タカダ　ヒデト   Takada Hideto   髙田　秀人    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	総説
言語種別	英語
査読の有無	査読なし
表題	Molecular targeted therapies for microscopic polyangiitis and granulomatosis with polyangiitis.
掲載誌名	正式名：The Korean journal of internal medicine 略　 称：Korean J Intern Med ISSNコード：20056648/12263303
掲載区分	国外
巻・号・頁	34(3),pp.492-503
著者・共著者	Harigai Masayoshi, Tsutsumino Michi, Takada Hideto, Nagasaka Kenji
発行年月	2019/05
概要	Clinical trials and observational studies have established cyclophosphamide (CY) or rituximab plus glucocorticoid (GC) as standard remission induction therapies in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, because these regimens are associated with serious adverse drug reactions, the development of drugs with novel mechanisms of actions are needed. Progress in basic and clinical research has identified novel candidate targeting molecules, including B-cell activating factor (BAF), C5a receptor, and interleukin-6. The combination of rituximab and BAF blockade in patients with MPA and GPA is under investigation in an effort to strike a better benefit-risk balance. Phase II clinical trials of avacopan (CCX168), an orally administered C5a receptor antagonist, have suggested a reduction in the dosage of concomitant GC or the replacement of GC in patients with MPA and GPA. The results from a currently ongoing phase III trial are awaited. Anecdotal case reports and an open-label pilot study have indicated the effectiveness of tocilizumab in patients with MPA and GPA. A randomized clinical trial comparing tocilizumab and intravenous CY in combination with GC is currently in progress. Molecular targeted therapy is expected to transform the treatment strategy for MPA and GPA to allow GC-free or at least less GC-dependent forms of therapy.
DOI	10.3904/kjim.2018.366
PMID	30613065