response can result in decreased cirrhosis and complications of liver disease, decreased rates of liver cancer (hepatocellular carcinoma), and decreased mortality.

“With the approval of Incivek, there are now two important new treatment options for hepatitis C that offer a greater chance at a cure for some patients with this serious condition,” said Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in FDA’s Center for Drug Evaluation and Research. “The availability of new therapies that significantly increase responses while potentially decreasing the overall duration of treatment is a major step forward in the battle against chronic hepatitis C infection.”

According to the U.S. Centers for Disease Control and Prevention, about 3.2 million people in the United States have chronic hepatitis C infection, a viral disease that causes inflammation of the liver that can lead to diminished liver function or liver failure.
Most people with hepatitis have no symptoms of the disease until liver damage occurs, which may take several years.

Most liver transplants performed in the United States are due to progressive liver disease caused by hepatitis C virus infection. After the initial infection with hepatitis C (HCV), most people develop chronic hepatitis C. Some will develop cirrhosis of the liver over many years. Cirrhosis can lead to liver damage with complications such as bleeding, jaundice (yellowish eyes or skin), fluid accumulation in abdomen, infections, or liver cancer.

People can get HCV in a number of ways, including: exposure to blood that is infected with the virus; being born to a mother with HCV; sharing a needle; having sex with an infected person; sharing personal items such as a razor or toothbrush with someone who is infected with the virus, or from unsterilized tattoo or piercing tools.

Incivek is a pill taken three times a day with food. Incivek should be taken for the first 12 weeks in combination with peginterferon alfa and ribavirin. Most people with a good early response to the Incivek combination regimen can be treated for 24 weeks rather than the recommended 48 weeks of treatment with the standard of care. Incivek is part of a class of drugs referred to as protease inhibitors, which work by binding to the virus and preventing it from multiplying.

The most commonly reported side effects in patients receiving Incivek in combination with peginterferon alfa and ribavirin include rash, low red blood cell count (anemia), nausea, fatigue, headache, diarrhea, itching (pruritus), and anal or rectal irritation and pain. Rash can be serious and can require stopping Incivek or all three drugs in the treatment regimen.

On May 13, FDA approved Victrelis (boceprevir), another new treatment for chronic hepatitis C, marketed by Merck of Whitehouse Station, N.J.

Incivek is marketed by Cambridge, Mass.-based Vertex Pharmaceuticals.

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Good video about hepatitis C (C型肝炎全般に関する丁寧な動画)

2011年 05月 25日:  

dr.gif 千葉県 木更津市 はやさかクリニック 院長 肝臓専門医 早坂章です。

英語なのがなんてんですが、C型肝炎の診療についての丁寧な動画の御紹介です。

特に「肝生検」について必要性に応じて勧め、利点、欠点など、状況により、細かく説明してくださり、大変勉強になります。

[yframe url='http://www.youtube.com/watch?v=kfIu9uQODgQ&feature=related']

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maternal and paternal transmissions are both important in the intrafamilial spread of HBV infection in Taiwan.

2011年 05月 24日:  

dr.gifI’m Akira Hayasaka, a Liver Disease Expert in Japan.

Today, I would like to introduce a little bit old, but important article about maternal and paternal transmission of hepatiris B virus in Taiwan. Although similar studies have been published so far, this article is clear cut good article. I think that you could confirm your knowledge again.

Clin Infect Dis. (2005) 41 (11):1576-1581.

Application of Hepatitis B Virus Genotyping and Phylogenetic Analysis in Intrafamilial Transmission of Hepatitis B Virus

Abstract

Background. Infection with hepatitis B virus (HBV) in early life frequently results in persistent infection, and clustering of the chronic infection within a family is common. However, the relative contribution of perinatal mother-to-infant transmission or early horizontal transmission to the intrafamilial clustering of HBV infection remains unclear. Therefore, we used HBV genotyping and phylogenetic analysis to elucidate the modes of intrafamilial HBV transmission in Taiwan.

Methods. HBV genotypes and serological markers were determined for 103 individuals from 20 families with evidence of clustering HBV infection.

Results. Three patterns of intrafamilial clustering of HBV infection were identified. Among the 20 families, 8 included a hepatitis B surface antigen (HBsAg)-positive mother (pattern I), 7 included an HBsAg-positive father (pattern II), and in the remaining 5, both parents were positive for HBsAg (pattern III). The rates of HBsAg positivity for children of the 3 representative groups of families were 85.7%, 65.4%, and 87.5%, respectively (P = .16). The identical genotyping results between index parent and carrier children indicated that pattern I clustering was caused by maternal transmission, whereas pattern II clustering was caused by paternal transmission. In pattern III clustering, a concordant HBV genotype between carrier children and mother or father was found in 3 and 2 families, respectively. The modes of transmission were confirmed by phylogenetic analysis in 1 family of each pattern.

Conclusions. In Taiwan, maternal and paternal transmissions are both important in the intrafamilial spread of HBV infection.

 


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肝臓週間2011千葉県(千葉市)での市民公開講座の御案内

2011年 05月 23日:  

dr.gif千葉県木更津市 肝臓内科 はやさかクリニック 院長 肝臓専門医 早坂章です。

昨日は、肝臓週間全般についてふれましたが、私が在住する、千葉県での市民公開公開講座のご案内が遅れました。下記の通りに千葉市の千葉大学医学部で予定されています。

きっと、参考になることと思います。講演終了後医療相談もあるようです。

肝臓週間(5月23日~29日)市民公開講座

日時 5月28日(土曜日)14時~17時
会場 千葉大学医学部本館1階第一講義室
内容 講演「慢性肝炎の診断と治療」ほか
※直接会場にお越しください。
※講演終了後医療相談可
千葉大学医学部消化器内科
TEL 043-226-2083
※県ではウイルス肝炎に対するインターフェロン治療及び核酸アナログ製剤治療への公費による医療助成を行っています。
県疾病対策課
TEL 043-223-2665

 

御紹介させていただきます。i07.gif

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