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Fujita M, Nagashima K, Shimazu M, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Hanaoka H, Shozu M, Tsuruoka N, Kasai T, Hata A. Effectiveness of self-sampling human papillomavirus test on precancer detection and screening uptake in Japan: The ACCESS randomized controlled trial. Int J Cancer 2024. [PMID: 38648390 DOI: 10.1002/ijc.34970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Japan is lagging in cervical cancer prevention. The effectiveness of a self-sampling human papillomavirus (HPV) test, a possible measure to overcome this situation, has not yet been evaluated. A randomized controlled trial was performed to evaluate the effectiveness of a self-sampling HPV test on detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and screening uptake. Women between 30 and 58 years old who did not participate in the cervical cancer screening program for ≥3 years were eligible and assigned to the intervention group (cytology or self-sampling HPV test) or control group (cytology). Participants assigned to the intervention group were sent a self-sampling kit according to their ordering (opt-in strategy). A total of 7337 and 7772 women were assigned to the intervention and control groups, respectively. Screening uptake in the intervention group was significantly higher than that in the control group (20.0% vs. 6.4%; risk ratio: 3.10; 95% confidence interval [CI]: 2.82, 3.42). The compliance rate with cytology triage for HPV-positive women was 46.8% (95% CI: 35.5%, 58.4%). CIN2+ was detected in five and four participants in the intervention and control groups, respectively; there was no difference for intention-to-screen analysis (risk ratio: 1.32; 95% CI: 0.36, 4.93). Self-sampling of HPV test increased screening uptake; however, no difference was observed in the detection of CIN2+, probably due to the low compliance rate for cytology triage in HPV-positive women. Efforts to increase cytology triage are essential to maximize precancer detections.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | | | | | | | | | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Evolution and Reproduction Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Aoki A, Iwamura C, Kiuchi M, Tsuji K, Sasaki A, Hishiya T, Hirasawa R, Kokubo K, Kuriyama S, Onodera A, Shimada T, Nagaoka T, Ishikawa S, Kojima A, Mito H, Hase R, Kasahara Y, Kuriyama N, Nakamura S, Urushibara T, Kaneda S, Sakao S, Nishida O, Takahashi K, Kimura MY, Motohashi S, Igari H, Ikehara Y, Nakajima H, Suzuki T, Hanaoka H, Nakada TA, Kikuchi T, Nakayama T, Yokote K, Hirahara K. Suppression of Type I Interferon Signaling in Myeloid Cells by Autoantibodies in Severe COVID-19 Patients. J Clin Immunol 2024; 44:104. [PMID: 38647550 PMCID: PMC11035476 DOI: 10.1007/s10875-024-01708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Auto-antibodies (auto-abs) to type I interferons (IFNs) have been identified in patients with life-threatening coronavirus disease 2019 (COVID-19), suggesting that the presence of auto-abs may be a risk factor for disease severity. We therefore investigated the mechanism underlying COVID-19 exacerbation induced by auto-abs to type I IFNs. METHODS We evaluated plasma from 123 patients with COVID-19 to measure auto-abs to type I IFNs. We performed single-cell RNA sequencing (scRNA-seq) of peripheral blood mononuclear cells from the patients with auto-abs and conducted epitope mapping of the auto-abs. RESULTS Three of 19 severe and 4 of 42 critical COVID-19 patients had neutralizing auto-abs to type I IFNs. Patients with auto-abs to type I IFNs showed no characteristic clinical features. scRNA-seq from 38 patients with COVID-19 revealed that IFN signaling in conventional dendritic cells and canonical monocytes was attenuated, and SARS-CoV-2-specific BCR repertoires were decreased in patients with auto-abs. Furthermore, auto-abs to IFN-α2 from COVID-19 patients with auto-abs recognized characteristic epitopes of IFN-α2, which binds to the receptor. CONCLUSION Auto-abs to type I IFN found in COVID-19 patients inhibited IFN signaling in dendritic cells and monocytes by blocking the binding of type I IFN to its receptor. The failure to properly induce production of an antibody to SARS-CoV-2 may be a causative factor of COVID-19 severity.
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Grants
- (S) 26221305 Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- (B) 20H03685 Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- (C) 17K08876 Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- (C) 18K07164 Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- 19K16683 Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- (B) JP21H05120 Transformative Research Areas
- (B) JP21H05121 Transformative Research Areas
- JP21ek0410060 Practical Research Project for Allergic Diseases and Immunology (Research on Allergic Diseases and Immunology) from the Japan Agency for Medical Research and Development, AMED
- JP21ek0410082 Practical Research Project for Allergic Diseases and Immunology (Research on Allergic Diseases and Immunology) from the Japan Agency for Medical Research and Development, AMED
- JP19ek0410045 Practical Research Project for Allergic Diseases and Immunology (Research on Allergic Diseases and Immunology) from the Japan Agency for Medical Research and Development, AMED
- JP20gm6110005 AMED-PRIME
- JP21gm1210003 AMED-CREST
- JPMJFR200R JST FOREST Project
- Ministry of Education, Culture, Sports, Science and Technology (MEXT Japan) Grants-in-Aid for Scientific Research
- Transformative Research Areas
- Practical Research Project for Allergic Diseases and Immunology (Research on Allergic Diseases and Immunology) from the Japan Agency for Medical Research and Development, AMED
- JST FOREST Project
- Mochida Memorial Foundation for Medical and Pharmaceutical Research
- MSD Life Science Foundation, Public Interest Incorporated Foundation
- Japanese Respiratory Foundation
- Takeda Science Foundation
- The Japanese Association for Infectious Diseases, Grant for Clinical Research Promotion
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Affiliation(s)
- Ami Aoki
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8510, Japan
| | - Chiaki Iwamura
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan
| | - Masahiro Kiuchi
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Kaori Tsuji
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Atsushi Sasaki
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Takahisa Hishiya
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Rui Hirasawa
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Kota Kokubo
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Sachiko Kuriyama
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Atsushi Onodera
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Tadanaga Shimada
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Tetsutaro Nagaoka
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, 113-8431, Japan
| | | | - Akira Kojima
- Funabashi Central Hospital, Chiba, 273-8556, Japan
| | - Haruki Mito
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, 286-0041, Japan
| | - Ryota Hase
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, 286-0041, Japan
| | - Yasunori Kasahara
- Department of Respiratory Medicine, Eastern Chiba Medical Center, Chiba, 283-8686, Japan
| | - Naohide Kuriyama
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | | | | | - Satoru Kaneda
- Department of Gastroenterology, NHO Chiba Medical Center, Chiba, 260-8606, Japan
| | - Seiichiro Sakao
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Chiba, 286-8520, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, 113-8431, Japan
| | - Motoko Y Kimura
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan
- Department of Experimental Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Shinichiro Motohashi
- Department of Medical Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Hidetoshi Igari
- Department of Infectious Diseases, Chiba University Hospital, Chiba, 260-8677, Japan
- COVID-19 Vaccine Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Yuzuru Ikehara
- Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Hiroshi Nakajima
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan
- COVID-19 Vaccine Center, Chiba University Hospital, Chiba, 260-8677, Japan
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Takuji Suzuki
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Hideki Hanaoka
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8510, Japan
| | - Toshinori Nakayama
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.
- AMED-CREST, AMED, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Kiyoshi Hirahara
- Department of Immunology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.
- Synergy Institute for Futuristic Mucosal Vaccine Research and Development, Chiba University, Chiba, Japan.
- AMED-CREST, AMED, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Hidaka M, Hanaoka H, Uyama Y. Different Development Strategies Affecting Japan's Drug lag between Japan-Based and Foreign-Based Companies. Ther Innov Regul Sci 2024:10.1007/s43441-024-00649-y. [PMID: 38575785 DOI: 10.1007/s43441-024-00649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
We examined the development strategies of new molecular entities approved during a 10-year period (fiscal years of 2012-2021) in Japan to determine the differences in drug lag between Japan and foreign companies. The results demonstrated a clear difference in development strategies. For example, products were usually developed through a "only-Japan" strategy by Japan companies (51.1% of products), compared to a "MRCT (multi-regional clinical trials)" strategy by foreign companies (54.9% of products). Regarding types of licenses, for Japan companies, the percentage of original products was higher in the category of less drug lag, such as "no approval in the US and EU" (59.1%), whereas the percentage of "license-in" products was markedly higher in the "drug lag ≥ 5 years" category (52.5%). Such differences were not observed for products developed by foreign companies. Of 64 license-in products developed by Japan companies with a drug lag > 5 years, 51 (79.7%) had already been approved in the US or EU at initiation of clinical development in Japan. The origin of approximately half (34) of the products was from the emerging companies (non-member foreign companies of the Japan Pharmaceutical Manufacture Association). These results suggest that more global cooperation of Japan companies, particularly with emerging foreign companies, is necessary in terms of the earlier timing of license-in and development strategies of products to promote drug development without drug lag or drug loss in Japan.
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Affiliation(s)
- Masayasu Hidaka
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Global Regulatory Sciences Japan, Bristol-Myers Squibb K.K., Tokyo, Japan
| | - Hideki Hanaoka
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshiaki Uyama
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
- Regulatory Science Center, Pharmaceuticals and Medical Devices Agency, Shin‑Kasumigaseki Building, 3‑3‑2, Kasumigaseki, Chiyoda‑ku, Tokyo, 100‑0013, Japan.
- Graduate School of Medicine, Nagoya University, Nagoya, Japan.
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Ishikawa H, Yoshino O, Taniguchi F, Harada T, Momoeda M, Osuga Y, Hikake T, Hattori Y, Hanawa M, Inaba Y, Hanaoka H, Koga K. Efficacy and safety of a novel pain management device, AT-04, for endometriosis-related pain: study protocol for a phase III randomized controlled trial. Reprod Health 2024; 21:12. [PMID: 38279180 PMCID: PMC10811886 DOI: 10.1186/s12978-024-01739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Endometriosis-related pain encompassing dysmenorrhea, dyspareunia, and chronic pelvic pain, reduces the quality of life in premenopausal women. Although treatment options for endometriosis alleviate this pain, approximately one-third of women still experience pain even after receiving treatment, indicating the need for novel approaches to pain relief in those women. The Angel Touch device (AT-04) is a portable magnetic fields irradiation device that incorporates a combination of mixed alternative magnetic fields at 2 kHz and 83.3 MHz. A phase III trial confirmed the efficacy and safety of AT-02, a prototype of AT-04, for pain relief in patients with fibromyalgia. METHODS This is a phase III, multicenter, prospective, randomized, sham device-controlled, double-blind, parallel study. The participants will be premenopausal women aged > 18 years who have endometriosis-related pain with at least moderate severity. Considering dropouts, 50 participants have been deemed appropriate. Eligible women will be centrally registered, and the data center will randomly allocate them in a 1:1 ratio to the intervention and control groups. Women in the intervention group will receive electromagnetic wave irradiation generated by AT-04 and those who in the control group will wear a sham device for 16 weeks, and both groups will wear AT-04 for another 4 weeks. The primary outcome measure is the change in the Numeric Rating Scale score at 16 weeks compared with the baseline. Secondary outcome measures are efficacy for pelvic pain including dysmenorrhea and non-menstrual pain, and chronic pelvic pain not related to menstruation, dysmenorrhea, and dyspareunia, and improvement of quality of life during the study period. Safety will be evaluated by device defects and the frequency of adverse events. The study protocol has been approved by the Clinical Study Review Board of Chiba University Hospital, Chiba, Japan, and will be conducted in accordance with the principles of the Declaration of Helsinki and the Japanese Clinical Trials Act and relevant notifications. DISCUSSION This study aims to develop a novel method of managing endometriosis-related pain. The AT-04 is an ultralow-invasive device that can be used without inhibiting ovulation, suggesting potential benefits to women of reproductive-age. Trial registration number Japan Registry of Clinical Trials (jRCTs032230278).
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Affiliation(s)
- Hiroshi Ishikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan.
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, 260-8677, Japan.
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi Graduate School of Medicine, Yamanashi, 409-3898, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tottori University, Tottori, 683-8504, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tottori University, Tottori, 683-8504, Japan
| | - Mikio Momoeda
- Department of Obstetrics and Gynecology, Aiiku Hospital, Tokyo, 105-8321, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo Graduate School of Medicine, Tokyo, 113-8655, Japan
| | - Tamiki Hikake
- Chiba University Clinical Research Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Youko Hattori
- Data Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Michiko Hanawa
- Chiba University Clinical Research Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Yosuke Inaba
- Chiba University Clinical Research Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Hideki Hanaoka
- Chiba University Clinical Research Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba, 260-8677, Japan
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Furuta S, Nakagomi D, Kobayashi Y, Hiraguri M, Sugiyama T, Amano K, Umibe T, Kono H, Kurasawa K, Kita Y, Matsumura R, Kaneko Y, Ninagawa K, Hiromura K, Kagami SI, Inaba Y, Hanaoka H, Ikeda K, Nakajima H. Reduced-dose versus high-dose glucocorticoids added to rituximab on remission induction in ANCA-associated vasculitis: predefined 2-year follow-up study. Ann Rheum Dis 2024; 83:96-102. [PMID: 37734880 DOI: 10.1136/ard-2023-224343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES The LoVAS trial reported non-inferiority in remission induction rates between the reduced-dose and conventional high-dose glucocorticoid regimens plus rituximab for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis at 6 months; however, maintenance glucocorticoid requirements and long-term outcomes are unknown. METHODS A total of 140 patients with new-onset ANCA-associated vasculitis without severe glomerulonephritis or alveolar haemorrhage were randomised to receive reduced-dose prednisolone (0.5 mg/kg/day) plus rituximab (375 mg/m2/week×4) or high-dose prednisolone (1 mg/kg/day) plus rituximab. After achieving remission, patients received the rituximab maintenance therapy (1 g/6 months). RESULTS A total of 134 patients were analysed. Among patients who achieved remission with the protocolised treatments, the majority of patients in the reduced-dose group (89.7%) and 15.5% in the high-dose group discontinued prednisolone (median time to withdrawal, 150 and 375 days, respectively). During 24-month trial period, two patients in the reduced-dose group (2.8%) died, while five patients in the high-dose group (7.6%) died (p=0.225). Relapse occurred in nine patients in the reduced-dose group (13.0%) (two major and seven minor) and five in the high-dose group (7.6%) (two major and three minor) (p=0.311). Serious adverse events (SAEs) were less frequent in the reduced-dose group (36 events in 19 patients, 27.5%) than in the high-dose group (54 events in 30 patients, 46.2%) (p=0.025). CONCLUSION At 24 months, frequencies of relapse did not differ between the groups, and SAEs were less frequent in the reduced-dose group due to the lower event rate in the 6-month induction phase. The bias to myeloperoxidase-ANCA positivity (85.8%) in the trial population should be noted. TRIAL REGISTRATION NUMBER NCT02198248.
