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書籍詳細

未契約
書籍名 トロンボポエチン受容体作動薬のすべて
出版社 先端医学社
発行日 2012-10-05
著者
  • 池田康夫(編集)
ISBN 9784884078348
ページ数 118
版刷巻号 第1版第1刷
分野
閲覧制限 未契約

2011年に特発性血小板減少性紫斑病(ITP)の治療薬としてトロンボポエチン(TPO)受容体作動薬が保険適用となり、本薬剤の適正かつ有効な使用が期待される。本書には血小板産生機構の解説からTPO受容体作動薬開発の歴史、国内外の臨床試験にて示されたエビデンスにもとづく最新の知見に至るまで網羅されており、TPO受容体作動薬への理解を深め、基礎研究・臨床応用における今後の更なる発展に貢献する、血液学分野に携わる医療者・研究者必携の一冊。

目次

  • 表紙
  • 執筆者一覧
  • 目次
  • Part 1 血小板産生機構とトロンボポエチンの基礎をみる
    • [1] 巨核球造血の最新知見から血小板産生機構を知る
      • はじめに
      • 1. 巨核球の発生起源
      • 2. TPO - c - Mpl複合体の形成
      • 3. TPO - c - Mpl系のシグナル伝達機構
      • 4. 巨核球造血・血小板産生に作用する要素 ( 転写因子・miRNA・組織微小環境 )
      • 5. 巨核球造血・血小板産生と連鎖する全ゲノム関連解析
      • 6. 巨核球, 血小板のin vitro分化誘導
      • 7. In vivoにおける血小板産生
      • おわりに
    • [2] トロンボポエチン研究の歴史とクローニング, トロンボポエチンの基礎を知る
      • はじめに
      • 1. TPOクローニング以前の歴史的背景
      • 2. 著者らのTPO発見の経緯
      • 3. 米国のグループによるTPOの発見と著者らとの交流
      • 4. TPOの構造
      • 5. TPOの生物活性
      • おわりに
  • Part 2 トロンボポエチン受容体作動薬の基礎と臨床をみる
    P.31
    • [1] 第一世代トロンボポエチン受容体作動薬 ( rHuTPO製剤, rHuMGDF製剤 )
      • はじめに
      • 1. 第一世代TPO受容体作動薬
      • 2. 安全性と有効性の確認を目的とした第I / II相臨床試験
        • 1) PEG - rHuMGDF
        • 2) rHuTPO
      • 3. 骨髄抑制の軽度の化学療法時の血小板減少に対する効果
        • 1) PEG - rHuMGDF
        • 2) rHuTPO
        • 3) まとめ
      • 4. 急性骨髄性白血病 ( AML ) 治療における第一世代TPO受容体作動薬
      • 5. 造血幹細胞移植と第一世代TPO受容体作動薬
        • 1) rHuTPO
        • 2) PEG - rHuMGDF
      • 6. 第一世代TPO受容体作動薬の末梢血造血幹細胞動員効果
      • 7. MDSおよび再生不良1生貧血に対する効果
      • 8. 効率的な血小板採取を目的とした血小板輸血ドナーへの投与
      • 9. ITP症例に対する第一世代TPO受容体作動薬の投与
      • 10. 第一世代TPO受容体作動薬と中和抗体
      • おわりに
    • [2] 第二世代トロンボポエチン受容体作動薬
      • a. ロミプロスチム
        • はじめに
        • 1. 開発の経緯
        • 2. 薬効・薬理・薬物動態
        • 3. 国内臨床試験成績
          • 1) 国内第II相試験
          • 2) 国内第III相試験
          • 3) 国内長期継続投与試験
        • 4. 海外臨床試験成績
          • 1) 海外第III相試験
          • 2) 海外長期継続投与試験
          • 3) 出血および血栓イベントと骨髄レチクリン増生の評価
        • 5. 臨床上の役割への期待
        • おわりに
      • b. エルトロンボパグ
        • はじめに
        • 1. TPO受容体作動薬開発の経緯
        • 2. エルトロンボパグの薬効・薬理・薬物動態
        • 3. エルトロンボパグの海外臨床試験成績
