" /> 【特集】免疫・アレルギー疾患における分子標的薬の使い方■血管炎症候群における分子標的薬の使い方■佐藤洋志，ほか |
呼吸臨床

【特集】免疫・アレルギー疾患における分子標的薬の使い方

企画：宮崎泰成


　近年，肺癌治療だけでなく，喘息を含む免疫アレルギー性疾患に分子標的薬が使用されるようになってきている。分子標的薬はそれぞれの免疫アレルギー性疾患の病態に直接ピンポイントに効果が期待できる。しかし，高価な薬でもあるので，有効性のエビデンス，どのような症例に，どのようなタイミングで使うのかなど新しい知識を身につけることが必要である。そこで「免疫・アレルギー疾患における分子標的薬の使い方」の特集を組んだ。

血管炎症候群における分子標的薬の使い方

佐藤洋志*，南木敏宏*

*東邦大学医学部内科学講座膠原病学分野（〒143-8541　東京都大田区大森西6-11-1）


Molecularly targeted drugs in vasculitis syndrome

Hiroshi Sato*，Toshihiro Nanki*

*Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo


Keywords：ANCA関連血管炎，Behçet病，高安動脈炎，巨細胞性動脈炎，分子標的薬／ANCA-associated vasculitis, Behcet’s disease, Takayasu arteritis, giant cell arteritis, molecularly targeted drugs


呼吸臨床 2019年3巻11号　論文No.e00074
Jpn Open J Respir Med　2019 Vol. 3 No. 11  Article No.e00074

DOI: 10.24557/kokyurinsho.3.e00074


掲載日：2019年11月8日


©️Hiroshi Sato, et al. 本論文の複製権，翻訳権，上映権，譲渡権，貸与権，公衆送信権（送信可能化権を含む）は弊社に帰属し，それらの利用ならびに許諾等の管理は弊社が行います。





要旨

　血管炎症候群は全身の血管に炎症を来す疾患である。各疾患は罹患血管径により分類されており，大型，中型，小型血管炎それぞれにおいて特有の肺病変を呈する。治療は副腎皮質ステロイドと免疫抑制薬が中心であるが，現在，分子標的薬も適応となっており効果が期待されている。今回，ANCA関連血管炎，Behçet病，高安動脈炎，巨細胞性動脈炎における分子標的薬の使い方について概説する。



文献

  1. Jennette JC, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994; 37: 187-92.
  2. Jennette JC, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013; 65: 1-11.
  3. Stone JH, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010; 363: 221-32.
  4. Jones RB, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010; 363: 211-20.
  5. Nagafuchi H, et al. Long-term safety and efficacy of rituximab in 7 Japanese patients with ANCA-associated vasculitis. Mod Rheumatol. 2015; 25: 603-8.
  6. Guillevin L, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med. 2014; 371: 1771-80.
  7. Charles P, et al. Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2). Ann Rheum Dis. 2018; 77: 1143-9.
  8. Caetano J, et al. Refractory Wegener's granulomatosis presenting with alveolar haemorrhage, treated with rituximab. BMJ Case Rep. 2014; 2014.
  9. Yun S, et al. Concurrent diffuse alveolar haemorrhage and venous thromboembolism in p-ANCA associated vasculitis treated with rituximab. BMJ Case Rep. 2014; 2014.
  10. Szczeklik W, et al. Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis. Clin Rheumatol. 2010; 29: 1127-34.
  11. Kim YK, et al. Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings. Eur Radiol. 2007; 17: 3157-65.
  12. Ribi C, et al. Treatment of Churg-Strauss syndrome without poor-prognosis factors: a multicenter, prospective, randomized, open-label study of seventy-two patients. Arthritis Rheum. 2008; 58: 586-94.
  13. Schonermarck U, et al. Circulating cytokines and soluble CD23, CD26 and CD30 in ANCA-associated vasculitides. Clin Exp Rheumatol. 2000; 18: 457-63.
  14. Kim S, et al. Mepolizumab as a steroid-sparing treatment option in patients with Churg-Strauss syndrome. J Allergy Clin Immunol. 2010; 125: 1336-43.
  15. Moosig F, et al. Targeting interleukin-5 in refractory and relapsing Churg-Strauss syndrome. Ann Intern Med. 2011; 155: 341-3.
  16. Wechsler ME, et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med. 2017; 376: 1921-1932.
  17. Sakane T, et al. Behcet's disease. N Engl J Med. 1999; 341: 1284-91.
  18. Ideguchi H, et al. Characteristics of vascular involvement in Behcet's disease in Japan: a retrospective cohort study. Clin Exp Rheumatol. 2011; 29: S47-53.
  19. Seyahi E, et al. Pulmonary artery involvement and associated lung disease in Behcet disease: a series of 47 patients. Medicine (Baltimore). 2012; 91: 35-48.
  20. Endo LM, et al. Pulmonary aneurysms and intracardiac thrombi due to Behcet's disease in an African-American adolescent with oculocutaneous albinism. Clin Rheumatol. 2007; 26: 1537-9.
  21. Adler SI. Baumgartner, and P.M. Villiger, Behcet's disease: successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis. Arthritis Care Res (Hoboken). 2012; 64: 607-11.
  22. Chan E, et al. Pulmonary artery aneurysms in Behcet's disease treated with anti-TNFalpha: A case series and review of the literature. Autoimmun Rev. 2016; 15: 375-8.
  23. Hatemi G, et al. 2018 update of the EULAR recommendations for the management of Behcet's syndrome. Ann Rheum Dis. 2018; 77: 808-18.
  24. Fabiani C, et al. Ten-Year Retention Rate of Infliximab in Patients with Behcet's Disease-Related Uveitis. Ocul Immunol Inflamm. 2019; 27: 34-9.
  25. Nakaoka Y, et al. Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rheum Dis. 2018; 77: 348-54.
  26. Stone JH, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017; 377: 317-28.

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