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Affiliation(s)
- Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, University of Yamanashi, Chuo, Japan
| | - Yoshihisa Kobayashi
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Masaki Hiraguri
- Allergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Takao Sugiyama
- Department of Rheumatology, Shimoshizu Hospital, National Hospital Organization, Yotsukaido, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan
| | - Takeshi Umibe
- Department of Rheumatology, Matsudo City General Hospital, Matsudo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiko Kita
- Department of Rheumatology, Yokohama Rosai Hospital, Yokohoma, Japan
| | - Ryutaro Matsumura
- Department of Rheumatology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keita Ninagawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shin-Ichiro Kagami
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Japan
| | - Yosuke Inaba
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
- Chiba University Synergy Institute for Futuristic Mucosal Vaccine Research and Development (cSIMVa), Chiba University, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Chiba University Synergy Institute for Futuristic Mucosal Vaccine Research and Development (cSIMVa), Chiba University, Chiba, Japan
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Murayama Y, Hamada H, Shiko Y, Onouchi Y, Kakimoto N, Ozawa Y, Hanaoka H, Hata A, Suzuki H. Risk factors for coronary artery abnormalities and resistance to immunoglobulin plus ciclosporin A therapy in severe Kawasaki disease: subanalysis of the KAICA trial, randomized trial for cicrosporin A as the first-line treatment. Front Pediatr 2023; 11:1321533. [PMID: 38161433 PMCID: PMC10755003 DOI: 10.3389/fped.2023.1321533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Background To investigate risk factors for coronary arterial abnormalities (CAAs) and resistance to treatment in patients with Kawasaki disease (KD) receiving intravenous immunoglobulin (IVIG) plus ciclosporin A (CsA) as the first-line treatment, we performed a subanalysis of baseline data of participants in the KAICA trial, a phase 3, randomized study (JMA-ILA00174). Methods All data of the patients enrolled in the KAICA trial, who had a Gunma score ≥5 at diagnosis and had been randomly assigned to either IVIG (2 g/kg/24 h) plus CsA (5 mg/kg/day for 5 days) (n = 86) or IVIG alone (n = 87), were subjected to this study. CAA was defined by a Z score ≥2.5 observed within 4 weeks after treatment initiation. Baseline data including genotypes of KD susceptibility genes were compared between subgroups of patients for CAA or treatment response for each treatment group. Backword-forward stepwise logistic regression analyses were performed. Results Pre-Z-max, defined as the maximum among Z scores on four coronary artery branches before treatment, was higher in patients with CAA in both treatment groups and was associated with CAA in IVIG plus CsA treatment group [odds ratio (OR) = 17.0]. High serum total bilirubin level was relevant to treatment resistance only in the IVIG plus CsA group (OR = 2.34). Conclusions Coronary artery enlargement before treatment is a major determinant of CAA even in KD patients treated with initial IVIG treatment intensified by addition of CsA. Baseline serum total bilirubin level was a risk factor associated with resistance to IVIG plus CsA.
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Affiliation(s)
- Yuri Murayama
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshihito Ozawa
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, School of Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Pediatrics, Tsukushi Medical and Welfare Center, Iwade, Japan
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Takabayashi K, Ando F, Ikeda K, Nakajima H, Hanaoka H, Suzuki T. Incidence of opportunistic infections in patients with rheumatoid arthritis treated with different molecular-targeted drugs: A population-based retrospective cohort study. Mod Rheumatol 2023; 33:1078-1086. [PMID: 36308397 DOI: 10.1093/mr/roac133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2023]
Abstract
OBJECTIVES We compared the incidences of four opportunistic infections (OIs) in patients with rheumatoid arthritis (RA) treated with molecular-targeted drugs from big claims data. MATERIALS AND METHODS We identified 205,906 patients with RA who were prescribed molecular-targeted drugs in 2010-17 from the National Database of Japan and calculated the incidence of four OIs (Pneumocystis pneumonia, tuberculosis, nontuberculous mycobacterial infection, and herpes zoster). RESULTS The total number of Pneumocystis pneumonia, tuberculosis, nontuberculous mycobacterial infection, and herpes zoster patients with biological disease-modifying antirheumatic drugs or tofacitinib treatment history in RA was 765, 1158, 834, and 18,336, respectively. The incidence rates of each OI for all biological disease-modifying antirheumatic drugs were 0.14, 0.14, 0.09, and 2.40 per 100 person-years, respectively, while for tofacitinib they were 0.22, 0.22, 0.07, and 7.00 per 100 person-years. No big difference was observed among biological disease-modifying antirheumatic drugs. All OIs showed higher incidence in those >65 years, but Pneumocystis pneumonia, nontuberculous mycobacterial infection, and herpes zoster showed no difference between those 65-74 years old and those >75 years old. The median of occurrence was the third, seventh, ninth, and thirteenth month after treatment, respectively. CONCLUSIONS We counted real incidence rates of OIs for the whole nation from big claims data.
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Affiliation(s)
- Katsuhiko Takabayashi
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
- Department of Internal Medicine, Sanwa Hospital, Chiba, Japan
| | - Fumihiko Ando
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahiro Suzuki
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
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Miura G, Fujiwara T, Ozawa Y, Shiko Y, Kawasaki Y, Nizawa T, Tatsumi T, Kurimoto T, Mori S, Nakamura M, Hanaoka H, Baba T, Yamamoto S. Efficacy and safety of transdermal electrical stimulation in patients with nonarteritic anterior ischemic optic neuropathy. Bioelectron Med 2023; 9:22. [PMID: 37876021 PMCID: PMC10598888 DOI: 10.1186/s42234-023-00125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND No effective treatment for NAION with strong evidence has been established till date. The aim of this investigator-led, prospective, non-randomized, open-label, uncontrolled multi-center exploratory clinical trial is to evaluate the efficacy and safety of transdermal electrical stimulation (TdES) using skin electrodes in patients with NAION. METHODS Five patients with monocular NAION underwent TdES (10-ms biphasic pulses, 1.0 mA, 20 Hz, 30 min) of the affected eye six times at 2-week intervals. The primary endpoint was the logarithm of the mini-mum angle of resolution (logMAR) visual acuity at 12 weeks compared with 0 weeks. The secondary endpoints were changes in the best-corrected logMAR visual acuity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, and mean deviation (MD) of the Humphrey field analyzer (HFA) 10-2 and HFA Esterman test scores. Additionally, the safety of TdES was evaluated. RESULTS LogMAR visual acuity improved by ≥ 0.1 in two eyes, and ETDRS visual acu-ity improved by ≥ 5 characters in one eye. The mean change in logMAR visual acuity from week 0 showed an increasing trend. The mean MD of HFA 10-2 showed no obvious change, while HFA Esterman score improved in four eyes. All patients completed the study according to the protocol, and no treatment-related adverse events were observed. CONCLUSIONS TdES treatment may have improved visual acuity and visual field in some patients. Further sham-controlled study in larger cohort is needed on its effectiveness. TRIAL REGISTRATION UMIN, UMIN000036220. Registered 15 March, 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041261 .
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Affiliation(s)
- Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Tadami Fujiwara
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tomohiro Nizawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan
| | - Takuji Kurimoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Sotaro Mori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-Ku, Chiba, 260-8670, Japan
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9
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Katsushima M, Nakamura H, Hanaoka H, Shiko Y, Komatsu H, Shimizu E. Randomised controlled trial on the effect of video-conference cognitive behavioural therapy for patients with schizophrenia: a study protocol. BMJ Open 2023; 13:e069734. [PMID: 37696635 PMCID: PMC10496719 DOI: 10.1136/bmjopen-2022-069734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Cognitive behavioural therapy for psychosis (CBTp) has demonstrated effectiveness in reducing positive symptoms, improving depression, enhancing coping skills and increasing awareness of illness. However, compared with cognitive behavioural therapy for depression and anxiety, the spread of CBTp in clinical practice is minimal. The present study designed a randomised controlled trial (RCT) research protocol to evaluate whether real-time remote video-conference CBTp (vCBTp) could facilitate access to psychosocial interventions and effectively improve symptoms compared with usual care (UC) for patients with schizophrenia. METHODS AND ANALYSIS This exploratory RCT will consist of two parallel groups (vCBTp+UC and UC alone) of 12 participants (n=24) diagnosed with schizophrenia, schizoaffective disorder or paranoid disorder, who remain symptomatic following pharmacotherapy. Seven 50-min weekly vCBTp interventions will be administered to test efficacy. The primary outcome will be the positive and negative syndrome scale score at week 8. The secondary outcome will be the Beck Cognitive Insight Scale to assess insight, the Patient Health Questionnaire-9 to assess depression, the Generalised Anxiety Disorder-7 to assess anxiety, the 5-level EuroQol 5-dimensional questionnaire to assess quality of life and the Impact of Event Scale-Revised to assess subjective distress about a specific stressful life event. We will take all measurements at 0 weeks (baseline) and at 8 weeks (post-intervention), and apply intention-to-treat analysis. ETHICS AND DISSEMINATION We will conduct this study in the outpatient department of Cognitive Behavioral Therapy Center at Chiba University Hospital. Further, all participants will be informed of the study and will be asked to sign consent forms. We will report according to the Consolidated Standards of Reporting Trials. TRIAL REGISTRATION NUMBER UMIN000043396.
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Affiliation(s)
- Masayuki Katsushima
- Departments of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
- Department of Rehabilitation, Faculty of Health Care and Medical Sports, Teikyo Heisei University - Chiba Campus, Ichihara, Japan
| | - Hideki Nakamura
- Departments of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
- Department of Nursing, Faculty of Medicine, Jikei University School of Medicine, Minato-ku, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
- Future Medicine Research Center, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Komatsu
- Department of Psychiatry and Psychosomatic Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan
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Okonogi N, Murata K, Yamada S, Habu Y, Hori M, Kurokawa T, Inaba Y, Fujiwara T, Fujii Y, Hanawa M, Kawasaki Y, Hattori Y, Suzuki K, Tsuyuki K, Wakatsuki M, Koto M, Hasegawa S, Ishikawa H, Hanaoka H, Shozu M, Tsuji H, Usui H. A Phase Ib Study of Durvalumab (MEDI4736) in Combination with Carbon-Ion Radiotherapy and Weekly Cisplatin for Patients with Locally Advanced Cervical Cancer (DECISION Study): The Early Safety and Efficacy Results. Int J Mol Sci 2023; 24:10565. [PMID: 37445743 DOI: 10.3390/ijms241310565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
We conducted a phase Ib study to examine the safety of a combination of carbon-ion RT (CIRT) with durvalumab (MEDI4736; AstraZeneca) in patients with locally advanced cervical cancer. This was an open-label, single-arm study with a modified 3 + 3 design. Patients with newly diagnosed histologically proven locally advanced cervical cancer were enrolled. All patients received 74.4 Gy of CIRT in 20 fractions and concurrent weekly cisplatin (chemo-CIRT) at a dose of 40 mg/m2. Durvalumab was administered (1500 mg/body) at weeks two and six. The primary endpoint was the incidence of adverse events (AEs) and serious AEs (SAEs), including dose-limiting toxicity (DLT). All three enrolled patients completed the treatment without interruption. One patient developed hypothyroidism after treatment and was determined to be an SAE. No other SAEs were observed. The patient recovered after levothyroxine sodium hydrate treatment. None of the AEs, including hypothyroidism, were associated with DLT in the present study. All three patients achieved complete responses within the CIRT region concerning treatment efficacy. This phase 1b trial demonstrates the safety of combining chemo-CIRT and durvalumab for locally advanced cervical cancer in the early phase. Further research is required as only three patients were included in this study.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yuji Habu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-Ku, Tokyo 150-0012, Japan
| | - Yoko Hattori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Kazuko Suzuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kyoko Tsuyuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Sumitaka Hasegawa
- Department of Charged Particle Therapy Research, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Miyazaki T, Hosogaya N, Fukushige Y, Takemori S, Morimoto S, Yamamoto H, Hori M, Ozawa Y, Shiko Y, Inaba Y, Kurokawa T, Hanaoka H, Iwanami S, Kim K, Iwami S, Watashi K, Miyazawa K, Umeyama T, Yamagoe S, Miyazaki Y, Wakita T, Sumiyoshi M, Hirayama T, Izumikawa K, Yanagihara K, Mukae H, Kawasuji H, Yamamoto Y, Tarumoto N, Ishii H, Ohno H, Yatera K, Kakeya H, Kichikawa Y, Kato Y, Matsumoto T, Saito M, Yotsuyanagi H, Kohno S. A Multicenter Randomized Controlled Trial To Evaluate the Efficacy and Safety of Nelfinavir in Patients with Mild COVID-19. Microbiol Spectr 2023; 11:e0431122. [PMID: 37140398 PMCID: PMC10269734 DOI: 10.1128/spectrum.04311-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/11/2023] [Indexed: 05/05/2023] Open
Abstract
Nelfinavir, an orally administered inhibitor of human immunodeficiency virus protease, inhibits the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. We conducted a randomized controlled trial to evaluate the clinical efficacy and safety of nelfinavir in patients with SARS-CoV-2 infection. We included unvaccinated asymptomatic or mildly symptomatic adult patients who tested positive for SARS-CoV-2 infection within 3 days before enrollment. The patients were randomly assigned (1:1) to receive oral nelfinavir (750 mg; thrice daily for 14 days) combined with standard-of-care or standard-of-care alone. The primary endpoint was the time to viral clearance, confirmed using quantitative reverse-transcription PCR by assessors blinded to the assigned treatment. A total of 123 patients (63 in the nelfinavir group and 60 in the control group) were included. The median time to viral clearance was 8.0 (95% confidence interval [CI], 7.0 to 12.0) days in the nelfinavir group and 8.0 (95% CI, 7.0 to 10.0) days in the control group, with no significant difference between the treatment groups (hazard ratio, 0.815; 95% CI, 0.563 to 1.182; P = 0.1870). Adverse events were reported in 47 (74.6%) and 20 (33.3%) patients in the nelfinavir and control groups, respectively. The most common adverse event in the nelfinavir group was diarrhea (49.2%). Nelfinavir did not reduce the time to viral clearance in this setting. Our findings indicate that nelfinavir should not be recommended in asymptomatic or mildly symptomatic patients infected with SARS-CoV-2. The study is registered with the Japan Registry of Clinical Trials (jRCT2071200023). IMPORTANCE The anti-HIV drug nelfinavir suppresses the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. However, its efficacy in patients with COVID-19 has not been studied. We conducted a multicenter, randomized controlled trial to evaluate the efficacy and safety of orally administered nelfinavir in patients with asymptomatic or mildly symptomatic COVID-19. Compared to standard-of-care alone, nelfinavir (750 mg, thrice daily) did not reduce the time to viral clearance, viral load, or the time to resolution of symptoms. More patients had adverse events in the nelfinavir group than in the control group (74.6% [47/63 patients] versus 33.3% [20/60 patients]). Our clinical study provides evidence that nelfinavir, despite its antiviral effects on SARS-CoV-2 in vitro, should not be recommended for the treatment of patients with COVID-19 having no or mild symptoms.
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Affiliation(s)
- Taiga Miyazaki
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Nagasaki University, Nagasaki, Japan
| | - Naoki Hosogaya
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuri Fukushige
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Sachiko Takemori
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinpei Morimoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Yamamoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Makoto Hori
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yosuke Inaba
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoya Kurokawa
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Shoya Iwanami
- interdisciplinary Biology Laboratory (iBLab), Division of Biological Sciences, Graduate School of Science, Nagoya University, Aichi, Japan
| | - Kwangsu Kim
- interdisciplinary Biology Laboratory (iBLab), Division of Biological Sciences, Graduate School of Science, Nagoya University, Aichi, Japan
| | - Shingo Iwami
- interdisciplinary Biology Laboratory (iBLab), Division of Biological Sciences, Graduate School of Science, Nagoya University, Aichi, Japan
| | - Koichi Watashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ken Miyazawa
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takashi Umeyama
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Yamagoe
- Section of Infectious Resource Coordination, Department of Research Resource, Center of Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takaji Wakita
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Sumiyoshi
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tatsuro Hirayama
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Pharmacotherapeutics, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hitoshi Kawasuji
- Department of Infectious Disease, Toyama University Hospital, Toyama, Japan
| | - Yoshihiro Yamamoto
- Department of Infectious Disease, Toyama University Hospital, Toyama, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University Hospital, Saitama, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hideaki Ohno
- Department of Infectious Disease and Infection Control, Saitama Medical Center, Saitama, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, Hospital of the University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Yasuyuki Kato
- Department of Infectious Diseases, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Makoto Saito
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Fujita M, Nagashima K, Shimazu M, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Hanaoka H, Shozu M, Tsuruoka N, Kasai T, Hata A. Acceptability of self-sampling human papillomavirus test for cervical cancer screening in Japan: A questionnaire survey in the ACCESS trial. PLoS One 2023; 18:e0286909. [PMID: 37289798 PMCID: PMC10249862 DOI: 10.1371/journal.pone.0286909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE In terms of medical policy for cervical cancer prevention, Japan lags far behind other industrialized countries. We initiated a randomized controlled trial to evaluate the self-sampling human papillomavirus (HPV) test as a tool to raise screening uptake and detection of pre-cancer. This study was conducted to explore the acceptability and preference of self-sampling using a subset of the data from this trial. METHODS A pre-invitation letter was sent to eligible women, aged 30-59 years who had not undergone cervical cancer screening for three or more years. After excluding those who declined to participate in this trial, the remaining women were assigned to the self-sampling and control groups. A second invitation letter was sent to the former group, and those wanting to undergo the self-sampling test ordered the kit. A self-sampling HPV kit, consent form, and a self-administered questionnaire were sent to participants who ordered the test. RESULTS Of the 7,340 participants in the self-sampling group, 1,196 (16.3%) administered the test, and 1,192 (99.7%) answered the questionnaire. Acceptability of the test was favorable; 75.3-81.3% of participants agreed with positive impressions (easy, convenient, and clarity of instruction), and 65.1-77.8% disagreed with negative impressions (painful, uncomfortable, and embarrassing). However, only 21.2% were confident in their sampling procedure. Willingness to undergo screening with a self-collected sample was significantly higher than that with a doctor-collected sample (89.3% vs. 49.1%; p<0.001). Willingness to undergo screening with a doctor-collected sample was inversely associated with age and duration without screening (both p<0.001), but that with a self-collected sample was not associated. CONCLUSIONS Among women who used the self-sampling HPV test, high acceptability was confirmed, while concerns about self-sampling procedures remained. Screening with a self-collected sample was preferred over a doctor-collected sample and the former might alleviate disparities in screening rates.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Misae Suzuki
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Ichiro Tauchi
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Miwa Sakuma
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Setsuko Yamamoto
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Departments of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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13
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Ando F, Takabayashi K, Fujita S, Nakajima H, Hanaoka H, Suzuki T. Seasonal exacerbation of rheumatoid arthritis detected by big claims data analysis: A retrospective population study. Mod Rheumatol 2023; 33:46-53. [PMID: 35165740 DOI: 10.1093/mr/roab122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The objective of the study was to determine the seasonal changes in the initiation of biological disease-modifying antirheumatic drugs (bDMARDs) and methotrexate (MTX) using big claims data. METHODS We counted the monthly number of initial administrations of each bDMARD and MTX in patients with rheumatoid arthritis (RA) between April 2010 and March 2017. Data were collected from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. This database covers more than 95% of Japanese citizens. Seasonal changes in the number of initiations were determined. Patient claims were also classified according to drugs, districts, gender, and ages. RESULTS The initiation of bDMARDs and MTX administration varied according to the season in a sine curve shape, with the highest numbers in May to July and the lowest numbers in November to January. The same changing pattern was observed among each bDMARD, district, gender, and age groups particularly when the number was on the higher side. CONCLUSION We noted an apparent seasonal change in the number of bDMARDs initiated, with a peak during spring, suggesting an exacerbation of RA in the spring in Japan. These changes are overlooked in daily practice and are only visible using big data.
