ࡑࢀ௨እ ( ࣞࣅ࣮ࣗ➼ ) ࡼࡿⓎ⾲㸦 0 㸧௳
ࡑࡢ࠺ࡕ࡞ࡶࡢ Ⓨ⾲ㄽᩥ
ㄽᩥⓎ⾲
1. Koike H, Kadoya M, Kaida K, Ikeda S, Kawagashira Y, Iijima M, Kato D, Ogata H, Yamasaki R, Matsukawa N, Kira J, Katsuno M, Sobue G: Paranodal dissection in chronic inflammatory demyelinating
polyneuropathy with anti-neurofascin-155 and anti-contactin-1 antibodies. J Neurol Neurosurg Psychiatry 2017
2. Ohyama K, Koike H, Takahashi M, Kawagashira Y, Iijima M, Watanabe H, Sobue G:
Immunoglobulin G4-related pathologic features in inflammatory neuropathies. Neurology.
2015;85(16):1400-7.
3. Ohyama K, Koike H, Katsuno M, Takahashi M, Hashimoto R, Kawagashira Y, Iijima M, Adachi H, Watanabe H, Sobue G: Muscle atrophy in chronic inflammatory demyelinating
polyneuropathy: a computed tomography assessment. Eur J Neurol. 2014;21: 1002-10
ᏛⓎ⾲
1.
Koike H, Takahashi M, Ohyama K, Kawagashira Y, Iijima M, Sobue G: Morphology of
nonmyelinating Schwann cells in chronic inflammatory demyelinating polyneuropathy.
PNS/Inflammatory Neuropathy Consortium Meeting. Düsseldorf, Germany, 2014.
2.
Ohyama K, Koike H, Katsuno M, Takahashi M, Hashimoto R, Kawagashira Y, Iijima M, Adachi H, Watanabe H, Sobue G: Muscle Atrophy in Chronic Inflammatory Demyelinating Polyneuropathy: A Computed Tomography Assessment. PNS/Inflammatory Neuropathy Consortium Meeting. Düsseldorf, Germany, 2014.
