WO2010038796A1 - C型肝炎治療剤 - Google Patents
C型肝炎治療剤 Download PDFInfo
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- WO2010038796A1 WO2010038796A1 PCT/JP2009/067066 JP2009067066W WO2010038796A1 WO 2010038796 A1 WO2010038796 A1 WO 2010038796A1 JP 2009067066 W JP2009067066 W JP 2009067066W WO 2010038796 A1 WO2010038796 A1 WO 2010038796A1
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- hepatitis
- interferon
- pharmaceutical composition
- interferon therapy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/20—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids
- A61K31/202—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids having three or more double bonds, e.g. linolenic
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
- A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
- A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
- A61K31/23—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin of acids having a carboxyl group bound to a chain of seven or more carbon atoms
- A61K31/232—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin of acids having a carboxyl group bound to a chain of seven or more carbon atoms having three or more double bonds, e.g. etretinate
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- A61K38/19—Cytokines; Lymphokines; Interferons
- A61K38/21—Interferons [IFN]
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
- A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/12—Antivirals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/12—Antivirals
- A61P31/14—Antivirals for RNA viruses
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
Definitions
- the present invention relates to a pharmaceutical composition for treating hepatitis C and a method for treating hepatitis C.
- HCV hepatitis C virus
- Hepatic steatosis in hepatitis C is due to the accumulation of C18: 1 fatty acids such as oleic acid (18: 1 (9)) and vaccenic acid (18: 1 (11)). It's different from that. HCV is considered to cause fatty liver specific to hepatitis C by affecting the specific pathway of lipid metabolism (Non-patent Document 3).
- hepatic steatosis reduces the therapeutic effect of antiviral agents against hepatitis C.
- IFN ⁇ and ribavirin 66% of patients without hepatic steatosis obtained sustained virological response (SVR), but the average was 50% in patients with hepatic steatosis (Non-patent Document 4). ).
- hepatitis C hepatic steatosis is observed at a high rate, and when hepatic steatosis is present, the therapeutic effect of the antiviral agent on hepatitis C is diminished. This shows that not only HCV removal but also measures against liver steatosis are necessary.
- Hepatic steatosis and HCV core protein in hepatitis C are related to each other.
- the liver fat composition of the HCV core protein gene transgenic mice was accumulated more C18: 1 fatty acid than that of the simple obese mice.
- a similar difference in liver fat composition was also observed in HCV-infected fatty liver patients and HCV-uninfected fatty liver patients (Non-patent Document 3).
- the HCV core protein sticks to the lipid droplets accumulated in the liver by the HCV core protein, and new HCV is formed around the lipid droplets (Non-patent Document 5).
- the HCV core protein leads to fat accumulation / hepatic steatosis through a unique pathway different from other fatty livers, and the fat accumulated in the liver promotes the growth of HCV.
- HCV proliferation and hepatic steatosis are other exacerbating factors, in other words, there is a cycle of hepatitis C exacerbation between HCV proliferation and hepatic steatosis. This blockage of the hepatitis C exacerbation cycle is necessary to optimize the treatment of hepatitis C.
- Polyunsaturated fatty acids are defined as fatty acids having a plurality of carbon-carbon double bonds in the molecule, and are classified into ⁇ 3, ⁇ 6, etc., depending on the position of the double bond.
- ⁇ 3 polyunsaturated fatty acids include ⁇ -linolenic acid, icosapentoic acid (EPA), docosahexaenoic acid (DHA), and the like.
- Non-patent Document 6 There is a report that polyunsaturated fatty acids such as arachidonic acid, EPA, and DHA suppressed HCV replication in cultured cells using Ava5 cells.
- Patent Document 1 There is also a report that EPA can prevent anemia during interferon and ribavirin combination therapy.
- ⁇ 3 PUFAs are effective in reducing various side effects in interferon therapy for hepatitis C.
- the administration of ⁇ 3 PUFAs also means that it did not show a direct effect on the treatment of hepatitis C itself.
- the present inventors have reported that patients with hepatitis C who have a history of receiving (treated) interferon but who have been ineffective, or who have been transiently effective but have relapsed, have relapsed ⁇ 3. It has been found that when a polyunsaturated fatty acid, particularly EPA ethyl ester, is continuously administered, a therapeutic effect for hepatitis C can be obtained. Furthermore, the present inventors have found that continuous administration of ⁇ 3 polyunsaturated fatty acid, especially EPA ethyl ester, improves the effectiveness of interferon therapy.
- the present invention provides the following pharmaceutical compositions.
- a medicament for treating interferon-resistant hepatitis C comprising as an active ingredient at least one selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof Composition.
- the pharmaceutical composition according to (1) above, wherein the interferon-resistant hepatitis C is associated with hypertriglyceridemia.
- the pharmaceutical composition according to any one of the above (6) to (8) which is applied to a patient for whom interferon therapy has been ineffective.
- the pharmaceutical composition according to any one of (6) to (8) above which is applied to a patient who has been temporarily effective in interferon therapy but has relapsed.