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Affiliation(s)
- Fumihiko Ando
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Katsuhiko Takabayashi
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan.,Department of Internal Medicine, Sanwa Hospital, Chiba, Japan
| | - Shinsuke Fujita
- Department of Clinical Design and Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahiro Suzuki
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
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Miura G, Fujiwara T, Iwase T, Ozawa Y, Shiko Y, Kawasaki Y, Nizawa T, Tatsumi T, Baba T, Kurimoto T, Mori S, Nakamura M, Hanaoka H, Yamamoto S. Exploratory clinical trial to evaluate the efficacy and safety of transdermal electrical stimulation in patients with central retinal artery occlusion. PLoS One 2023; 18:e0282003. [PMID: 36827287 PMCID: PMC9955643 DOI: 10.1371/journal.pone.0282003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transdermal electrical stimulation (TdES) using skin electrodes in patients with central retinal artery occlusion (CRAO). METHODS Five eyes of five patients with CRAO underwent TdES (10-ms biphasic pulses, 20 Hz, 30 min) six times at 2-week intervals. Only the affected eye was stimulated with 1.0-mA pulses in all patients. The primary endpoint was the best-corrected logMAR visual acuity. The secondary endpoints were changes in the best-corrected logMAR visual acuity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, mean deviation of the Humphrey field analyzer (HFA) 10-2, and HFA Esterman test score. We also evaluated its safety. RESULTS The logMAR visual acuity at 12 weeks was improved by 0.1 or more in two patients and was maintained in two patients compared to the baseline. No obvious changes in the mean logMAR visual acuity, ETDRS visual acuity, mean deviation, and HFA Esterman score were observed at 12 weeks compared to the baseline. All five enrolled patients completed the study according to the protocol. No treatment-related adverse events were observed during this study. CONCLUSION In this study, logMAR visual acuity was slightly improved in two patients, confirming the safety of TdES. Since CRAO has no established treatment method, further research into the effects of TdES treatment in CRAO patients may be beneficial.
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Affiliation(s)
- Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
- * E-mail:
| | - Tadami Fujiwara
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Takayuki Iwase
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tomohiro Nizawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuji Kurimoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sotaro Mori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Kohno S, Miyazaki T, Hosogaya N, Morimoto S, Yamamoto H, Iwami S, Miyazaki Y, Hanaoka H. 1128. Efficacy and Safety of Nelfinavir in Asymptomatic and Mild COVID-19 Patients: A Multicenter, Randomized Controlled Trial. Open Forum Infect Dis 2022. [PMCID: PMC9752835 DOI: 10.1093/ofid/ofac492.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Nelfinavir, an orally administered inhibitor of human immunodeficiency virus protease, inhibited the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. To evaluate the efficacy and safety of nelfinavir, we conducted a randomized controlled trial. Methods Adult patients testing positive for SARS-CoV-2 infection within 3 days were eligible for the study if they had no or mild symptoms of coronavirus disease 2019. Exclusion criteria included the followings: onset of symptoms ≥ 8 days before enrollment; oxygen saturation of 95% or less on room air; and vaccinated patients. Patients were randomly assigned (1:1) to receive oral nelfinavir 750 mg (×3 times daily) combined with standard-of-care or standard-of-care alone. The primary endpoint was the time to clearance of SARS-CoV-2. Saliva was collected every day and viral load was measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Nelfinavir was administered for 14 days. However, the treatment could be discontinued by the decision of investigator, if patients had 2 consecutive negative test results by qRT-PCR. Clinical course and safety information were collected through day 28. The study is registered with the Japan Registry of Clinical Trials (number, jRCT2071200023). Results Between July 2020 and October 2021, 123 patients (63 in the nelfinavir group and 60 in the control group) were enrolled into the study and included in the analysis. The median time to viral clearance was 8.0 (95% confidence interval [CI] 7.0 to 12.0) days in the nelfinavir group and 8.0 (95% CI 7.0 to 10.0) days in the control group without statistically significant difference between the treatment group (hazard ratio 0.815, 95% CI 0.563 to 1.182; P = 0.1870). Adverse events were reported in 47 (74.6%) patients in the nelfinavir group and 20 (33.3%) in the control group. The most common adverse events in the nelfinavir group were diarrhea (49.2%) and nausea (6.3%). Conclusion Nelfinavir did not reduce the time to viral clearance in this setting. Disclosures Shigeru Kohno, n/a, Pfizer: Grant/Research Support|Pfizer: Honoraria Taiga Miyazaki, n/a, Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria.
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Mashimo Y, Yamazaki K, Kageyama T, Tanaka S, Taniguchi T, Matsushita K, Igari H, Hanaoka H, Yokote K, Nakajima H, Onouchi Y. Germline variants of IGHV3-53 / V3-66 are determinants of antibody responses to the BNT162b2 mRNA COVID-19 vaccine. J Infect 2022; 85:702-769. [PMID: 36341890 PMCID: PMC9627529 DOI: 10.1016/j.jinf.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Yoichi Mashimo
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Keiko Yamazaki
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Takahiro Kageyama
- Department of Allergy and Clinical Immunology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Toshibumi Taniguchi
- Department of Infectious Diseases, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan; Chiba University Hospital COVID-19 Vaccine Center, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Kazuyuki Matsushita
- Division of Laboratory Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Hidetoshi Igari
- Department of Infectious Diseases, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan; Chiba University Hospital COVID-19 Vaccine Center, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan; Chiba University Hospital COVID-19 Vaccine Center, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, Chiba 260-8670, Japan.
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Aso M, Yamamoto TT, Kuroda M, Wada J, Kubota Y, Ishikawa K, Maezawa Y, Teramoto N, Tawada A, Asada S, Aoyagi Y, Kirinashizawa M, Onitake A, Matsuura Y, Yasunaga K, Konno SI, Nishino K, Yamamoto M, Miyoshi J, Kobayashi N, Tanio M, Ikeuchi T, Igari H, Mitsukawa N, Hanaoka H, Yokote K, Saito Y. First-in-human autologous implantation of genetically modified adipocytes expressing LCAT for the treatment of familial LCAT deficiency. Heliyon 2022; 8:e11271. [PMID: 36387451 PMCID: PMC9663876 DOI: 10.1016/j.heliyon.2022.e11271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/21/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Familial lecithin: cholesterol acyltransferase (LCAT) deficiency (FLD) is a severe inherited disease without effective treatment. Patients with FLD develop severe low HDL, corneal opacity, hemolytic anemia, and renal injury. Objective We developed genetically modified adipocytes (GMAC) secreting LCAT (LCAT-GMAC) for ex vivo gene therapy. GMACs were prepared from the patient’s adipocytes to express LCAT by retroviral gene transduction to secrete functional enzymes. This study aimed to evaluate the safety and efficacy of LCAT-GMAC implantation in an FLD patient. Methods Proliferative preadipocytes were obtained from a patient using a ceiling culture and retrovirally transduced with LCAT. After obtaining enough cells by expansion culture of the transduced cells, the resulting LCAT-GMACs were implanted into a patient with FLD. To evaluate the safety and efficacy, we analyzed the outcome of the autologous implantation for 24 weeks of observation and subsequent 240 weeks of the follow-up periods. Results This first-in-human autologous implantation of LCAT-GMACs was shown to be safe by evaluating adverse events. The LCAT-GMAC implantation increased serum LCAT activity by approximately 50% of the baseline and sustained over three years. Consistent with increased LCAT activity, intermediate-density lipoprotein (IDL) and free cholesterol levels of the small and very small HDL fractions decreased. We found the hemoglobin/haptoglobin complex in the hemolyzed pre-implantation sera of the patient. After one week of the implantation, the hemoglobin/haptoglobin complex almost disappeared. Immediately after the implantation, the patient's proteinuria decreased temporarily to mild levels and gradually increased to the baseline. At 48 weeks after implantation, the patient's proteinuria deteriorated with the development of mild hypertension. By the treatment with antihypertensives, the patient's blood pressure normalized. With the normalization of blood pressure, the proteinuria rapidly decreased to mild proteinuria levels. Conclusions LCAT-GMAC implantation in a patient with FLD is shown to be safe and appears to be effective, in part, for treating anemia and proteinuria in FLD.
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Affiliation(s)
| | | | - Masayuki Kuroda
- Center for Advanced Medicine, Chiba University Hospital, 2608677 Chiba, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 7008530 Okayama, Japan
| | - Yoshitaka Kubota
- Department of Plastic and Reconstructive Surgery, Chiba University, Faculty of Medicine, 2608670 Chiba, Japan
| | - Ko Ishikawa
- Department of Endocrinology, Hematology, and Gerontology, Chiba University, Graduates School of Medicine and Department of Diabetes, Metabolism, and Endocrinology, Chiba University Hospital, 2608670 Chiba, Japan
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology, and Gerontology, Chiba University, Graduates School of Medicine and Department of Diabetes, Metabolism, and Endocrinology, Chiba University Hospital, 2608670 Chiba, Japan
| | - Naoya Teramoto
- Department of Endocrinology, Hematology, and Gerontology, Chiba University, Graduates School of Medicine and Department of Diabetes, Metabolism, and Endocrinology, Chiba University Hospital, 2608670 Chiba, Japan
| | - Ayako Tawada
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 2608670 Chiba, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Takayuki Ikeuchi
- Chiba University Hospital Clinical Research Center, 2608677 Chiba, Japan
| | - Hidetoshi Igari
- Division of Infection Control, Chiba University Hospital, 2608677 Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic and Reconstructive Surgery, Chiba University, Faculty of Medicine, 2608670 Chiba, Japan
| | - Hideki Hanaoka
- Chiba University Hospital Clinical Research Center, 2608677 Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology, and Gerontology, Chiba University, Graduates School of Medicine and Department of Diabetes, Metabolism, and Endocrinology, Chiba University Hospital, 2608670 Chiba, Japan
- Corresponding author.
