コルチコステロイド依存性慢性重度の喘息におけるサイクロスポリンの臨床試験
A G Alexander1, N C Barnes, A B Kay
1Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, UK.
Lancet (London, England)
|February 8, 1992
まとめ
シクロスポリンは,慢性重度の喘息患者の肺機能を有意に改善し,喘息の悪化を軽減しました. この免疫抑制薬は,喘息の病原化に関与するTリンパ球をターゲットにすることで,潜在的な新しい治療の道を提供します.
科学分野:
- 免疫学 免疫学とは
- 肺内科 肺内科 肺内科
- 薬理学 薬理学とは
背景:
- 慢性重度の喘息の治療は,多くの患者にとって依然として困難です.
- コルチコステロイド依存症は,重度の喘息において一般的であり,潜在的炎症的プロセスを示す.
- Tリンパ球は,喘息の病原化に関与しており,治療のターゲットとして示唆されています.
研究 の 目的:
- コルチコステロイド依存性喘息患者の肺機能改善におけるサイクロスポリンの有効性を評価する.
- 喘息の悪化と病気のコントロールに対するサイクロスポリンの影響を評価する.
- この患者集団におけるサイクロスポリンの安全性と耐受性を調査する.
主な方法:
- ランダム化,ダブルブラインド,プラセボ対照,クロスオーバー試験が行われました.
- 長期にわたる,重症な,コルチコステロイド依存性喘息の患者33人が参加しました.
- 患者は12週間にわたってサイクロスポリン (5mg/kg/日) またはプラセボを投与され,その後2週間の洗い流し後にクロスオーバーが行われました.
主要な成果:
- サイクロスポリンは,プラセボと比較して,朝のピーク呼吸器流量 (PEFR) を12.0%増加させ,1秒間の強制呼吸量 (FEV1) を17.6%増加させました.
- プレドニゾロンの投与量を増加させる必要のある喘息悪化の頻度は,サイクロスポリンで48%減少しました.
- PEFRの昼間変動は,サイクロスポリン治療で27.6%減少し,薬剤は一般的に良好に耐えました.
結論:
- サイクロスポリンは,肺機能を改善し,重度のコルチコステロイド依存性喘息の悪化を軽減する上で有意義な利点を示しています.
- これらの発見は,喘息の病原性における活性化されたTリンパ球の役割を支持しています.
- サイクロスポリンなどの薬剤でTリンパ球を標的にすることは,喘息の管理のための有望な新しい治療戦略を表しています.
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