㹅 . ▱ⓗᡤ᭷ᶒࡢྲྀᚓ≧ἣ ヱᙜࡍࡿࡶࡢ࡞ࡋ
᪥ᮏேከⓎᛶ◳ / ど⚄⤒⬨㧊⅖㛵㐃ᝈᝈ⪅䛻㐺䛧䛯⒪ἲ䛾 㛤Ⓨ䛻㛵䛩䜛◊✲䠖
intermittent drug holiday(s) 㻘㻌 య㔜ᙜ䛯䜚ᢞἲ䚸⾑୰⃰ᗘ䝰䝙䝍䝸䞁䜾㻌 ศᢸ◊✲⪅䠖㻌 ⏣୰ṇ⨾㻌
ᡤᒓタྡ䠖㻌 ᅜ❧㝔ᶵᵓᏱከ㔝㝔䚸ி㒔Ẹ་㐃୰ኸ㝔
◊✲せ᪨㻌
ከⓎᛶ◳(MS)ᝈ⪅䛻Ⓨ㜵Ṇ┠ⓗ䛷ᢞ䛥䜜䛶䛔䜛⸆(DMD)䛿䚸䝸䞁䝟⌫ᩘ䜢పୗ䛥䛫䜛䛣䛸䛜ᑡ䛺䛟䛺 䛔䚹䝣䝬䝹㓟䛷䛿㐍⾜ᛶከᒙᛶⓑ㉁⬻䠄PML䠅䛜5ሗ࿌䛥䜜䛶䛔䛶䚸PML䝸䝇䜽పῶ䛾䛯䜑䛻500/mm3௨ୗ䛜༙ᖺᣢ⥆䛩 䜛㝿䛻䛿ᢞ୰᩿䜢Ḣ⡿䛷䛿່࿌䛥䜜䛶䛔䜛䚹Natalizumab (NTZ)-associated PML䛿ᅜෆ䛷䜒ሗ࿌䛥䜜䚸Fingolimod (FTY)䛿 ୡ⏺䛾11୰3䛜ᅜෆ䛷䛒䜛䚹䜟䜜䜟䜜䛿᪥ᮏேMSᝈ⪅䛷䛿PML䝸䝇䜽䛜㧗䛔ྍ⬟ᛶ䜢ྰᐃ䛷䛝䛺䛔䛸⪃䛘䛶䛔䜛䚹 䝸䞁䝟⌫ᩘపୗ䛻䜘䜛⒪୰᩿䜔PML䝸䝇䜽పῶ䛾䛯䜑䛾ᢞἲ䜢ᥦ䛧䛯䚹䜎䛯䚸ど⚄⤒⬨㧊⅖㛵㐃ᝈ(NMOsd)ᝈ⪅䜈 䛾䝍䜽䝻䝸䝮䝇䛾䝰䝙䝍䝸䞁䜾䛾ᐇ㝿䜢ᥦ䛧䛯䚹㸿.◊✲┠ⓗ
㻌FTY 䛷䛿䝦䝹䝨䝇⣔䜴䜲䝹䝇䛜άᛶ䛥䜜䚸ᖏ≧⑁⑈
䛜 ฟ ⌧ 䛩 䜛 䛣 䛸 䛜 ⛥ 䛷 䛿 䛺 䛟 䚸 䛣 䛾 䛾 䝸 䞁 䝟 ⌫ ᩘ 䛿
500/mm3௨ୖ䛷䛒䛳䛯䚹FTY 䛷䛿䜴䜲䝹䝇ឤᰁ䛾㢖ᗘ䛿
䝸䞁䝟⌫ᩘ䛸䛿┦㛵䛧䛺䛔䛜䚸PMDA䛿200/mm3௨ୖ䜢䜻 䞊䝥䛩䜛䛣䛸䜢່࿌䛧䛶䛔䜛䚹
NTZ-associated PML䛜䛩䛷䛻700௨ୖሗ࿌䛥䜜䛶䛔䜛䚹 䛣䛾䝸䝇䜽䜢ୗ䛢䜛䛯䜑䛻䚸Ḣ⡿䛷䛿ᢞ㛫㝸䜢䛒䛡䜛᪉ἲ
䛜䛒䜚䚸nadir䛷䛾㐣䛺⃰ᗘ䜢పୗ䛥䛫䜛䛶䛔䜛䚹
㻌 ど ⚄ ⤒ ⬨ 㧊 ⅖ 㛵 㐃 ᝈ(NMOsd)䛷 Ⓨ 䛻 ᑐ 䛧 䛶
Tacrolimus(TCR)䛜ᙉຊ䛺ᢚไຠᯝ䛜䛒䜛䛣䛸䜢ሗ࿌䛧䛯䛜䚸
⮬ᕫචᝈ䛷䛾⾑୰⃰ᗘ䛾䝰䝙䝍䝸䞁䜾ୖ䛾ၥ㢟䛿㆟ㄽ 䛥䜜䛶䛣䛺䛛䛳䛯䚹䛣䛾3ᖺ㛫䛾䜟䜜䜟䜜䛾◊✲ᡂᯝ䛻䛴䛔 䛶ሗ࿌䛩䜛䚹
㹀.◊✲᪉ἲ㻌 ⏣୰䛾እ᮶䜢ཷデ䛧䛯MS/NMOsd᪥ᮏேᝈ
⪅䜢ᑐ㇟䛸䛧䚸nadir䛷䛾NTZ⾑୰⃰ᗘ䛸య㔜䛾┦㛵䛻䛴䛔 䛶䛿䚸⡿ᅜDr Folley䛜ົ䛩䜛Rocky Mountain MS Center 䛾⾑୰⃰ᗘ䛾䝕䞊䝍䜢⏝䛔䛯䚹TCR䛾⾑୰⃰ᗘ䛿CLIAἲ (BML)䜢ᇶ‽䛸䛧䚸ECLIAἲ(SRL)䛸ẚ㍑䛧䛯䚹
⌮㠃䛻䛴䛔䛶䠖㻌 ಶேሗ䛿㝔ෆ䛷ཝ㔜䛻⟶⌮䛧䚸㝔እ䛻
₃ฟ䛧䛺䛔䜘䛖䛻㓄៖䛧䛯䚹㻌 㹁.◊✲⤖ᯝ
1). NTZ䛷䛿య㔜䛻䜘䜚nadir䛷䛾⾑୰⃰ᗘ䛸ᶆⓗศᏊ䛷䛒
䜛VLA4㣬ᗘ䛜┤⥺ⓗ䛺┦㛵㛵ಀ䛜䛒䜛䛣䛸䜢⡿ᅜேᝈ
⪅䛾䝕䞊䝍䛛䜙ồ䜑䛶ሗ࿌䛧䚸ᚲせ䛺VLA4㣬䜢㑊䛡䜛 䛯䜑䛻య㔜䛒䛯䜚䛾ᢞἲ䜢ᥦ䛧䛯䚹
2). FTY䜢ῶ㔞䛩䜛䛻ᙜ䛯䛳䛶䛿䚸㐃᪥ᢞ䛛䜙䛔䛝䛺䜚㝸