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Ikeda K, Nakada TA, Kageyama T, Tanaka S, Yoshida N, Ishikawa T, Goshima Y, Otaki N, Iwami S, Shimamura T, Taniguchi T, Igari H, Hanaoka H, Yokote K, Tsuyuzaki K, Nakajima H, Kawakami E. Detecting time-evolving phenotypic components of adverse reactions against BNT162b2 mRNA SARS-CoV-2 vaccine via non-negative tensor factorization. iScience 2022; 25:105237. [PMID: 36188188 PMCID: PMC9515008 DOI: 10.1016/j.isci.2022.105237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/05/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Symptoms of adverse reactions to vaccines evolve over time, but traditional studies have focused only on the frequency and intensity of symptoms. Here, we attempt to extract the dynamic changes in vaccine adverse reaction symptoms as a small number of interpretable components by using non-negative tensor factorization. We recruited healthcare workers who received two doses of the BNT162b2 mRNA COVID-19 vaccine at Chiba University Hospital and collected information on adverse reactions using a smartphone/web-based platform. We analyzed the adverse-reaction data after each dose obtained for 1,516 participants who received two doses of vaccine. The non-negative tensor factorization revealed four time-evolving components that represent typical temporal patterns of adverse reactions for both doses. These components were differently associated with background factors and post-vaccine antibody titers. These results demonstrate that complex adverse reactions against vaccines can be explained by a limited number of time-evolving components identified by tensor factorization. Tensor factorization identified 4 components that explain vaccine adverse reactions These components were differently associated with background factors Only 1 component was significantly associated with post-vaccine antibody titer These methods and results will inform future studies on vaccine safety and efficacy
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Edamoto M, Kikuchi J, Hanaoka H, Saito S, Hiramoto K, Kaneko Y. POS0760 HIGH LEVELS OF PROTEINS, CELL COUNTS, AND IL-6 IN CEREBROSPINAL FLUID IN PATIENTS WITH NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS ARE ASSOCIATED WITH DAMAGE ACCRUAL OF NON-NEUROPSYCHIATRIC DOMAINS AS WELL AS THAT OF NEUROPSYCHIATRIC DOMAINS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNeuropsychiatric systemic lupus erythematosus (NPSLE) is one of severe organ manifestations and directly associated with neuropsychiatric damages, such as cerebral vascular accident, cognitive impairment, or seizures. However, factors associated with damage accrual of neuropsychiatric and non-neuropsychiatric domains in NPSLE patients remain unknown.ObjectivesThe aim of this study was to identify factors associated with damage accrual in patients with NPSLE.MethodsWe reviewed all patients with SLE who had attended our hospital between January 2010 to December 2020 retrospectively and identified those with NPSLE. We analyzed clinical characteristics and laboratory data including cerebrospinal fluid (CSF) in association with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) progression after the onset of NPSLE.Results461 patients with SLE were reviewed. Among them, 37 (8.0%) were diagnosed with NPSLE. Thirty-six patients were included in the analysis after excluding one patient with insufficient information. Seventeen (47.2%) patients were diagnosed with NPSLE at the same time with SLE diagnosis and 19 patients were diagnosed at relapse. At NPSLE onset, the mean age was 33.7 years, 35 were female, and the mean SLEDAI-2K was 21.8. Eighteen (50.0%) patients had active lupus nephritis simultaneously at the onset of NPSLE. The most frequent NPSLE types according to the 1999 ACR classification were lupus headache in 10 patients, followed by cerebrovascular disease in 7, seizure disorders in 6, acute confusional state, psychosis and mononeuropathy in 3, and aseptic meningitis in 2. All patients were treated with glucocorticoids, and the mean initial dose of prednisolone was 52.3 mg/day with steroid pulse therapy in 19 patients. Thirty (83.3%) patients were treated with concomitant immunosuppressive treatments. During the observation period with the mean of 10.0 years, 17 (47.2%) patients developed at least one point of SDI. Among them, 9 patients (25.0%) had neuropsychiatric damage progression including cerebrovascular accident in 6, seizures requiring drug treatment for more than 6 months in 2, and cognitive impairment in 1. Non-neuropsychiatric damage was also increased such musculoskeletal in 5, ocular in 3, cardiovascular in 2, renal, gastrointestinal, premature gonadal failure, diabetes, and malignancy in each one case. Neither neuropsychiatric nor overall damage progression were associated with SLEDAI-2K, anti-cardiolipin antibodies positivity, abnormal electroencephalogram, abnormal single photon-emission computed tomography at NPSLE onset or kinds of immunosuppressive treatments. In 21 patients who underwent CSF examination, the high level of CSF IL-6 was associated with neuropsychiatric damage progression (p=0.032). Also, high levels of CSF protein (p=0.030), cell counts (p=0.007), and IL-6 (p=0.032) were associated with overall SDI progression.ConclusionCSF IL-6 concentrations are associated with neuropsychiatric damage progression, and high CSF protein, cell counts and IL-6 at onset in patients with NPSLE can predict overall damage accrual.References[1]Liang MH, Corzillius M, Bae SC, et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42: 599–608.[2]Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for systemic lupus erythematosus. Arthritis Rheum 1996; 39: 363–369.Disclosure of InterestsNone declared
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Fukui H, Hanaoka H, Kaneko Y. POS1436 CLINICAL CHARACTERISTICS AND RISK FACTORS OF INVASIVE FUNGAL INFECTION DURING IMMUNOSUPPRESSIVE INDUCTION THERAPY IN PATIENTS WITH CONNECTIVE TISSUE DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundInvasive fungal infection (IFI) is a life-threatening complication among immunosuppressed patients. Whereas intensive immunosuppressive therapy during remission induction phase in patients with connective tissue disease is a major risk of IFI, little is known about the clinical characteristics and risk factors of IFI.ObjectivesThis study aims to reveal prevalence, clinical characteristics, and associated risk factors of IFI during immunosuppressive induction therapy in patients with connective tissue disease.MethodsWe reviewed consecutive patients with connective tissue diseases who underwent immunosuppressive remission induction therapy in Keio University Hospital Rheumatology Department from January 2012 to August 2020. Patients with 0.5mg/kg or more equivalent dose of daily prednisone use were included for IFI, diagnosed according to the definition of invasive fungal diseases from EORTC/MSG 2008. Infections caused by Pneumocystis jirovecii were not included.ResultsAmong 2701 hospitalized cases, 627 patients had undergone induction or re-induction therapy. Total of 24(3.8%) patients were diagnosed as IFI, of whom there were 8 proven cases and 16 probable cases; 14 aspergillosis, 5 candidiasis, 2 cryptococcosis, 1 phaeohyphomycosis, and 2 cases with unknown pathogen. Median duration from the start of immunosuppressive therapy to the onset of IFI was 95 days (interquartile range, 36,249 days; range, 13-1397 days) and the mean dose of daily prednisolone was 0.53±0.29 mg/kg at the onset of IFI. Total of 11 patients died; 6 patients (25.0%) due to IFI and 5 patients (20.8%) due to the exacerbation of underlying disease. Univariable analysis comparing the IFI and non-IFI groups, age (65.8±3.7 vs. 56.1±0.7; P=0.01), initial prednisolone dose (0.87±0.01 vs 0.95±0.04 mg/kg; P=0.037), the history of methylprednisolone (mPSL) pulse therapy (54.2% vs. 20.0%; P<0.001), tumor necrosis factor (TNF) inhibitor use (8.3% vs. 1.1%; P=0.039), 2 or more immunosuppressant or biologic use (33.3% vs. 12.9%; P=0.010), HbA1c 6.5% or higher (58.3% vs. 28.9%; P=0.003), lowest serum IgG during the clinical course (599.4±62.1 vs 787.7±12.4 mg/dl; P=0.003), and cytomegalovirus reactivation defined by pp65 antigen 6 or higher (33.3% vs. 11.2%; P=0.004) were significantly different, respectively. Sex, body mass index, presence of interstitial lung disease, and the use of cyclophosphamide, rituximab, or interleukin-6 inhibitors were not significantly different. Multivariable analysis revealed older age (for each 10-year increase: OR 1.40, 95% CI 1.03-1.91; P=0.023), the history of methylprednisolone pulse therapy (OR 2.60, 95% CI 1.06-6.77; P=0.049), TNF inhibitor use (OR 11.2, 95% CI 1.70-74.0; P=0.012), and serum IgG less than 550 mg/dl (OR 2.59, 95% CI 1.03-6.55; P=0.041) as the independent risk factors of IFI.ConclusionPatients with connective tissue disease with older age, lower serum IgG, mPSL pulse therapy, or TNF inhibitor use are at higher risk of IFI. Further studies are needed to determine the benefit of prophylactic anti-fungal treatment in such patients.References[1]De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813-1821.Disclosure of Interests:None declared
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Hiramoto K, Saito S, Hanaoka H, Suzuki K, Kikuchi J, Fukui H, Takano R, Miyoshi F, Seki N, Sugahara K, Kaneko Y, Takeuchi T. POS0459 APTAMER-BASED PROTEOMIC SCREENING IN IDENTIFICATION OF PATHOGENIC SIGNAL PATHWAY AND URINARY BIOMARKERS ASSOCIATED WITH HISTOLOGICAL FINDINGS IN LUPUS NEPHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe current gold standard for the diagnosis and classification, assessment of the severity of lupus nephritis (LN) is a renal biopsy. On the other hand, since the procedure is highly invasive, there is a pressing need to identify biomarkers for predicting the presence and its histological severity of LN. In addition, the background pathogenesis of each histological findings is not clearly understood.ObjectivesThe purpose of this study was to elucidate the urine biomarkers for predicting the presence and the severity of histological findings of LN, and to search the pathogenic signal pathway.MethodsUrine samples from 24 biopsy-proven active LN patients were initially screened for the levels of 1305 distinct human proteins using an aptamer-based-targeted proteomic assay. We developed histological scoring system based on ISN/RPS lesion definitions and classification, NIH activity and chronicity score. Two experienced evaluators assessed the histological scores. Cluster analysis and pathway analysis were performed.ResultsA total of 24 LN patients were included: 20 (83%) had a proliferative histological class (III or IV +/-V), 4 (17%) pure membranous (V). Through cluster analysis, several histological subgroups were extracted according to correlation with each histological finding, and proteins which corelated with each histological scores were analyzed. We focused on two subgroups: one in which including active glomerular histological findings (endocapillary hypercellularity, karyorrhexis, neutrophil infiltration, subendothelial deposits) and the other in which including interstitial histological findings (interstitial inflammation, interstitial fibrosis, tubular atrophy). Histological scores in the former group showed strong positive correlation with protein group which contained 59 proteins (Group A), including CCL21, CXCL10, VCAM1. Histological scores in the latter group corelated with another protein group which contained 85 proteins (Group B), including MCP-1, CCL11. Ingenuity Pathway Analysis showed 16 pathways (PDGF Signaling, Granulocyte Adhesion and Diapedesis, etc) were upregulated in Group A and 11 pathways (IL-17 signaling, Fibrosis signaling pathway, etc) upregulated in Group B. Among group A and group B urine proteins, those showed strong correlation between respective histological findings were validated with ELISA assays.ConclusionAn aptamer-based-targeted proteomic assay screening by combining with renal histological scoring system suggested several urine proteins can predict the severity and the presence of major renal histological findings, and suggested to be related with the pathogenesis in patients with LN.Disclosure of InterestsKazuoto Hiramoto: None declared, Shuntaro Saito: None declared, Hironari Hanaoka: None declared, Katsuya Suzuki: None declared, Jun Kikuchi: None declared, Hiroyuki Fukui: None declared, Ryo Takano Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Fumihiko Miyoshi Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Noriyasu Seki Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Kunio Sugahara Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Yuko Kaneko: None declared, Tsutomu Takeuchi: None declared.
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Ota Y, Kondo Y, Saito S, Kikuchi J, Hanaoka H, Kaneko Y. POS1183 RISK FACTORS FOR CYTOMEGALOVIRUS INFECTION IN PATIENTS WITH RHEUMATIC DISEASE; SINGLE-CENTER PROSPECTIVE COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCytomegalovirus (CMV) infection is one of serious opportunistic infections for immunosuppressed patients, therefore, identifying patients at risk for CMV infection is of importance. However, no prospective study about CMV infection in systemic rheumatic disease has been reported.ObjectivesTo identify risk factors relevant with CMV infection in patients with systemic rheumatic disease during intensive remission induction therapy.MethodsConsecutive systemic rheumatic disease cases who started intensive immunosuppressive therapy from February 2017 until February 2019 were enrolled. Serum CMV-IgG was measured before the induction therapy, and subsequently, CMV pp65 antigen was monitored weekly. Patients were divided into 2 groups according to the presence or absence of CMV infection, and risk factors for CMV infection were analyzed.Results157 patients consisting of 136 CMV-IgG positive and 21 CMV-IgG negative patients were enrolled in the study. Mean age was 60.8 ± 17.4 y/o, and female was 70.7%. The underlying diseases were following; vasculitides 54, systemic lupus erythematosus 27, polymyositis/dermatomyositis 25, rheumatoid arthritis 14, IgG4-related disease 13, mixed connected tissue disease 6, Behçet disease 5, adult-onset Still’s disease 4, and others 9. The initial dose of glucocorticoid (GC) was 48.4 ± 11.5 mg/day (0.91 ± 0.16 mg/kg/day) as prednisolone (PSL) with additional methylprednisolone (mPSL) pulse therapy being conducted in 44 (28.0%). Concomitant immunosuppressive therapies were intravenous cyclophosphamide (IVCY) in 55, calcineurin inhibitor 27, mycophenolate mofetil 16, hydroxychloroquine 5, and methotrexate 4. Concomitant biological agents were rituximab 12, tocilizumab 6, infliximab 2, golimumab 1, and abatacept 1. CMV infection occurred in 52 patients (33.1%), and all of them were CMV-IgG positive before induction therapy (38.2% in the CMV-IgG positive patients). Univariable analysis revealed initial PSL dose >0.91 mg/kg/day (odds ratio [OR] 5.2, p<0.01), IVCY (OR 3.4, p<0.01), diabetes mellitus (OR 5.2, p<0.01), and a history of malignancy (OR 2.9, p=0.02) were independent risk factors for CMV infection. CMV antiviral drugs were administered in 22 patients (42.3%). At the first detection of CMV pp65 antigen, PSL dose ≥37.5 mg/day (OR 5294.8, p<0.01), CMV pp65 antigen-positive cells ≥2 cells/2 slides (OR 16.0, p = 0.04), and serum albumin levels <3.0 g/dL (OR 26.3, p=0.01) were associated with subsequent CMV antiviral drug administration.ConclusionCMV infection occurred only in CMV-IgG positive patients with systemic rheumatic diseases who were undergoing intensive remission induction therapy. CMV infection was related with treatment regimen and comorbidities, and the necessity of CMV antiviral treatment was predicted with prednisolone dose, the number of CMV pp65 antigen positive cells, and albumin levels at the first detection of CMV pp65 antigen.Disclosure of InterestsNone declared
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Kondo Y, Takeshita M, Uwamino Y, Namkoong H, Saito S, Kikuchi J, Hanaoka H, Suzuki K, Hasegawa N, Murata M, Kaneko Y. POS0257 COMPARISON OF SARS-CoV-2 VACCINE RESPONSE IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASE; mRNA-1273 VACCINE INDUCES HIGHER HUMORAL IMMUNOGENICITY THAN BNT162b2. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe SARS-CoV-2 messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) have benefitted all countries amid the coronavirus disease 2019 (COVID-19) crisis. Whereas both of them have shown efficacy in preventing COVID-19 illness in healthy participants, there is paucity of data about immunogenicity and safety of mRNA COVID-19 vaccines in patients with autoimmune, inflammatory rheumatic disease. Recent observational studies evaluated mainly BNT162b2, suggesting that glucocorticoids, immunosuppressive agents impair SARS-CoV-2 vaccine responses. However, difference in immune reactions and safety between BNT162b2 and mRNA-1273 have not been clarified in patients with inflammatory rheumatic diseases.ObjectivesTo assess humoral and T cell immune responses and safety profiles after two doses of different mRNA vaccine against SARS-CoV-2; BNT162b2 and mRNA-1273.MethodsWe enrolled consecutive, previously uninfected patients with inflammatory rheumatic diseases receiving mRNA vaccine including BNT162b2 and mRNA-1273. Healthy participants receiving BNT162b2 were also recruited as control. Blood samples were obtained 3weeks, 2 months, 3 months, 4 months, and 6 months after second dose of vaccines. We measured titres of neutralizing antibodies against SARS-CoV-2 and calculated seroconversion rates to evaluate humoral responses. We also assessed T-cell immunity responses by using interferon releasing assay against SARS-CoV-2 in a part of the patients. Answers to questionnaires about adverse reactions were obtained from participants.ResultsA total of 974 patients with inflammatory rheumatic diseases and healthy 630 control participants were enrolled. Among them, 796 patients received BNT162b2, 178 patients received mRNA-1273, and all control participants received BNT162b2. Seroconversion rates and neutralizing antibody titres 3 weeks after vaccination were significantly higher in patients with mRNA-1273 and healthy participants with BNT162b2 compared with patients with BNT162b2; seroconversion rates, 97.2% vs 99.5% vs 83.3%, p<0.001; titers of neutralizing antibodies, 29.4±33.9 IU/mL vs 23.9±14.2 IU/mL vs 10.8±16.5 IU/mL, p<0.001, respectively. On another front, T cell reaction against SARS-CoV-2 was similar in both patients with mRNA-1273 and BNT162b2; interferon gamma levels for antigen 1, 1.2±2.1 IU/mL vs 0.8±2.5 IU/mL, p=0.23; and for antigen 2, 1.4±1.9 IU/mL vs 1.0±2.1 IU/mL, p=0.11, respectively. Regarding adverse reaction of each mRNA vaccine, the frequency of systemic adverse reactions including fever and general fatigue are also significantly higher in patients with mRNA-1273 and healthy controls than patients with BNT162b2; fever, 48.0% vs 44.9% vs 10.2%, p<0.001; general fatigue, 70.4% vs 61.8% vs 31.2%, p<0.001, respectively). In longitudinal measurement, neutralizing antibody titres in patients with BNT162b2 were decreased more rapidly than those in healthy controls; 3.3±3.2 IU/mL in patients with BNT162b2 at 4 months and 3.2±4.7 IU/mL in healthy controls with BNT162b2 at 6 months. We identified age, glucocorticoid dose (prednisolone > 7.5mg), use of immunosuppressants including methotrexate, mycophenolate, cyclophosphamide, and tacrolimus are associated with rapid attenuation of humoral responses in patients with BNT162b2.ConclusionOur results demonstrated a significant higher humoral immunogenicity and frequency of systemic adverse reaction of the SARS-CoV-2 mRNA-1273 (Moderna) compared with the BNT162b2 (Pfizer-BioNTech) in inflammatory rheumatic disease patients. Glucocorticoid and immunosuppressive agents impaired induction and sustention of neutralizing antibody, and earlier third booster vaccination may be required within 4 months, especially for those receiving BNT162b2.References[1]Steensels D, Pierlet N, Penders J et al. JAMA. 2021;326(15):1533–1535.[2]Friedman MA, Curtis JR and Winthrop KL. Ann Rheum Dis 2021;80:1255–1265.Disclosure of InterestsNone declared
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Miura G, Ozawa Y, Shiko Y, Kawasaki Y, Iwase T, Fujiwara T, Baba T, Hanaoka H, Yamamoto S. Evaluating the efficacy and safety of transdermal electrical stimulation on the visual functions of patients with retinitis pigmentosa: a clinical trial protocol for a prospective, multicentre, randomised, double-masked and sham-controlled design (ePICO trial). BMJ Open 2022; 12:e057193. [PMID: 35523495 PMCID: PMC9083404 DOI: 10.1136/bmjopen-2021-057193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Previously, we conducted a clinical trial to evaluate the safety and efficacy of transdermal electrical stimulation (TdES) with skin electrodes to improve the visual functions in patients with retinitis pigmentosa (RP). No adverse events were related to the treatment during follow-up examinations, and TdES significantly improved the mean visual acuity and visual field sensitivity. METHODS AND ANALYSIS We developed a study protocol for a prospective, multicentre, randomised, double-masked and sham-controlled clinical trial, planned to commence on June 2021. We intend to compare the maintenance or improvement in best-corrected visual acuity, and safety of TdES using skin electrodes between patients with RP and the sham group. The primary endpoint comprises the superiority of the logarithm of the minimum angle of resolution (logMAR) visual acuity change at week 24 from baseline in the treatment and sham groups. Secondary endpoints involve the comparison of the treatment and sham groups at week 24 for the logMAR visual acuity, early treatment diabetic retinopathy study visual acuity, the mean deviation value of Humphrey field analyser 10-2, monocular Humphrey Esterman visual field test score, ellipsoid zone length, central foveal thickness and 25-item National Eye Institute Visual Function Questionnaire score. We intend to enrol 50 patients from three Japanese institutions within 1 year and follow them up for 1 years. ETHICS AND DISSEMINATION The protocol was approved by the institutional review board at the Chiba University Hospital and two other institutions, and was registered with the Japan Registry of Clinical Trials on 17 May 2021. The trial will be conducted in accordance with the principles of the Declaration of Helsinki, and is in accordance with Good Clinical Practice standards. The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER JRCT2032210094.