        • 4. エルトロンボパグの国内臨床試験成績
        • 5. 臨床上の役割および問題点
        • 6. エルトロンボパグのその他の話題
        • おわりに
  • Part 3 トロンボポエチン受容体作動薬の安全性と副作用をみる - 副作用の頻度とその対策 -
    P.61
    • はじめに
    • 1. 一般的な副作用
    • 2. 注意を要する副作用
      • 1) 肝障害
    • 3. TPO受容体作動薬に特有な副作用
      • 1) 血栓症・血栓塞栓症の誘発
      • 2) 骨髄レチクリンの増生, 骨髄線維症の誘発
      • 3) 骨髄異形成症候群 ( MDS ) における白血病の誘導
      • 4) 治療中止時の反撥性血小板減少および出血傾向の増悪
      • 5) TPO中和抗体の誘導
      • 6) その他
    • おわりに
  • Part 4 特発性血小板減少性紫斑病 ( ITP ) 治療におけるトロンボポエチン受容体作動薬の位置付けを探る
    P.75
    • はじめに
    • 1. ITPの病態をみる
      • 1) ITPの疫学
      • 2) ITPの病態研究に関する歴史的背景
      • 3) 血小板に対する自己抗体の病的意義
      • 4) TPOとITP
    • 2. ITP治療の実際と国内外のガイドラインからTPO受容体作動薬の位置付けを探る
      • 1) ITPの治療概念
      • 2) ITP治療の基本
      • 3) ITPにおけるTPOによる血小板増加機序
      • 4) ITPにおけるTPO受容体作動薬の治験成績のまとめ
      • 5) TPO受容体作動薬のITPガイドラインへの掲載
    • 3. わが国の成人慢性ITP診療ガイドにおけるTPO受容体作動薬の位置付け
      • 1) ITPの治療目標
      • 2) ITPの治療手順
    • おわりに
  • Part 5 トロンボポエチン受容体作動薬の適応拡大への期待
    P.87
    • はじめに
    • 1. 慢性肝疾患による血小板減少症
      • 1) HCV陽性肝硬変による血小板減少症に対するエルトロンボパグの第II相試験 ( 海外 )
      • 2) IFN療法を目的にしたHCV陽性慢性肝疾患による血小板減少症に対するエルトロンボパグの第III相試験 ( ENABLE試験, 海外 )
      • 3) 慢性肝疾患による血小板減少症に対するエルトロンボパグの第II相試験 ( 国内 )
      • 4) 待機手術予定がある慢性肝疾患による血小板減少症に対するエルトロンボパグの第III相試験 ( ELEVATE試験, 海外 )
    • 2. 再生不良性貧血に対する第II相試験
    • 3. 骨髄異形成症候群 ( MDS )
      • 1) 低リスク群のMDSに対するロミプロスチムの安全性と効果を評価するための第I / II相試験 ( 海外 )
      • 2) 低リスク群のMDSに対するロミプロスチムの第III相試験 ( 海外 )
      • 3) アザシチジン治療を受けている低・中間リスク群MDSを対象にしたロミプロスチムの第II相試験 ( 海外 )
    • 4. 固形がんに対する化学療法による血小板減少症
    • 5. わが国発のTPO受容体作動薬の開発状況
    • おわりに
  • トロンボポエチン受容体作動薬の臨床応用に関するQuestion
    P.101
    • [Q1] なぜトロンボポエチン受容体作動薬はITP治療に有効性を有するのでしょうか ?
    • [Q2] 製剤の違い, 投与経路の違いで有効性はどう違うのですか ?
    • [Q3] トロンボポエチン受容体作動薬の有効性に人種差はありますか ?
    • [Q4] 適正に使用するには何にどのように注意すべきですか ?
    • [Q5] 長期使用における有効性と安全性について教えてください.
    • [Q6] トロンボポエチン受容体作動薬に中和抗体発現の可能性はありますか ?
    • [Q7] 小児にトロンボポエチン受容体作動薬を処方できますか ?
    • [Q8] 妊婦さんにトロンボポエチン受容体作動薬を処方できますか ?
    • [Q9] 脾臓摘出術前にトロンボポエチン受容体作動薬を処方できますか ?
    • [Q10] ITP治療におけるトロンボポエチン受容体作動薬に期待される役割 ( 臨床的意義 ) を教えてください.
  • 索引
    P.112
  • 奥付