᪥䜈⛣⾜䛩䜛䛾䛷䛿䛺䛟䚸ᾘኻ༙ῶᮇ䛜㛗䛔䛣䛸䜢⏝䛧䛶 䛂୰ᢤ䛝䛃ᢞ䜢⾜䛖䜉䛝䛷䛒䜛䚹㛗ᮇ㛫䛾ᢞ୰᩿ᚋ䛾
㛤䛾ᚰ⮚䜈䛾㈇ᢸ䜢㜵䛠䛯䜑䛷䜒䛒䜛䚹
3). య㔜䛾㍍䛔᪥ᮏேᝈ⪅䛻NTZ䜢100 kg䛾ᝈ⪅䜎䛷䜹䝞 䞊䛷䛝䜛⏝㔞䜢ᢞ䛩䜛䛣䛸䛿䚸nadir䛷䛾ᚲせ䛺⃰ᗘ䜢䜒 䛯䜙䛧䚸PMLⓎ䝸䝇䜽䜢㧗䜑䜛༴㝤ᛶ䛜䛒䜛䚹EIDT䛻䜘䜚 PML䛜ᮍⓎ䛰䛜䚸୍᪉䛷Ⓨ䜢䛝䛯䛧䛶䛔䜛䛣䛸䛿ᢞ
㔞䛾ྠ୍䛾༴㝤ᛶ䜢≀ㄒ䛳䛶䛔䜛䚹䛯䛰䚸య㔜ᙜ䛯䜚ᢞ
ἲ䛿ᝈ⪅䛤䛸䛻ᢞ㔞䛜␗䛺䜛䛯䜑䛂་⒪ᨾ䛃䛾䝸䝇䜽䜒 䜒䛯䜙䛩䛣䛸䛻䛿␃ព䛜ᚲせ䛷䛒䜝䛖䚹
4). 㐺ษ䛺 TCR 䛾䝖䝷䝣䛷䛾⾑୰⃰ᗘ䛥䛘⥔ᣢ䛷䛝䜜䜀
NMOsdⓎண㜵䛻䛿TCR䛿ᴟ䜑䛶ᙉຊ䛷䛒䜛䚹␗䛺䜛
ᐃἲ䛻䜘䜛⤖ᯝ䚸≉䛻Ⓨண㜵䛻㔜せ䛺ప್䛷䛾ホ౯䛻䛿
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ὀព䜢せ䛩䜛䚹䝰䝙䝍䝸䞁䜾䛻ᙜ䛯䛳䛶䛾ලయⓗ䛺䝫䜲䞁䝖䜢 ᣦ䛧䛯䚹
㹃.⤖ㄽ PML 䝸䝇䜽䜢⪃៖䛧䛶䚸㐣㔞䛻䛺䜙䛺䛔䜘䛖䛻㓄៖
䛧䛴䛴䚸Ⓨ䛧䛺䜘䛖䛻ᚲせศ䛺⏝㔞䜢㐺ษ䛻☜ಖ䛩䜛᪉ ἲ䛾㛤Ⓨ䛜ᚋ䛾ㄢ㢟䛷䛒䜛䚹
䛺ཎⴭㄽᩥ䛻䜘䜛Ⓨ⾲
㻝㻚㻌Tanaka M, Tanaka K. Dose reduction therapy of fingolimod for Japanese patients with multiple sclerosis: 24-months experience. Clin Exp Neuroimmunol 2014;5:383-4.
2. Tanaka M, Kinoshita M. Daily fingolimod administration may cause lymphopenia but alternate-day administration may be too little to inhibit disease activity. J Neuroimmunol 2015; 288:69.
㻟㻚㻌 ⏣୰ṇ⨾㻚㻌 䝣䜱䞁䝂䝸䝰䝗ᢞ୰䛻ᖏ≧⑁⑈䜢Ⓨ䛧䛯ከ
Ⓨᛶ◳䛾᳨ウ㻚㻌 ⮫ᗋ⚄⤒㻌 㻞㻜㻝㻢㻧㻡㻢㻦㻞㻣㻜㻙㻞㻚㻌
4. Tanaka M, Kinoshita M, Foley JF, Tanaka K, Kira J, Carroll WM. Body weight based natalizumab treatment in adult patients with multiple sclerosis. J Neurol, 2015;262:781-2.
5. Tanaka M, Kinoshita M, Tanaka K. Anti-JC virus index in Japanese patients with multiple sclerosis and neuromyelitis optica related disorder. Clin Exp Neuroimmunol, 2015;6:309-11.