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Affiliation(s)
- Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Yoshihito Ozawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takayuki Iwase
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chiba, Japan
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Sasaki T, Hashimoto K, Niitsu T, Hosoda Y, Oda Y, Shiko Y, Ozawa Y, Kawasaki Y, Kanahara N, Shiina A, Hashimoto T, Suzuki T, Sugawara T, Hanaoka H, Iyo M. Ifenprodil tartrate treatment of adolescents with post-traumatic stress disorder: A double-blind, placebo-controlled trial. Psychiatry Res 2022; 311:114486. [PMID: 35263680 DOI: 10.1016/j.psychres.2022.114486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several lines of evidence suggest that glutamatergic neurotransmission via the N-methyl-D-aspartate (NMDA) receptor plays a role in certain behavioral manifestations common to Post-Traumatic Stress Disorder (PTSD). Ifenprodil tartrate is a neuroprotective agent that binds to the GluN2B subunit of the NMDA receptor. The aim of this study is to confirm whether ifenprodil tartrate is effective in the adolescent PTSD patients. METHODS This is a randomized, double-blind, placebo-controlled trial. Ten adolescent (13 to 18 years old) PTSD patients were randomized into two arms: placebo (n = 4), 40 mg/day ifenprodil tartrate (n = 6) for 4 weeks. All of the patients were assessed by IES-R-J (Primary outcome measure), TSCC-J, CDRS-R, DSRS-C-J and CGI-I. RESULTS A comparison of baseline IES-R-J total scores and 4-week end-point scores showed a mild trend of improvement (p = 0.0895) and the difference score was -9.314. A comparison of baseline scores and 2-week intermediate-point scores showed that IES-R-J hyperarousal subscores and TSCC-J subscores (dissociation subscores, sexual concerns subscores) improved significantly. A comparison of baseline TSCC-J sexual concerns subscores and 4-week end-point scores improved significantly. CONCLUSIONS Our study may prove to be an short-term effective alternative safe treatment for adolescent patients with PTSD.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Child Psychiatry, Chiba University Hospital, Inohana 1-8-1, Chiba 260-8670, Japan; Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Kenji Hashimoto
- Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yutaka Hosoda
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | | | - Akihiro Shiina
- Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Tasuku Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Takeshi Sugawara
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Child Psychiatry, Chiba University Hospital, Inohana 1-8-1, Chiba 260-8670, Japan; Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan; Chiba University Center for Forensic Mental Health, Chiba, Japan
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Ogasawara S, Koroki K, Makishima H, Wakatsuki M, Takahashi A, Yumita S, Nakagawa M, Ishino T, Ogawa K, Fujiwara K, Iwanaga T, Sakuma T, Fujita N, Kojima R, Kanzaki H, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Saito T, Kondo T, Nakagawa R, Nakamoto S, Muroyama R, Chiba T, Ozawa Y, Kawasaki Y, Kurokawa T, Hanaoka H, Tsuji H, Kato N. Durvalumab with or without tremelimumab combined with particle therapy for advanced hepatocellular carcinoma with macrovascular invasion: protocol for the DEPARTURE phase Ib trial. BMJ Open 2022; 12:e059779. [PMID: 35396315 PMCID: PMC8995959 DOI: 10.1136/bmjopen-2021-059779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Advanced hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) has the worst prognosis among all phenotypes. This trial aims to evaluate whether treatment with durvalumab, alone or in combination with tremelimumab, plus particle therapy is a safe and synergistically effective treatment in patients with advanced HCC and MVI. METHODS AND ANALYSIS This phase Ib, multicentre (two sites in Japan), open-label, single-arm, investigator-initiated clinical trial will assess durvalumab monotherapy in combination with particle therapy (cohort A) and that of durvalumab plus tremelimumab in combination with particle therapy (cohort B) for patients with advanced HCC with MVI. Cohort A will receive 1500 mg durvalumab every 4 weeks. Cohort B will receive 1500 mg durvalumab every 4 weeks in principle and 300 mg tremelimumab only on day 1 of the first cycle. Carbon-ion radiotherapy will be administered after day 8 of the first cycle. The primary endpoints are rates of any and severe adverse events, including dose-limiting toxicities (DLTs); secondary endpoints are overall survival, 6-month survival, objective response, 6-month progression-free survival and time to progression. Patients are initially enrolled into cohort A. If cohort A treatment is confirmed to be tolerated (ie, no DLT in three patients or one DLT in six patients), the trial proceeds to enrol more patients into cohort B. Similarly, if cohort B treatment is confirmed to be tolerated (ie, no DLT in three patients or one DLT in six patients), a total of 15 patients will be enrolled into cohort B. ETHICS AND DISSEMINATION This study was approved by the ethics committees of the two participating institutions (Chiba University Hospital and National Institutes for Quantum (approval number: 2020040) and Radiological Science and Technology, QST Hospital (approval number: C20-001)). Participants will be required to provide written informed consent. Trial results will be reported in a peer-reviewed journal publication. TRIAL REGISTRATION NUMBER jRCT2031210046.
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Affiliation(s)
- Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masaru Wakatsuki
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Asahi Takahashi
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takafumi Sakuma
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoto Fujita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryuta Kojima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryosuke Muroyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihito Ozawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Tsuji
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Okonogi N, Usui H, Murata K, Hori M, Kurokawa T, Fujiwara T, Fujii Y, Hanawa M, Kawasaki Y, Hattori Y, Suzuki K, Tsuyuki K, Wakatsuki M, Hasegawa S, Yamada S, Hanaoka H, Shozu M, Tsuji H. Phase Ib study of durvalumab (MEDI4736) in combination with carbon-ion radiotherapy and weekly cisplatin for patients with locally advanced cervical cancer (DECISION study): study protocol for a prospective open-label single-arm study. BMJ Open 2022; 12:e056424. [PMID: 35236732 PMCID: PMC8896055 DOI: 10.1136/bmjopen-2021-056424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Concurrent chemoradiotherapy is considered the standard treatment strategy for locally advanced cervical cancer. Most recent reports indicate that patients with bulky tumours or adenocarcinoma subtypes have poorer local control. Carbon-ion radiotherapy (CIRT) with the concurrent use of chemotherapy has shown promising results in such cases of difficult-to-treat uterine cervical cancer. Programmed death-ligand 1 (PD-L1) upregulation was observed in tumour tissue samples from patients who had undergone CIRT. Thus, a combination of CIRT and anti-PD-L1 antibody may suppress metastasis by activating antitumour immune response, in addition to exhibiting strong local effects. OBJECTIVE We will assess the safety and tolerability (primary endpoint) of the concomitant use of durvalumab, an anti-PD-L1 antibody, with CIRT and weekly cisplatin for locally advanced cervical cancer. METHODS AND ANALYSIS This study is a non-randomised, open-label, prospective phase 1b study. Up to 10 patients with histologically proven uterine cervical cancer at stage IIB, IIIA, IIIB, IIIC1 or IVA as per International Federation of Gynecology and Obstetrics (2018) staging will be enrolled. All patients will receive CIRT of 74.4 Gy relative biological effectiveness in 20 fractions over 5 weeks (four fractions per week). Weekly cisplatin at a dose of 40 mg/m2 will be administrated up to five times. Durvalumab at a dose of 1500 mg/body will be administrated at weeks 2 and 6. Safety and tolerability will be evaluated based on the frequency of dose-limiting toxicities until 92 days after CIRT starts. Patients will be followed-up strictly as per the scheduled protocol for 1 year after CIRT initiation. ETHICS AND DISSEMINATION The Human Research Ethics Committees of QST Hospital (#C21-002) and Chiba University (#2021006) have approved this study protocol. The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials (jRCT2031210083), registered on 12 May 2021.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hirokazu Usui
- Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoko Hattori
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuko Suzuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kyoko Tsuyuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Sumitaka Hasegawa
- Radiation and Cancer Biology Group, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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Fujita M, Shimazu M, Nagashima K, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Shozu M, Hanaoka H, Tsuruoka N, Kasai T, Hata A. Study protocol of the ACCESS trial: a randomised trial to evaluate the effectiveness of human papillomavirus testing by self-sampling in cervical cancer screening uptake and precancer detection. BMJ Open 2022; 12:e049803. [PMID: 35115348 PMCID: PMC8814812 DOI: 10.1136/bmjopen-2021-049803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recently, the incidence of cervical cancer has increased in Japan, probably because of an interruption in human papillomavirus (HPV) vaccination and a low cervical cancer screening rate. There is a lack of evidence for self-sampling HPV testing as a cervical cancer screening tool in Japan. The Accelerating Cervical Cancer Elimination by Self-Sampling test trial aims to compare the effectiveness of screening using the self-sampling HPV test with that of routine screening concerning screening uptake and precancer detection. METHODS AND ANALYSIS This trial has a single-municipality, open-label, parallel, superiority and randomised design. Approximately 20 000 women who have not undergone cervical cancer screening for at least 3 years will be assigned randomly to the self-sampling arm and the control arm using a 1:1 ratio. Participants assigned to the control arm will undergo routine cervical cancer screening (cytology test) provided by Ichihara City, while those assigned to the self-sampling arm will choose the routine screening or self-sampling HPV test. HPV tests will be performed using the cobas 8800 system (Roche Diagnostics, Rotkreuz, Switzerland). Participants who will undergo the self-sampling HPV testing will be recommended to undergo routine screening. The results of the cytology test and further tests, such as colposcopy and biopsy, will be collected and used for this trial. The risk ratio and risk difference in the proportion of participants with cervical intraepithelial neoplasia two or worse between the two arms will be calculated. The test for the null hypothesis (the detection rates are equal between the two arms) will be performed using Pearson's χ2 test. ETHICS AND DISSEMINATION This trial was approved by the Research Ethics Committees of the Chiba Foundation for Health Promotion and Disease Prevention and the collaborating research institutes. The results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER jRCT1030200276. Pre-results.
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Affiliation(s)
- Misuzu Fujita
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kengo Nagashima
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Misae Suzuki
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Japan
| | - Ichiro Tauchi
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Japan
| | - Miwa Sakuma
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Japan
| | - Setsuko Yamamoto
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Ogasawara S, Koroki K, Makishima H, Wakatsuki M, Sakuma T, Fujita N, Kanzaki H, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Saito T, Kondo T, Nakagawa R, Nakamoto S, Muroyama R, Chiba T, Hanaoka H, Tsuji H, Kato N. Phase Ib trial of durvalumab plus tremelimumab in combination with particle radiotherapy in advanced hepatocellular carcinoma patients with macrovascular invasion: DEPARTURE trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS495 Background: Advanced hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) has the worst prognosis among all HCC cases, due to its uniqueness of disease condition. Development of revolutionary therapeutic approaches to improve prognosis in these patients is an essential medical issue. A phase I/II trial demonstrated that treatment with durvalumab, an anti-programmed death-ligand 1 antibody, alone or in combination with tremelimumab, an anti-cytotoxic T-lymphocyte antigen 4 antibody, exhibited potential efficacy in patients with advanced HCC. Conversely, particle radiotherapy, including carbon-ion radiotherapy, has been shown to achieve unique dose distribution by delivering high-dose radiation to the target tumor while reducing the radiation dose to normal tissues due to its physical characteristics. Studies demonstrated that particle radiotherapy could achieve good local control in patients with HCC, including those with MVI. Additionally, particle radiotherapy as well as photon irradiation not only mediate localized tumor killing but also modify the tumor microenvironment, thereby potentiating the efficacy of immune checkpoint inhibitors. The DEPARTURE trial aims to evaluate whether treatment with durvalumab, alone or in combination with tremelimumab, plus particle radiotherapy is a safe and synergistically effective treatment in patients with advanced HCC and MVI. Methods: This is a phase Ib, multi-center, open-label, single-arm, investigator-initiated clinical trial to assess the safety of durvalumab monotherapy in combination with particle radiotherapy (Cohort A) and that of durvalumab plus tremelimumab in combination with particle radiotherapy (Cohort B) in advanced HCC patients with MVI who are ineligible for standard systemic therapy and Child–Pugh A liver disease. Cohort A will receive 1500 mg durvalumab every four weeks in principle. Cohort B will receive 1500 mg durvalumab every four weeks in principle and 300 mg tremelimumab only on day 1 of the first cycle. Carbon-ion radiotherapy will be administered after day 8 of the first cycle, following the first dose of either durvalumab or durvalumab plus tremelimumab on day 1. Dose prescription and fractionations are 60 Gy (RBE) in four fractions/1 week. Intrahepatic nodule with MVI is the target lesion for carbon-ion radiotherapy. Primary study endpoints are rates of all and severe adverse events including DLTs. Secondary endpoints include rates of overall survival, 6-month survival, objective response, and 6-month progression-free survival as well as time to progression. Clinical trial information: jRCT2031210046.
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Affiliation(s)
- Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Masaru Wakatsuki
- National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takafumi Sakuma
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoto Fujita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryosuke Muroyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Tsuji
- National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Takabayashi K, Ando F, Ikeda K, Fujita S, Nakajima H, Hanaoka H, Suzuki T. Trend in Prescription and Treatment Retention of Molecular-Targeted Drugs in 121,131 Japanese Patients With Rheumatoid Arthritis: A Population-Based Real-World Study. Mod Rheumatol 2021; 32:857-865. [PMID: 34907436 DOI: 10.1093/mr/roab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the real-world prescription and treatment retention of molecular-targeted drugs for rheumatoid arthritis (RA) in Japan. MATERIALS AND METHODS 204,416 patients with RA prescribed at least one of the eight molecular-targeted drugs in 7 years from the National Database of Health Insurance Claims and Specific Health Checkups of Japan covering 98.3% of the Japanese population. The retention rate of each drug as well as head-to head comparisons were estimated by Kaplan-Meier method. RESULTS 121,131 RA patients were prescribed any molecular-targeted drug for the first time, while 36,633 uses of molecular-targeted drug switched from another (switch use). The overall retention rates of molecular-targeted drugs at 12, 36, and 60 months were 0.64, 0.42, and 0.32 for the naïve use and 0.59, 0.40, and 0.31 for the switch use, respectively. Non-tumor necrosis factor (TNF)-inhibitor molecular-targeted drugs, particularly tocilizumab and tofacitinib, had higher retention rates than TNF inhibitors for both naïve and switch uses regardless of the previous drug, and showed higher retention rates in head-to-head comparisons between eight molecular-targeted drugs. CONCLUSIONS Our data reveal that the real-world drug retention is overall lower than previously reported and higher with non-TNF inhibitors than with TNF inhibitors.