- (11) The above (3), wherein at least one selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof is administered for at least 2 weeks prior to interferon therapy.
- the present invention also provides the following method.
- (14) A method for treating interferon-resistant hepatitis C, comprising administering a pharmaceutical composition containing as an active ingredient at least one selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof .
- 15) The method according to (14) above, wherein the interferon-resistant hepatitis C is accompanied by liver steatosis.
- (16) The method according to (14) above, wherein the interferon-resistant hepatitis C is associated with hypertriglyceridemia.
- 17.) The method according to any one of (14) to (16) above, which is applied to a patient for whom interferon therapy has been ineffective.
- a pharmaceutical composition comprising, as an active ingredient, at least one compound selected from the group consisting of icosapentic acid, docosahexaenoic acid, ⁇ -linolenic acid, pharmaceutically acceptable salts and esters thereof, The method according to any one of 14) to (24). (26) The method according to any one of (14) to (25) above, wherein a pharmaceutical composition containing icosapentic acid ethyl ester as the active ingredient is administered.
- the present invention also provides at least one use selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof for the manufacture of a medicament for treating interferon-resistant hepatitis C. . Furthermore, the use of at least one selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, their pharmaceutically acceptable salts and esters for the manufacture of a medicament for improving the effectiveness of interferon therapy in patients with hepatitis C. provide.
- the C type polyunsaturated fatty acid, a pharmaceutically acceptable salt thereof, and at least one selected from the group consisting of esters and esters are contained as an active ingredient.
- a therapeutic agent for hepatitis Provides a therapeutic agent for hepatitis.
- the effective rate of interferon therapy in hepatitis C patients, comprising as an active ingredient at least one selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof Provide an improver.
- the present invention also provides the following uses.
- (27) Use of at least one compound selected from the group consisting of ⁇ 3 polyunsaturated fatty acids, pharmaceutically acceptable salts and esters thereof for the manufacture of a medicament for treating interferon-resistant hepatitis C.
- (28) The use according to (27) above, wherein the interferon-resistant hepatitis C is accompanied by liver fat metastasis.
- (29) The use according to (27) above, wherein the interferon-resistant hepatitis C is associated with hyperglyceridemia.
- (30) The use according to any one of (27) to (29) above, wherein the medicament is applied to a patient for whom interferon therapy has been ineffective.
- the pharmaceutical composition of the present invention also shows a therapeutic effect on hepatitis C that is resistant to interferon therapy, which is the first choice in the treatment of hepatitis C.
- the pharmaceutical composition of the present invention is particularly effective for such patient groups.
- the pharmaceutical composition of the present invention can improve the effective rate of interferon therapy.
- the pharmaceutical composition of the present invention is a therapeutic agent for hepatitis C with high safety and few side effects.
- ⁇ 3 polyunsaturated fatty acids are defined as fatty acids having multiple carbon-carbon double bonds in the molecule and the position of the double bond Is classified into ⁇ 3, ⁇ 6, and the like.
- PUFAs polyunsaturated fatty acids
- ⁇ 3 is the first double bond carbon counted from the methyl end of the fatty acid
- ⁇ 6 is the sixth double bond carbon counted from the methyl end of the fatty acid.
- Examples of ⁇ 3 PUFAs include ⁇ -linolenic acid, EPA, DHA and the like.
- PUFAs is exemplified by not only polyunsaturated fatty acids but also pharmaceutically acceptable salts, esters, amides, phospholipids, or glycerides thereof. Used to include polyunsaturated fatty acid derivatives.
- ⁇ 3 PUFAs used in the present invention may be a synthetic product, a semi-synthetic product or a natural product, or may be in the form of a natural oil containing them.
- the “natural product” is one extracted from a natural oil containing ⁇ 3 PUFAs by a known method, one obtained by crude purification, or one obtained by further highly refining them.
- “Semi-synthetic products” include polyunsaturated fatty acids produced by microorganisms and the like, and the polyunsaturated fatty acids or natural polyunsaturated fatty acids are subjected to chemical treatment such as esterification and transesterification. Also included. In the present invention, as ⁇ 3PUFAs, one of these can be used alone, or two or more can be used in combination.
- ⁇ 3PUFAs include EPA, DHA, ⁇ -linolenic acid, and pharmaceutically acceptable salts and esters thereof.
- Pharmaceutically acceptable salts and esters include inorganic bases such as sodium and potassium salts, and organic bases such as benzylamine and diethylamine salts, and salts with basic amino acids such as arginine and lysine salts, and ethyl. Examples include alkyl esters such as esters, and esters such as mono-, di-, and tri-glycerides. Preferred is ethyl ester, and more preferred is EPA ethyl ester (EPA-E) and / or DHA ethyl ester (DHA-E).
- EPA-E EPA ethyl ester
- DHA-E DHA ethyl ester
- the purity of ⁇ 3 PUFAs is not particularly limited, but usually, the content of ⁇ 3 PUFAs in the total fatty acids of the composition of the present agent is preferably 25% by mass or more, more preferably 50% by mass or more, still more preferably 70% by mass or more, even more preferably. Is 85% by mass or more, and it is particularly preferable that the present composition is substantially free of other fatty acid components other than ⁇ 3 PUFAs.