6. Tanaka M, Kinoshita M, Tanaka K. Corticosteroid and tacrolimus treatment in neuromyelitis optica related disorders.
Mult Scler 2015;21:669.
7. Tanaka M, Kinoshita M, Tanaka K. Comparison of tacrolimus blood levels by chemiluminescent enzyme immunoassay and electrochemiluminescence immunoassay in neuromyelitis optica related disorder. Clin Exp Neuroimmunol, 2015;6:433-4.
8. Tanaka M, Yokoyama K. Comparison of nadir serum
concentrations in the extended dosing therapy of natalizumab between American and Japanese multiple sclerosis patients.
Mult Scler J Exp Trans Clin 2016;2:2055217316642263.
9. Tanaka M, Tanaka K. Sudden hearing loss as the initial symptom in Japanese patients with multiple sclerosis and seropositive neuromyelitis optica spectrum disorders. J Neuroimmunol, 2016:298:16-8.
䛺䝺䝡䝳䞊䛺䛹䛻䜘䜛Ⓨ⾲㻌
1. Tanaka M. Commentary The mechanism of action of interferon-β in relapsing-remitting multiple sclerosis: effects on Th17 and Th9 cells. Clin Exp Neuroimmunol, 2014;5:
283-5.
㻞㻚㻌 ⏣୰Ꮚ㻘㻌 ⏣୰ṇ⨾㻚㻌 ⬺㧊ᛶᝈ䛻䛚䛡䜛⮬ᕫᢠయ䛾 ព⩏䛸⨨䛵䛡䚹᪥ᮏ⮫ᗋ㻌 㻞㻜㻝㻠㻧㻣㻞㻦㻞㻜㻢㻣㻙㻣㻞㻚㻌
㻟㻚㻌 ⏣୰ṇ⨾䠖㻌 ከⓎᛶ◳䜈䛾䝘䝍䝸䝒䝬䝤⒪䚹⮫㻌 ᗋ⚄⤒㻌 㻞㻜㻝㻡㻧㻡㻡㻦㻡㻟㻣㻙㻠㻟㻚㻌
4. Tanaka M and Kinoshita M. Congress report of the 67th annual meeting of American Academy of Neurology. Clin Exp Neuroimmunol, 2015;6:335-9.
5. ⏣ ୰ ṇ ⨾ 䚸 ⏣ ୰ Ꮚ 㻦㻌 ᢠ 㼙㼥㼑㼘㼕㼚㻌 㼛㼘㼕㼓㼛㼐㼑㼚㼐㼞㼛㼏㼥㼠㼑㻌 㼓㼘㼥㼏㼛㼜㼞㼛㼠㼑㼕㼚㻌 㻔㻹㻻㻳㻕㻌 ᢠ య 䚹 ᪥ ᮏ ⮫ ᗋ 㻌 㻞㻜㻝㻡㻦㻣㻟㻔㻿㼡㼜㼜㼘㻌 㻣㻕㻦㻤㻠㻞㻙㻢㻚㻌
㻢㻚㻌 ⏣୰ṇ⨾䚸⏣୰Ꮚ㻚㻌 䝕䜱䝧䞊䝖㻌 㻿㼑㼞㼛㼚㼑㼓㼍㼠㼕㼢㼑㻌 㻺㻹㻻 䛿 Ꮡᅾ䛧䛺䛔䛸䛔䛖❧ሙ䛛䜙䚹㻹㻿㻌㻲㼞㼛㼚㼠㼕㼑㼞㻘㻌㻞㻜㻝㻡㻧㻠㻦㻟㻣㻙㻥㻚㻌 㻣㻚㻌 ⏣୰ṇ⨾䠖ከⓎᛶ◳䛸 㻱㻮 䜴䜲䝹䝇䚹㻺㼑㼡㼞㼛㼕㼚㼒㼑㼏㼠㼕㼛㼚㻌 㻞㻜㻝㻡㻧㻞㻜㻦㻝㻤㻙㻞㻝㻚㻌
8. Tanaka M, Kinoshita M. Practical tips of tacrolimus treatment in neuromyelitis optica spectrum disorder. Clin Exp Neuroimmunol, 2016;7: 197-8.
ᗣ༴㝤ሗ㻌 䛺䛧㻌
▱ⓗ㈈⏘ᶒ䛾ฟ㢪䞉Ⓩ㘓≧ἣ㻌 㻌 ≉チྲྀᚓ䠖䛺䛧㻌
㻌 ᐇ⏝᪂Ⓩ㘓䠖䛺䛧㻌
－ 66 －