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Affiliation(s)
- Katsuhiko Takabayashi
- Department of Internal Medicine, Sanwa Hospital, Chiba, Japan.,Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Fumihiko Ando
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shinsuke Fujita
- Department of Clinical Design and Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahiro Suzuki
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
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Nakamura K, Ozawa H, Shibata T, Ushirozawa N, Hata T, Okita N, Fuse N, Sato N, Ikeda K, Hanaoka H, Maruyama T, Wada M, Shimizu S, Kasai H, Yamamoto Y, Sakurai J, Todaka K, Tashiro S, Yamamoto H. Survey Results and Recommendations from Japanese Stakeholders for Good Clinical Practice Renovation. Ther Innov Regul Sci 2021; 56:220-229. [PMID: 34787814 PMCID: PMC8596855 DOI: 10.1007/s43441-021-00350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) is undertaking a major revision of ICH E6 Good Clinical Practice (GCP) decided to involve external stakeholders in ICH-GCP renovation. Activities such as surveys and public conferences have taken place in the United States, European Union, and Japan. For stakeholder engagement in Japan, a designated research group conducted a survey of academic stakeholders. METHODS A total of 105 academic stakeholders from 18 institutions responded to the survey. The research group developed recommendations reflecting the survey results and the opinions from patients and the public. RESULTS The survey showed the top four principles needing renovation were (i) informed consent (Chapter 2.9, 12.4% of respondents believed it needed renovation), (ii) systems for quality assurance (Chapter 2.13, 9.5%), (iii) information on an investigational product (Chapter 2.4, 5.7%), and (iv) procedures on clinical trial information (Chapter 2.10, 5.7%). The top three sections identified as needing renovation were: (i) informed consent (Chapter 4.8, 27.6%), (ii) monitoring (Chapter 5.18, 22.9%), and (iii) composition, functions, and operations of the ethics committee (Chapter 3.2, 14.3%). Recommendations included clarification of ICH-GCP's scope, proportionality in various aspects of clinical trials, diversity and liquidity of ethics committee members, modernization of informed consent procedures, variations in monitoring, and regulatory grade when using real-world data. CONCLUSION The recommendations from Japanese investigators and patients have been submitted to the ICH E6 Expert Working Group, which will strengthen the robustness of the GCP renovation.
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Affiliation(s)
- Kenichi Nakamura
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan. .,Department of International Clinical Development, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hitoshi Ozawa
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Taro Shibata
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan.,Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Nobuko Ushirozawa
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan.,Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Tomomi Hata
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan.,Department of International Clinical Development, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Natsuko Okita
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Fuse
- Clinical Research Support Office, National Cancer Center Hospital East, Chiba, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Hokkaido, Japan
| | - Koji Ikeda
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Miyagi, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tatsuya Maruyama
- Clinical Research Support Center, The Tokyo University of Tokyo Hospital, Tokyo, Japan
| | - Michihiko Wada
- Clinical & Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Shinobu Shimizu
- Department of Advanced Medicine, Nagoya University Hospital, Aichi, Japan
| | - Hiroi Kasai
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Yoichi Yamamoto
- Department of Medical Innovation, Academic Clinical Research Center, Osaka University Hospital, Osaka, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Koji Todaka
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Shimon Tashiro
- Department of Sociology, Graduate School of Arts and Letters, Tohoku University, Miyagi, Japan
| | - Haruko Yamamoto
- Department of Data Science, National Cerebral and Cardiovascular Center, Osaka, Japan.,Pharmaceuticals and Medical Devices Agency (PMDA), Tokyo, Japan
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Akita S, Unno N, Maegawa J, Kimata Y, Ota Y, Yabuki Y, Shinaoka A, Sano M, Ohnishi F, Sakuma H, Nuri T, Ozawa Y, Shiko Y, Kawasaki Y, Hanawa M, Fujii Y, Imanishi E, Fujiwara T, Hanaoka H, Mitsukawa N. A phase III, multicenter, single-arm study to assess the utility of indocyanine green fluorescent lymphography in the treatment of secondary lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:728-737.e3. [PMID: 34592477 DOI: 10.1016/j.jvsv.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indocyanine green (ICG) fluorescent lymphography might be useful for assessing patients undergoing lymphatic surgery for secondary lymphedema. The present clinical trial aimed to confirm whether ICG fluorescent lymphography would be useful in evaluating lymphedema, identifying lymphatic vessels suitable for anastomosis, and confirming patency of lymphaticovenular anastomosis in patients with secondary lymphedema. METHODS The present phase III, multicenter, single-arm, open-label, clinical trial (HAMAMATSU-ICG study) investigated the accuracy of lymphedema diagnosis via ICG fluorescent lymphography compared with lymphoscintigraphy, rate of identification of lymphatic vessels at the incision site, and efficacy for confirming patency of lymphaticovenular anastomosis. The external diameter of the identified lymphatic vessels and the distance from the skin surface to the lymphatic vessels using preoperative ICG fluorescent lymphography were measured intraoperatively under surgical microscopy. RESULTS When the clinical decision for surgery at each research site was made, the standard diagnosis of lymphedema was considered correct. For the 26 upper extremities, a central judgment committee who was unaware of the clinical presentation confirmed the imaging diagnosis was accurate for 100.0% of cases, whether the assessments had been performed via lymphoscintigraphy or ICG lymphography. In contrast, for the 88 lower extremities, the accuracy of the diagnosis compared with the diagnosis by the central judgment committee was 70.5% and 88.2% for lymphoscintigraphy and ICG lymphography, respectively. The external diameter of the identified lymphatic vessels was significantly greater in the lower extremities than in the upper extremities (0.54 ± 0.21 mm vs 0.42 ± 0.14 mm; P < .0001). Also, the distance from the skin surface to the lymphatic vessels was significantly longer in the lower extremities than in the upper extremities (5.8 ± 3.5 mm vs 4.4 ± 2.6 mm; P = .01). For 263 skin incisions, with the site placement determined using ICG fluorescent lymphography, the rate of identification of lymphatics vessels suitable for anastomosis was 97.7% (95% confidence interval, 95.1%-99.2%). A total of 267 lymphaticovenular anastomoses were performed. ICG fluorescent lymphography was judged as "useful" for confirming patency after the anastomosis in 95.1% of the cases. CONCLUSIONS ICG fluorescent lymphography could be useful for improving the treatment of patients with secondary lymphedema from the outpatient setting to surgery.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Naoki Unno
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan; Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yusuke Ota
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Akira Shinaoka
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Fumio Ohnishi
- Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe City, Japan
| | - Hisashi Sakuma
- Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Tokyo, Japan
| | - Takashi Nuri
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yoshihito Ozawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Eri Imanishi
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Toyoda T, Kamata T, Tanaka K, Ihara F, Takami M, Suzuki H, Nakajima T, Ikeuchi T, Kawasaki Y, Hanaoka H, Nakayama T, Yoshino I, Motohashi S. Phase II study of α-galactosylceramide-pulsed antigen-presenting cells in patients with advanced or recurrent non-small cell lung cancer. J Immunother Cancer 2021; 8:jitc-2019-000316. [PMID: 32188702 PMCID: PMC7078938 DOI: 10.1136/jitc-2019-000316] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Invariant natural killer T (iNKT) cells produce copious amounts of cytokines in response to specific glycolipid antigens such as α-galactosylceramide (αGalCer) presented by CD1d-expressing antigen-presenting cells (APCs), thus orchestrating other immune cells to fight tumors. Because of their ability to induce strong antitumor responses activated by αGalCer, iNKT cells have been studied for their application in cancer immunotherapy. In our previous phase I/II trial in non-small cell lung cancer (NSCLC) patients who had completed the standard treatment, we showed a relatively long median survival time without severe treatment-related adverse events. Based on these results, we performed a phase II trial to evaluate clinical responses, safety profiles and immune responses as a second-line treatment for advanced NSCLC. Methods Patients with advanced or recurrent NSCLC refractory to first-line chemotherapy were eligible. αGalCer-pulsed APCs were intravenously administered four times. Overall survival time was evaluated as the primary endpoint. The safety profile and immune responses after APC injection were also monitored. This study was an open label, single-arm, phase II clinical trial performed at Chiba University Hospital, Japan. Results Thirty-five patients were enrolled in this study, of which 32 (91.4%) completed the trial. No severe adverse events related to the treatment were observed. The estimated median survival time of the 35 cases was 21.9 months (95% CI, 14.8 to 26.0). One case (2.9%) showed a partial response, 14 cases (40.0%) remained as stable disease, and 19 cases (54.3%) were evaluated as progressive disease. The geometric mean number of iNKT cells in all cases was significantly decreased and the mean numbers of natural killer (NK) cells, interferon-γ-producing cells in response to αGalCer, and effector CD8+ T cells were significantly increased after the administration of αGalCer-pulsed APCs. Conclusions The intravenous administration of αGalCer-pulsed APCs was well-tolerated and was accompanied by prolonged overall survival. These results are encouraging and warrant further evaluation in a randomized phase III trial to demonstrate the survival benefit of this immunotherapy. Trial registration number UMIN000007321.
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Affiliation(s)
- Takahide Toyoda
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshiko Kamata
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhisa Tanaka
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Fumie Ihara
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mariko Takami
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Ikeuchi
- Center for Advanced Medicine, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Toshinori Nakayama
- Department of Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichiro Motohashi
- Department of Medical Immnunology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Koda M, Hanaoka H, Fujii Y, Hanawa M, Kawasaki Y, Ozawa Y, Fujiwara T, Furuya T, Ijima Y, Saito J, Kitamura M, Miyamoto T, Ohtori S, Matsumoto Y, Abe T, Takahashi H, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Hasegawa T, Yoshida G, Arima H, Yamato Y, Oe S, Togawa D, Kobayashi S, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Takigawa T, Morita T, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Sakai T, Imajo Y, Yamazaki M. Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. Brain 2021; 144:789-799. [PMID: 33764445 PMCID: PMC8041047 DOI: 10.1093/brain/awaa466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022] Open
Abstract
Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. The present trial failed to show a significant effect of G-CSF in primary end point.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Correspondence to: Masao Koda, MD, PhD Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City Ibaraki 305-8575 Japan E-mail:
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Miyamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kindai University, Nara Hospital, Nara, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takeshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Tomoyuki Takigawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takuya Morita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nihon University, Tokyo, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Yamaguchi Rosai Hospital, Japan Organization of Occupational Health and Safety, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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35
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Kageyama T, Ikeda K, Tanaka S, Taniguchi T, Igari H, Onouchi Y, Kaneda A, Matsushita K, Hanaoka H, Nakada TA, Ohtori S, Yoshino I, Matsubara H, Nakayama T, Yokote K, Nakajima H. Antibody responses to BNT162b2 mRNA COVID-19 vaccine and their predictors among healthcare workers in a tertiary referral hospital in Japan. Clin Microbiol Infect 2021; 27:1861.e1-1861.e5. [PMID: 34375755 PMCID: PMC8349446 DOI: 10.1016/j.cmi.2021.07.042] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 12/27/2022]
Abstract
Objectives This study aimed to determine antibody responses in healthcare workers who receive the BNT162b2 mRNA COVID-19 vaccine and identify factors that predict the response. Methods We recruited healthcare workers receiving the BNT162b2 mRNA COVID-19 vaccine at the Chiba University Hospital COVID-19 Vaccine Center. Blood samples were obtained before the 1st dose and after the 2nd dose vaccination, and serum antibody titers were determined using Elecsys® Anti-SARS-CoV-2S, an electrochemiluminescence immunoassay. We established a model to identify the baseline factors predicting post-vaccine antibody titers using univariate and multivariate linear regression analyses. Results Two thousand fifteen individuals (median age 37-year-old, 64.3% female) were enrolled in this study, of which 10 had a history of COVID-19. Before vaccination, 21 participants (1.1%) had a detectable antibody titer (≥0.4 U/mL) with a median titer of 35.9 U/mL (interquartile range [IQR] 7.8 – 65.7). After vaccination, serum anti-SARS-CoV-2S antibodies (≥0.4 U/mL) were detected in all 1774 participants who received the 2nd dose with a median titer of 2060.0 U/mL (IQR 1250.0 – 2650.0). Immunosuppressive medication (p < 0.001), age (p < 0.001), time from 2nd dose to sample collection (p < 0.001), glucocorticoids (p = 0.020), and drinking alcohol (p = 0.037) were identified as factors predicting lower antibody titers after vaccination, whereas previous COVID-19 (p < 0.001), female (p < 0.001), time between 2 doses (p < 0.001), and medication for allergy (p = 0.024) were identified as factors predicting higher serum antibody titers. Conclusions Our data demonstrate that healthcare workers universally have good antibody responses to the BNT162b2 mRNA COVID-19 vaccine. The predictive factors identified in our study may help optimize the vaccination strategy.
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Affiliation(s)
- Takahiro Kageyama
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Japan
| | | | - Hidetoshi Igari
- Department of Infectious Diseases, Chiba University Hospital, Japan; Chiba University Hospital COVID-19 Vaccine Center, Japan
| | | | - Atsushi Kaneda
- Department of Molecular Oncology, Graduate School of Medicine, Japan
| | | | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Japan
| | | | | | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Japan; Chiba University Hospital COVID-19 Vaccine Center, Japan.
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36
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Furuta S, Nakagomi D, Kobayashi Y, Hiraguri M, Sugiyama T, Amano K, Umibe T, Kono H, Kurasawa K, Kita Y, Matsumura R, Kaneko Y, Ninagawa K, Hiromura K, Kagami SI, Inaba Y, Hanaoka H, Ikeda K, Nakajima H. Effect of Reduced-Dose vs High-Dose Glucocorticoids Added to Rituximab on Remission Induction in ANCA-Associated Vasculitis: A Randomized Clinical Trial. JAMA 2021; 325:2178-2187. [PMID: 34061144 PMCID: PMC8170547 DOI: 10.1001/jama.2021.6615] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The current standard induction therapy for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis is the combination of high-dose glucocorticoids and cyclophosphamide or rituximab. Although these regimens have high remission rates, they are associated with considerable adverse events presumably due to high-dose glucocorticoids. OBJECTIVE To compare efficacy and adverse events between a reduced-dose glucocorticoid plus rituximab regimen and the standard high-dose glucocorticoid plus rituximab regimen in remission induction of ANCA-associated vasculitis. DESIGN, SETTING, AND PARTICIPANTS This was a phase 4, multicenter, open-label, randomized, noninferiority trial. A total of 140 patients with newly diagnosed ANCA-associated vasculitis without severe glomerulonephritis or alveolar hemorrhage were enrolled between November 2014 and June 2019 at 21 hospitals in Japan. Follow-up ended in December 2019. INTERVENTIONS Patients were randomized to receive reduced-dose prednisolone (0.5 mg/kg/d) plus rituximab (375 mg/m2/wk, 4 doses) (n = 70) or high-dose prednisolone (1 mg/kg/d) plus rituximab (n = 70). MAIN OUTCOMES AND MEASURES The primary end point was the remission rate at 6 months, and the prespecified noninferiority margin was -20 percentage points. There were 8 secondary efficacy outcomes and 6 secondary safety outcomes, including serious adverse events and infections. RESULTS Among 140 patients who were randomized (median age, 73 years; 81 women [57.8%]), 134 (95.7%) completed the trial. At 6 months, 49 of 69 patients (71.0%) in the reduced-dose group and 45 of 65 patients (69.2%) in the high-dose group achieved remission with the protocolized treatments. The treatment difference of 1.8 percentage points (1-sided 97.5% CI, -13.7 to ∞) between the groups met the noninferiority criterion (P = .003 for noninferiority). Twenty-one serious adverse events occurred in 13 patients in the reduced-dose group (18.8%), while 41 occurred in 24 patients in the high-dose group (36.9%) (difference, -18.1% [95% CI, -33.0% to -3.2%]; P = .02). Seven serious infections occurred in 5 patients in the reduced-dose group (7.2%), while 20 occurred in 13 patients in the high-dose group (20.0%) (difference, -12.8% [95% CI, -24.2% to -1.3%]; P = .04). CONCLUSIONS AND RELEVANCE Among patients with newly diagnosed ANCA-associated vasculitis without severe glomerulonephritis or alveolar hemorrhage, a reduced-dose glucocorticoid plus rituximab regimen was noninferior to a high-dose glucocorticoid plus rituximab regimen with regard to induction of disease remission at 6 months. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02198248.