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執筆者一覧

P.40 掲載の参考文献

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目次

P.73 掲載の参考文献

  • 1) Nurden AT, Viallard JF, Nurden P:New-generation drugs that stimulate platelet production in chronic immune thrombocytopenic purpura. Lancet 373:1562-1569, 2009
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  • 5) Cheng G, Saleh MN, Marcher C et al:Eltrombopag for management of chronic immune thrombocytopenia(RAISE):a 6-month, randomised, phase 3 study. Lancet 377:393-402, 2011
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  • 7) ロミプレート(R)皮下注250μg調製用添付文書
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  • 12) Bussel JB, Kuter DJ, Pullarkat V et al:Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood 113:2161-2171, 2009
  • 13) レボレード(R)錠を正しくご使用いただくために:適正使用ガイド, (池田康夫, 金倉譲総監修)2011年12月
  • 14) Tomiyama Y, Miyakawa Y, Okamoto S et al:A lower starting dose of eltrombopag is efficacious in Japanese patients with previously treated chronic immune thrombocytopenia. J Thromb Haemost 10:799-806, 2012
  • 15) レボレード(R)錠の適正使用に関するお願い~血栓塞栓症について~, 2012年7月
  • 16) Kuter DJ, Mufti GJ, Bain BJ et al:Evaluation of bone marrow reticulin formation in chronic immune thrombocytopenia patients treated with romiplostim. Blood 114:3748-3756, 2009
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  • 18) Giagounidis A, Mufti GJ, Kantarjian HM et al:Treatment with the thrombopoietin(TPO)-receptor agonist romiplostim in thrombocytopenic patients(Pts)with low or intermediate-1(Int-1)risk myelodysplastic syndrome(MDS):results of a randomized, double-blind, placebo(PBO)-controlled study[abstract]. Blood 118:117, 2011
  • 19) Olnes MJ, Scheinberg P, Calvo KR et al:Eltrombopag and improved hematopoiesis in refractory aplastic anemia. N Engl J Med 367:11-19, 2012
  • 20) Bussel JB, Kuter DJ, George JN et al:AMG 531, a thrombopoiesis-stimulating protein, for chronic ITP. N Engl J Med 355:1672-1681, 2006
  • 21) Li J, Yang C, Xia Y et al:Thrombocytopenia caused by the development of antibodies to thrombopoietin. Blood 98:3241-3248, 2001
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Part 1 血小板産生機構とトロンボポエチンの基礎をみる

P.85 掲載の参考文献

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  • 14) Kuter DJ, Bussel JB, Lyons RM et al:Efficacy of romiplostim in patients with chronic immune throm-bocytopenic purpura:a double-blind randomized controlled trial. Lancet 371:395-403, 2008
  • 15) Bussel JB, Cheng G, Saleh MN et al:Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med 357:2237-2247, 2007
  • 16) Cheng G, Saleh MN, Marcher C et al:Eltrombopag for management of chronic immune thrombocytopenia(RAISE):a 6-month, randomized, phase 3 study. Lancet 377:393-402, 2011
  • 17) Kuter DJ, Rummel M, Boccia R et al:Romiplostim or standard of care in patients with immune thrombocy-topenia. N Engl J Med 363:1889-1899, 2010
  • 18) Shirasugi Y, Ando K, Miyazaki K et al:An open-label extension study evaluating the safety and efficacy of romiplostim for up to 3.5 years in thrombocytopenic Japanese patients with immune thrombocytopenic purpura(ITP). Int J Hematol 95:652-659, 2012
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Part 2 トロンボポエチン受容体作動薬の基礎と臨床をみる

P.98 掲載の参考文献

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Part 3 トロンボポエチン受容体作動薬の安全性と副作用をみる - 副作用の頻度とその対策 -

P.105 掲載の参考文献

  • 1) 藤村欣吾, 宮川義隆, 倉田義之ほか:成人特発性血小板減少性紫斑病治療の参照ガイド2012年版. 臨床血液 53:433-442, 2012

P.108 掲載の参考文献

  • 2) Bussel JB, Buchanan GR, Nugent DJ et al:A random-ized, double-blind study of romiplostim to determine its safety and efficacy in children with immune thrombocytopenia. Blood 118:28-36, 2011
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