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Affiliation(s)
- Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Daiki Nakagomi
- Third Department of Internal Medicine, University of Yamanashi, Chuo, Japan
| | - Yoshihisa Kobayashi
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Masaki Hiraguri
- Allergy and Clinical Immunology Center, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Takao Sugiyama
- Department of Rheumatology, Shimoshizu Hospital, National Hospital Organization, Yotsukaido, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Takeshi Umibe
- Department of Internal Medicine, Matsudo City Hospital, Matsudo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiko Kita
- Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Ryutaro Matsumura
- Department of Rheumatology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keita Ninagawa
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shin-ichiro Kagami
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Chiba, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
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Hosogaya N, Miyazaki T, Fukushige Y, Takemori S, Morimoto S, Yamamoto H, Hori M, Kurokawa T, Kawasaki Y, Hanawa M, Fujii Y, Hanaoka H, Iwami S, Watashi K, Yamagoe S, Miyazaki Y, Wakita T, Izumikawa K, Yanagihara K, Mukae H, Kohno S. Efficacy and safety of nelfinavir in asymptomatic and mild COVID-19 patients: a structured summary of a study protocol for a multicenter, randomized controlled trial. Trials 2021; 22:309. [PMID: 33910617 PMCID: PMC8080096 DOI: 10.1186/s13063-021-05282-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this trial is to evaluate the antiviral efficacy, clinical efficacy, and safety of nelfinavir in patients with asymptomatic and mild COVID-19. TRIAL DESIGN The study is designed as a multicenter, open-label, blinded outcome assessment, parallel group, investigator-initiated, exploratory, randomized (1:1 ratio) controlled clinical trial. PARTICIPANTS Asymptomatic and mild COVID-19 patients will be enrolled in 10 university and teaching hospitals in Japan. The inclusion and exclusion criteria are as follows: Inclusion criteria: (1) Japanese male or female patients aged ≥ 20 years (2) SARS-CoV-2 detected from a respiratory tract specimen (e.g., nasopharyngeal swab or saliva) using PCR, LAMP, or an antigen test within 3 days before obtaining the informed consent (3) Provide informed consent Exclusion criteria: (1) Symptoms developed ≥ 8 days prior to enrolment (2) SpO2 < 96 % (room air) (3) Any of the following screening criteria: a) ALT or AST ≥ 5 × upper limit of the reference range b) Child-Pugh class B or C c) Serum creatinine ≥ 2 × upper limit of the reference range and creatinine clearance < 30 mL/min (4) Poorly controlled diabetes (random blood glucose ≥ 200 mg/dL or HbA1c ≥ 7.0%, despite treatment) (5) Unsuitable serious complications based on the assessment of either the principal investigator or the sub-investigator (6) Hemophiliac or patients with a marked hemorrhagic tendency (7) Severe diarrhea (8) Hypersensitivity to the investigational drug (9) Breastfeeding or pregnancy (10) With childbearing potential and rejecting contraceptive methods during the study period from the initial administration of the investigational drug (11) Receiving rifampicin within the previous 2 weeks (12) Participated in other clinical trials and received drugs within the previous 12 weeks (13) Undergoing treatment for HIV infection (14) History of SARS-CoV-2 vaccination or wishes to be vaccinated against SARS-CoV-2 (15) Deemed inappropriate (for miscellaneous reasons) based on the assessment of either the principal investigator or the sub-investigator INTERVENTION AND COMPARATOR: Patients who meet the inclusion criteria and do not meet any of the exclusion criteria will be randomized to either the nelfinavir group or the symptomatic treatment group. The nelfinavir group will be administered 750 mg of nelfinavir orally, three times daily for 14 days (treatment period). However, if a participant tests negative on two consecutive PCR tests of saliva samples, administration of the investigational drug for that participant can be discontinued at the discretion of the investigators. The symptomatic treatment group will not be administered the investigational drug, but all other study procedures and conditions will be the same for both groups for the duration of the treatment period. After the treatment period of 14 days, each group will be followed up for 14 days (observational period). MAIN OUTCOMES The primary endpoint is the time to negative conversion of SARS-CoV-2. During the study period from Day 1 to Day 28, two consecutive negative PCR results of saliva samples will be considered as the negative conversion of the virus. The secondary efficacy endpoints are as follows: For patients with both asymptomatic and mild disease: area under the curve of viral load, half decay period of viral load, body temperature at each time point, all-cause mortality, incidence rate of pneumonia, percentage of patients with newly developed pneumonia, rate of oxygen administration, and the percentage of patients who require oxygen administration. For asymptomatic patients: incidence of symptomatic COVID-19, incidence of fever (≥ 37.0 °C for two consecutive days), incidence of cough For patients with mild disease: incidence of defervescence (< 37.0 °C), incidence of recovery from clinical symptoms, incidence of improvement of each symptom The secondary safety endpoints are adverse events and clinical examinations. RANDOMIZATION Patients will be randomized to either the nelfinavir group or the symptomatic treatment group using the electric data capture system (1:1 ratio, dynamic allocation based on severity [asymptomatic], and age [< 60 years]). BLINDING (MASKING) Only the assessors of the primary outcome will be blinded (blinded outcome assessment). NUMBERS TO BE RANDOMIZED (SAMPLE SIZE) The sample size was determined based on our power analysis to reject the null hypothesis, S (t | z =1) = S (t | z = 0) where S is a survival function, t is time to negative conversion, and z denotes randomization group, by the log-rank test with a two-sided p value of 0.05. We estimated viral dynamic parameters by fitting a nonlinear mixed-effects model to reported viral load data, and simulated our primary endpoint from viral-load time-courses that were realized from sets of viral dynamics parameters sampled from the estimated probability distribution of the parameters (sample size: 2000; 1000 each for randomization group). From this estimation of the hazard ratio between the randomization groups for the event of negative conversion using this simulation dataset, the required number of events for rejecting our null hypothesis with a power of 0.80 felled 97.345 by plugging the estimated hazard ratio, 1.79, in Freedman's equation. Therefore, we decided the required number of randomizations to be 120 after consideration of the frequency of censoring and the anticipated rate of withdrawal caused by factors such as withdrawal of consent. TRIAL STATUS Protocol version 6.0 of February 12, 2021. Recruitment started on July 22, 2020 and is anticipated to be completed by March 31, 2022. TRIAL REGISTRATION This trial was registered in Japan Registry of Clinical Trials (jRCT) ( jRCT2071200023 ) on 21 July 21, 2020. FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Naoki Hosogaya
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. .,Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Yuri Fukushige
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Hospital Pharmacy Nagasaki University Hospital, Nagasaki, Japan
| | - Sachiko Takemori
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinpei Morimoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Yamamoto
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Shingo Iwami
- Department of Biology, Faculty of Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Watashi
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan.,Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Yamagoe
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takaji Wakita
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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Tanaka T, Hanaoka H, Sakurai S. Optimization of the quality by design approach for gene therapy products: A case study for adeno-associated viral vectors. Eur J Pharm Biopharm 2020; 155:88-102. [PMID: 32784043 DOI: 10.1016/j.ejpb.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023]
Abstract
The development of gene therapy products has been expanding globally, and among them, the recombinant adeno-associated virus (rAAV) vector is one of the most promising vectors for gene transfer. For efficient and rapid development of the manufacturing process and quality control strategy, the quality by design (QbD) approach can be as effective for gene therapy products as it is for gene recombinant proteins, which have been developed for decades. However, prior available knowledge required for the QbD approach is limited in the field of gene therapy. Here, we comprehensively review rAAV study results that can form the basis of QbD-based development and propose a critical quality attribute identification method suitable for gene therapy development. As a case study for rAAV, we propose a series of practical development steps, including a quality target product profile (QTPP) setting, identification of critical quality attributes (CQAs), repetitive risk assessment associated with process optimization, design space (DS) establishment, and control strategy using the QbD method. Our case study, which was based on publicly available literature, is a basic model that can be augmented by unique data pertaining to specific products. An improvement in rAAV development is expected using this model as the first step.
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Affiliation(s)
- Toshimitsu Tanaka
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hideki Hanaoka
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Division of Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8766, Japan.
| | - Shingo Sakurai
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013, Japan.
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39
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Akita S, Unno N, Maegawa J, Kimata Y, Fukamizu H, Yabuki Y, Shinaoka A, Sano M, Kawasaki Y, Fujiwara T, Hanaoka H, Mitsukawa N. HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema. Contemp Clin Trials Commun 2020; 19:100595. [PMID: 32617434 PMCID: PMC7322679 DOI: 10.1016/j.conctc.2020.100595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Secondary lymphoedema of the extremities is an important quality-of-life issue for patients who were treated for their malignancies. Indocyanine green (ICG) fluorescent lymphography may be helpful for assessing lymphoedema and for planning lymphaticovenular anastomosis (LVA). The objective of the present clinical trial is to confirm whether or not ICG fluorescent lymphography using the near-infrared monitoring camera is useful for assessing the indication for LVA, for the identification of the lymphatic vessels before the conduct of LVA, and for the confirmation of the patency of the anastomosis site during surgery. Methods and analysis This trial is a phase III, multicentre, single-arm, open-label clinical trial to assess the efficacy and safety of ICG fluorescent lymphography when assessing and treating lymphoedema of patients with secondary lymphoedema who are under consideration for LVA. The primary endpoint is the identification rate of the lymphatic vessels at the incision site based on ICG fluorescent lymphograms obtained before surgery. The secondary endpoints are 1) the sensitivity and specificity of dermal back flow determined by ICG fluorescent lymphography as compared with 99mTc lymphoscintigraphy—one of the standard diagnostic methods and 2) the usefulness of ICG fluorescent lymphography when confirming the patency of the anastomosis site after LVA. Ethics and dissemination The protocol for the study was approved by the Institutional Review Board of each institution. The trial was filed for and registered at the Pharmaceuticals and Medical Devices Agency in Japan. The trial is currently on-going and is scheduled to end in June 2020. Trial registration number jRCT2031190064; Pre-results. This study will examine the efficacy of a highly safe drug, indocyanine green for evaluating lymphatic anatomy. This is the first, multicentre, prospective, systematised clinical trial of Indocyanine green lymphography. The present clinical trial will not allow the assessment of the therapeutic efficacy of lymphaticovenular anastomosis.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoki Unno
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hidekazu Fukamizu
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Akira Shinaoka
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Hiramatsu A, Hanaoka H, Uyama Y. Characteristics on Drug Safety Measures in Japan Stratified by System Organ Classes and Therapeutic Categories in Relation to the Approval Date. Ther Innov Regul Sci 2020; 54:1534-1540. [PMID: 32524501 DOI: 10.1007/s43441-020-00180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
Revisions of drug package inserts (PIs) may be made immediately after approval or after considerable clinical experience; however, it is unclear whether there is a relationship between the characteristics of these safety measures and the period since drug approval. Here, we analyzed 209 cases of safety measures (revisions of the PIs) taken in Japan over 5 years (FY2014 to FY2018). The median, minimum, and maximum period from approval date in Japan to PI revision date was 6.29 years (interquartile range 2.68-15.53 years), 0.16 years, and 59.69 years, respectively. The cases were classified into four groups depending on types of adverse reaction and therapeutic category in relation to the national approval date and international birth date, resulting in the grouping together of particular adverse reactions and therapeutic drugs. For example, "Hepatobiliary disorders", "Blood and lymphatic system disorders", "Respiratory, thoracic and mediastinal disorders", "Antineoplastics", "Chemotherapeutics", and "Other agents affecting metabolism" were associated with the group of safety measures taken early after approval of a drug soon after the international birth date, suggesting that careful attention at an earlier stage after approval is necessary for these adverse reactions and drugs. Understanding such features of PI revisions makes pharmacovigilance planning more appropriate, contributing to the implementation of rapid and proper safety measures after drug approval.
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Affiliation(s)
- Ayaka Hiramatsu
- Office of New Drug II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Hanaoka
- Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiaki Uyama
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2 Kasumigaseki, Chiyodaku, Tokyo, 100-0013, Japan.
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
- Graduate School of Medicine, Nagoya University, Nagoya, Japan.
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41
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Ishibashi F, Sakairi Y, Iwata T, Moriya Y, Mizobuchi T, Hoshino H, Yoshida S, Hanaoka H, Yoshino I, Motohashi S. A phase I study of loco-regional immunotherapy by transbronchial injection of α-galactosylceramide-pulsed antigen presenting cells in patients with lung cancer. Clin Immunol 2020; 215:108457. [DOI: 10.1016/j.clim.2020.108457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
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42
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Nakagami H, Sugimoto K, Ishikawa T, Koshizaka M, Fujimoto T, Kiyohara E, Hayashi M, Nakagawa Y, Ando H, Terabe Y, Takami Y, Yamamoto K, Takeya Y, Takemoto M, Ebihara T, Nakamura A, Nishikawa M, Yao XJ, Hanaoka H, Yokote K, Rakugi H. Investigator-initiated clinical study of a functional peptide, SR-0379, for limb ulcers of patients with Werner syndrome as a pilot study. Geriatr Gerontol Int 2020; 19:1118-1123. [PMID: 31746528 DOI: 10.1111/ggi.13782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 02/01/2023]
Abstract
AIM An investigator-initiated clinical study was carried out to evaluate the therapeutic potency of SR-0379 for the treatment of leg ulcers in patients with Werner syndrome. METHODS A multicenter, open-label study was carried out from September 2017 to February 2018. The inclusion criteria for leg ulcers were: (i) leg ulcers in patients with Werner syndrome, diabetes or critical limb ischemia/venous stasis; and (ii) a wound size of >1 cm and <6 cm in diameter. Four individuals with Werner syndrome and diabetic ulcers, respectively, were enrolled. SR-0379 (0.1%) was sprayed on skin ulcers once per day for 4 weeks. Efficacy was evaluated by determining the rate of wound size reduction as a primary end-point at 4 weeks after the first treatment compared with the pretreatment wound size. As secondary end-points, the DESIGN-R score index, the 50% wound size reduction ratio, time to wound closure and quantification of wound bacteria were also evaluated. The safety of SR-0379 was evaluated during the study period. RESULTS The reduction rate of ulcer size treated with 0.1% SR-0379 was 22.90% (mean) in the Werner syndrome ulcers group (n = 4) and 35.70% (mean) in the diabetic ulcers group (n = 4), respectively. The DESIGN-R score decreased by 4.0 points in the Werner syndrome ulcers group and 4.3 points in the diabetic ulcers group. Two mild adverse events were reported in two patients, and causal relationships were denied in any events. CONCLUSION Treatment with SR-0379 was safe, well-tolerated, and effective for leg ulcers of both Werner syndrome and diabetes patients. Geriatr Gerontol Int 2019; 19: 1118-1123.
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Affiliation(s)
- Hironori Nakagami
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahiro Ishikawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaya Koshizaka
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taku Fujimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Misa Hayashi
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinobu Nakagawa
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Ando
- Department of Cardiology, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Yuta Terabe
- Plastic and Reconstructive Surgery, Tokyo Nishi Tokushukai Hospital, Akishima, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Takeya
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Minoru Takemoto
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of University, School of Medicine, International University of Health and Welfare, Department of Diabetes, Metabolism and Endocrinology, Narita, Japan
| | - Tamotsu Ebihara
- Department of Dermatology, Saiseikai Central Hospital, Tokyo, Japan
| | - Ayumi Nakamura
- Department of Pharmacy, Osaka University Hospital, Suita, Japan.,Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | | | - Xiang Jing Yao
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Mitsuhashi A, Kawasaki Y, Hori M, Fujiwara T, Hanaoka H, Shozu M. Medroxyprogesterone acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and endometrial carcinoma: trial protocol for a prospective, randomised, open, blinded-endpoint design, dose-response trial (FELICIA trial). BMJ Open 2020; 10:e035416. [PMID: 32114477 PMCID: PMC7050341 DOI: 10.1136/bmjopen-2019-035416] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Progestin therapy is the only fertility-sparing treatment option for patients with atypical endometrial hyperplasia (AEH) and endometrial cancer (EC). However, the results of three meta-analyses revealed a high remission rate, as well as an association with a high rate of relapse. We previously conducted a phase II of medroxyprogesterone acetate (MPA) plus metformin as a fertility-sparing treatment for AEH and EC patients, and reported that metformin inhibited disease relapse after remission. METHODS AND ANALYSIS A randomised, open, blinded-endpoint design phase IIb dose response trial was planned to commence in July 2019. The trial aims to identify the appropriate dose of metformin to be combined with MPA therapy for fertility-sparing treatment of patients with AEH and EC. The primary endpoint of the trial is the 3-year relapse-free survival (RFS) rate. The secondary endpoints are RFS rate, the overall rate of response to MPA therapy, the conception rate after treatment, the outcome of pregnancy, toxicity evaluation and changes in insulin resistance and body mass index. A total of 120 patients will be enrolled from 15 Japanese institutions within a 2.5-year period and followed up for at least 3 years. ETHICS AND DISSEMINATION The protocol was approved by the institutional review board at Chiba University Hospital and boards at 14 other institutions. The trial will be conducted according to the principles of the World Medical Association's Declaration of Helsinki and in accordance with Good Clinical Practice (GCP) standards. The trial findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Japan Registry of Clinical Trials (jRCT2031190065).
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Affiliation(s)
- Akira Mitsuhashi
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, Chiba, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, Chiba, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine School of Medicine, Chiba, Japan
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Ogasawara S, Kanzaki H, Koroki K, Kanayama K, Maruta S, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Kondo T, Suzuki E, Ooka Y, Nakamoto S, Tawada A, Chiba T, Arai M, Nakada H, Yamaguchi N, Hanaoka H, Kato N. Phase I study of a new concept cancer vaccine composed artificial intelligence (AI)-designed shared-antigen peptides plus combined synergistically activating antigen-specific CTL reaction (CYT001) in patients with advanced hepatocellular carcinoma (CRESCENT 1). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.tps595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS595 Background: CYT001 (CYTLIMIC Inc.) is a novel cancer vaccine involving artificial intelligence (AI)-designed shared-antigen peptides and optimal combined adjuvants that boost the cancer-immunity cycle. The two multi-HLA reactive peptides heat shock protein 70 (HSP70) and glypican 3 (GPC3) were screened by an AI-based prediction system according to the proteome, mRNA, and histopathology data fromhuman samples. These immunogenic peptides were confirmed to show cross-reactivity to HLA-A 24:02, 02:01, and 02:06. Poly-ICLC (Oncovir Inc.) binds to Toll-like receptor 3 (TLR3) and melanoma differentiation antigen 5 (MDA5) on antigen-presenting cells (APCs)and activates APCs. LAG-3Ig (Immutep Inc.) binds to the major histocompatibility complex (MHC) class II molecules of APCs and activates APCs. Both poly-ICLC and LAG-3Ig synergistically activate antigen-specific CTL reactions as effective combination adjuvants. The present study aims to evaluate the safety and tolerability of CYT001 (mixture of HSP70 peptide [2.0 mg], GPC3 peptide [2.0 mg], poly-ICLC [1.0 mg], and LAG-3Ig [1.4 mg]) in patients with advanced hepatocellular carcinoma (HCC). Methods: This is a single-center, phase 1, open-label, single-arm, investigator-initiated clinical trial of CYT001 for advanced HCC patients with no eligible standard systemic therapy, Child–Pugh A liver disease, and HLA-A 24:02, 02:01, or 02:06. Enrolled patients will receive CYT001 as a subcutaneous injection on days 1, 8, 15, and 21 in the 1st and 2nd cycles, days 1 and 15 in the 3rd and 4th cycles, and day 1 in the 5th cycle or later of 28-day cycles. The primary endpoint is dose-limiting toxicity, and the secondary endpoints are safety and the response rate. The transition of the CTL reactions of both the HSP70 and GPC3 peptides will be evaluated using blood samples of the subjects. Exploratory analyses include investigation of candidate biomarkers for treatment efficacy using liver tumor biopsy samples (baseline and after the 1st cycle) and blood samples (baseline and every days of administration). Clinical trial information: jRCT2031190072.
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Affiliation(s)
- Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kengo Kanayama
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Susumu Maruta
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Souichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hiroyuki Nakada
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Nobuko Yamaguchi
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Chiba, Japan
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Ebata R, Yasukawa K, Nagai K, Saito Y, Higashi K, Homma J, Takada N, Takechi F, Saito N, Kobayashi H, Okunushi K, Hamada H, Kohno Y, Hanaoka H, Shimojo N. Sivelestat sodium hydrate treatment for refractory Kawasaki disease. Pediatr Int 2019; 61:438-443. [PMID: 30916859 DOI: 10.1111/ped.13851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/16/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is still no definite treatment for refractory Kawasaki disease (KD). In this pilot study, we evaluated the safety and efficacy of a new protocol consisting of sivelestat sodium hydrate (SSH) combined with additional i.v. immunoglobulin (IVIG) for KD resistant to initial IVIG therapy. METHODS This study is a prospective non-randomized, open-label and single-arm study undertaken in a population of refractory KD patients at Chiba University Hospital from December 2006 to March 2016. The subjects had KD resistant to initial IVIG (2 g/kg) and received SSH (0.2 mg/kg/h for 5 days) combined with additional IVIG (2 g/kg) as a second-line therapy. We evaluated the safety and efficacy of the treatment during the study period. RESULTS Forty-six KD patients were enrolled in this study and no serious adverse event was noted. Of these, 45 patients were evaluated for the incidence of coronary artery lesions, which occurred in one patient (2.2%; 95% CI: 0.5-15.2). Twenty-eight (62.2%) responded promptly and were afebrile after the therapy. The median total duration of fever was 8 days (range, 6-28 days). CONCLUSIONS Additional IVIG combined with SSH as a second-line therapy for KD refractory to initial IVIG therapy was safe and well tolerated and could be a promising option for severe KD. Further investigations are expected to clarify the safety and timing of SSH treatment for KD.
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Affiliation(s)
- Ryota Ebata
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Kumi Yasukawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Kazue Nagai
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuko Saito
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Kouji Higashi
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Jun Homma
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Nobuyuki Takada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Fumie Takechi
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Naoki Saito
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Hironobu Kobayashi
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Kentaro Okunushi
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo, Japan
| | - Yoichi Kohno
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Yachiyo, Japan
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Hamada H, Suzuki H, Onouchi Y, Ebata R, Terai M, Fuse S, Okajima Y, Kurotobi S, Hirai K, Soga T, Ishiguchi Y, Okuma Y, Takada N, Yanai M, Sato J, Nakayashiro M, Ayusawa M, Yamamoto E, Nomura Y, Hashimura Y, Ouchi K, Masuda H, Takatsuki S, Hirono K, Ariga T, Higaki T, Otsuki A, Terauchi M, Aoyagi R, Sato T, Fujii Y, Fujiwara T, Hanaoka H, Hata A. Efficacy of primary treatment with immunoglobulin plus ciclosporin for prevention of coronary artery abnormalities in patients with Kawasaki disease predicted to be at increased risk of non-response to intravenous immunoglobulin (KAICA): a randomised controlled, open-label, blinded-endpoints, phase 3 trial. Lancet 2019; 393:1128-1137. [PMID: 30853151 DOI: 10.1016/s0140-6736(18)32003-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genetic studies have indicated possible involvement of the upregulated calcium-nuclear factor of activated T cells pathway in the pathogenesis of Kawasaki disease. We aimed to assess safety and efficacy of ciclosporin, an immunosuppressant targeting this pathway, for protection of patients with Kawasaki disease against coronary artery abnormalities. METHODS We did a randomised, open-label, blinded endpoints trial involving 22 hospitals in Japan between May 29, 2014, and Dec 27, 2016. Eligible patients predicted to be at higher risk for intravenous immunoglobulin (IVIG) resistance were randomly assigned to IVIG plus ciclosporin (5 mg/kg per day for 5 days; study treatment) or IVIG (conventional treatment) groups, stratified by risk score, age, and sex. The primary endpoint was incidence of coronary artery abnormalities using Japanese criteria during the 12-week trial, assessed in participants who received at least one dose of study drug and who visited the study institution at least once during treatment. This trial is registered to Center for Clinical Trials, Japan Medical Association, number JMA-IIA00174. FINDINGS We enrolled 175 participants. One patient withdrew consent after enrolment and was excluded and one patient (in the study treatment group) was excluded from analysis because of lost echocardiography data. Incidence of coronary artery abnormalities was lower in the study treatment group than in the conventional treatment group (12 [14%] of 86 patients vs 27 [31%] of 87 patients; risk ratio 0·46; 95% CI 0·25-0·86; p=0·010). No difference was found in the incidence of adverse events between the groups (9% vs 7%; p=0·78). INTERPRETATION Combined primary therapy with IVIG and ciclosporin was safe and effective for favourable coronary artery outcomes in Kawasaki disease patients who were predicted to be unresponsive to IVIG. FUNDING Japan Agency for Medical Research and Development (grant CCT-B-2503).
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Affiliation(s)
- Hiromichi Hamada
- Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pediatrics, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University of Medicine, Wakayama, Japan
| | | | - Ryota Ebata
- Department of Pediatrics, Chiba University, Chiba, Japan
| | - Masaru Terai
- Department of Pediatrics, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Shigeto Fuse
- Department of Pediatrics, NTT Sapporo Medical Center, Sapporo, Japan
| | | | | | - Katsuki Hirai
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Takashi Soga
- Department of Pediatrics, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yukiko Ishiguchi
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshiaki Okuma
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyuki Takada
- Department of Pediatrics, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masaaki Yanai
- Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Junichi Sato
- Department of Pediatrics, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Mami Nakayashiro
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Eiichi Yamamoto
- Department of Pediatrics, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuya Hashimura
- Department of Pediatrics, Takatsuki General Hospital, Osaka, Japan
| | - Kazunobu Ouchi
- Department of Pediatrics, Kawasaki Medical School Hospital, Okayama, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Tadashi Ariga
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Akio Otsuki
- Department of Pediatrics, Komatsu Municipal Hospital, Ishikawa, Japan
| | - Moe Terauchi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Reiko Aoyagi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Takatoshi Sato
- Department of Pediatrics, Funabashi Municipal Medical Center, Funabashi, Japan; Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Chiba University, Chiba, Japan.
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Takami A, Hirata K, Ishiguro C, Hanaoka H, Uyama Y. Lower Proportion of Spontaneous Adverse Event Reports for Generic Drugs by Comparison With Original Branded Drugs at the Postmarket Stage in Japan. Clin Pharmacol Ther 2018; 105:1471-1476. [PMID: 30588617 DOI: 10.1002/cpt.1342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/01/2018] [Indexed: 12/20/2022]
Abstract
We investigated impacts of increased generic drug use on spontaneous adverse event reports (SAERs), because SAERs have been a major source of data for drug safety assessment at the postmarket stage. Reporting proportion of SAERs for the generic drugs was consistently and significantly lower than that for the original branded drugs. The reporting proportion targeting for 55 active product ingredients, which had the longest follow-up period after generic drug marketed, gradually decreased for the original branded drugs and increased for the generic drugs. However, these transitions did not parallel the changes in market share over the same period. These results suggest that the reporting proportion of SAERs for generic drugs may not keep pace with growth in market share. When generic drugs account for the majority of market share, utilization of multiple sources of information and data, in addition to SAERs, may be a key to assuring drug safety at the postmarket stage.
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Affiliation(s)
- Akina Takami
- Office of New Drug I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.,Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kaori Hirata
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Chieko Ishiguro
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Hideki Hanaoka
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Division of Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshiaki Uyama
- Department of Regulatory Science of Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.,Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.,Graduate School of Medicine, Nagoya University, Nagoya, Japan
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48
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Hanaoka H, Iida H, Kiyokawa T, Takakuwa Y, Kawahata K. A positive direct Coombs’ test in the absence of hemolytic anemia predicts high disease activity and poor renal response in systemic lupus erythematosus. Lupus 2018; 27:2274-2278. [DOI: 10.1177/0961203318809182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We determined the clinical utility of the direct Coombs’ test in the absence of hemolytic anemia as an indicator of disease activity and therapeutic response in systemic lupus erythematosus (SLE). SLE patients without hemolytic anemia who visited our hospital from January 2016 to November 2016 were retrospectively evaluated with a direct Coombs’ test. Clinical features, including SLE disease activity index (SLEDAI), treatment and laboratory findings were analyzed. For patients with lupus nephritis, we additionally evaluated the cumulative complete renal response rate over one year after induction therapy. Among 182 patients evaluated, 10 (5.8%) patients had a positive direct Coombs’ test in the absence of hemolytic anemia. They had a higher SLEDAI ( p < 0.01), higher circulating immune complex levels ( p = 0.01), higher anti-DNA titers ( p < 0.01) and a lower complete renal response rate ( p = 0.03) compared with those who were negative. Multivariate analysis indicated that SLEDAI was an independent factor correlated with the direct Coombs’ test without hemolytic anemia (odds ratio 2.4, 95% confidence interval 1.66–4.98, p < 0.01). A positive direct Coombs’ test in the absence of hemolytic anemia may therefore represent a useful biomarker for assessing disease activity and therapeutic response.
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Affiliation(s)
- H Hanaoka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - H Iida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - T Kiyokawa
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Y Takakuwa
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - K Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Nishi T, Kitahara H, Fujimoto Y, Nakayama T, Nagashima K, Hanaoka H, Kobayashi Y. Intravenous nicorandil versus adenosine for fractional flow reserve measurement: a crossover, randomized study. Heart Vessels 2018; 33:1570-1575. [PMID: 29858919 DOI: 10.1007/s00380-018-1197-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/25/2018] [Indexed: 11/25/2022]
Abstract
Nicorandil has vasodilatory effects on both the epicardial coronary arteries and the coronary microvasculature, thereby increasing coronary blood flow. The objective of the present study was to investigate the effectiveness of intravenous (IV) nicorandil infusion for fractional flow reserve (FFR) measurement. In this crossover randomized study, 49 patients underwent FFR measurement with a consecutive randomized order of patient-blind infusions of continuous IV adenosine administration and a single bolus IV administration of nicorandil. The primary endpoint was the difference between the FFR by nicorandil and the FFR by adenosine, as assessed by the Bland-Altman method. The mean FFR value measured by nicorandil was not significantly different from that measured by adenosine [0.8125 ± 0.1349 vs. 0.7978 ± 0.124; mean difference, 0.0147 (95% confidence interval - 0.0373, 0.0667); P = 0.58]. There was no clinically significant diagnostic discordance, with the FFR by nicorandil > 0.80 and that by adenosine < 0.75. Hyperemia was achieved earlier using nicorandil than adenosine (34 ± 13 vs. 58 ± 15, P < 0.001). The duration of hyperemia after IV nicorandil was variable (6-570 s, mean 89 ± 98 s). IV nicorandil decreased systolic blood pressure by 32 ± 16 mm Hg (24 ± 10%) from baseline. Linear regression analysis showed that the average FFR value and the difference in systolic blood pressure were significantly associated with the bias in the FFR value between the two drugs. In conclusions, the results of the present study suggest that IV nicorandil can achieve maximal hyperemia easily and rapidly, providing an acceptable diagnostic performance for FFR assessment. However, a wide range of variation in hyperemic plateau and a decrease in blood pressure are the major limitations of this method.
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Affiliation(s)
- Takeshi Nishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Kengo Nagashima
- Department of Global Clinical Research, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, University Hospital, Chiba University School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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50
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Koda M, Hanaoka H, Sato T, Fujii Y, Hanawa M, Takahashi S, Furuya T, Ijima Y, Saito J, Kitamura M, Ohtori S, Matsumoto Y, Abe T, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Takahashi I, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Ozawa T, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Yamamoto Y, Togawa D, Hasegawa T, Kobayashi S, Yoshida G, Oe S, Banno T, Arima H, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Osaki S, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Idota M, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Yamazaki M. Study protocol for the G-SPIRIT trial: a randomised, placebo-controlled, double-blinded phase III trial of granulocyte colony-stimulating factor-mediated neuroprotection for acute spinal cord injury. BMJ Open 2018; 8:e019083. [PMID: 29730616 PMCID: PMC5942478 DOI: 10.1136/bmjopen-2017-019083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. METHODS AND ANALYSIS The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m2/day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). ETHICS AND DISSEMINATION The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. TRIAL REGISTRATION NUMBER UMIN000018752.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takatoshi Sato
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Sho Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Ikuko Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba City, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba City, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Tomoyuki Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Tsuyoshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Shuhei Osaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Masaru Idota
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
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