- the composition ratio of EPA-E / DHA-E and the content ratio of EPA-E + DHA-E in all fatty acids are not particularly limited, but the composition ratio is EPA-E / DHA-E is preferably 0.8 or more, more preferably 1.0 or more, and further preferably 1.2 or more.
- EPA-E + DHA-E has a high purity, for example, the content ratio of EPA-E + DHA-E in all fatty acids and derivatives thereof is preferably 40% by mass or more, more preferably 55% by mass or more, more preferably 84% by mass The above are more preferable, and those of 96.5% by mass or more are more preferable.
- the content of other long-chain saturated fatty acids is preferably low, and even long-chain unsaturated fatty acids are desired to have a low ⁇ 6 type, particularly arachidonic acid content, preferably less than 2% by mass, more preferably less than 1% by mass.
- EPA-E and / or DHA-E used in the pharmaceutical composition of the present invention has less unfavorable impurities for cardiovascular events such as saturated fatty acids and arachidonic acid compared to fish oil or fish oil concentrate, and is over-nutrition. It is possible to exert its effect without any problem of excessive intake of vitamin A. Further, since it is an ester, it has a higher oxidation stability than fish oil or the like, which is mainly a triglyceride, and a sufficiently stable composition can be obtained by adding a normal antioxidant.
- This EPA-E is a high-purity EPA-E (96.5 mass% or more) soft capsule (trade name Epadale: available as a therapeutic agent for obstructive arteriosclerosis (ASO) and hyperlipidemia in Japan. Mochida Pharmaceutical Co., Ltd.) can be used.
- EPA-E and DHA-E are, for example, Lovaza (Lovaza: Glaxo-SmithKline: EPA-E approximately 46.5% by mass, DHA-E, which is commercially available as a therapeutic agent for hypertension in the United States.
- a soft capsule containing about 37.5% by mass can also be used.
- Refined fish oil can also be used as ⁇ 3 PUFAs.
- ⁇ 3 PUFAs monoglyceride, diglyceride, triglyceride, or a combination thereof is one of the preferred embodiments.
- Incromega F2250, F2628, E2251, F2573, TG2162, TG2779, TG2928, TG3525, and E5015 (Croda International PLC, Indiana, England TG5EP, EPA10GEP , K85EE and K80EE (Pronova Biopharma, Lysaker, Norway) and other products containing various ⁇ 3 PUFAs, salts and esters thereof are commercially available and can be obtained and used.
- the HCV-RNA level became negative during the interferon administration but was not negative at 6 months after the end of the administration, it is judged as a relapse case (transient effective case). In addition, if no negative HCV-RNA level was observed during interferon administration, it is judged as an invalid case.
- the effective rate of interferon therapy should be calculated by dividing the number of cases with significant effect by the total number of cases, and the HCV-RNA level negative rate by dividing the number of HCV-RNA level negative cases by the total number of cases. Can do.
- the negative expression of the amount of HCV-RNA in blood means that HCV-RNA in blood is not detected when the HCV-RNA qualitative test method (detection limit: 50 IU / mL) is used.
- HCV-RNA qualitative test method detection limit: 50 IU / mL
- a quantitative method amplicore HCV monitor method, original PCR method, high-range PCR method, RT-PCR method, etc.
- a cut-off value corresponding to the detection sensitivity of each measurement method is used. By setting, it is possible to determine negativeity.
- the effective rate of interferon therapy In order to determine the effective rate of interferon therapy, it is necessary to carry out a follow-up survey of 6 months or more after the completion of interferon therapy, and there is a problem that it takes time for the determination.
- the effective rate can be determined earlier. For example, when the amount of virus decrease (the amount of decrease in blood HCV-RNA amount) 3 days after the start of interferon therapy is large, it is predicted that the effective rate of interferon therapy will be high. Therefore, the amount of virus reduction 3 days after the start of interferon therapy can be used as a leading indicator for determining the effectiveness of interferon therapy.
- the difference between the common logarithm value of the blood HCV-RNA amount before the start of interferon therapy and the common logarithm value of the blood HCV-RNA amount 3 days after the start is 2.0 or more.
- Interferon therapy is a therapy in which an interferon preparation is administered alone or in combination with an interferon preparation and another agent.
- interferon preparations include IFN ⁇ , IFN ⁇ , IFN ⁇ 2a, IFN ⁇ 2b, consensus IFN, PEGylated interferon (interferon to which polyethylene glycol is bound), and other agents include ribavirin and the like.
- the dose, interval and duration of interferon can be appropriately changed depending on the patient's condition, symptoms, side effects, effects, and the like.
- the treatment of interferon-resistant hepatitis C in the present invention is intended for hepatitis C cases that have been determined to be relapsed or ineffective in interferon therapy.
- the pharmaceutical composition of the present invention exhibits a therapeutic effect on interferon-resistant hepatitis C.
- the therapeutic effect in the present invention refers to showing at least one of the following effects: 1) reduction or negation of blood HCV-RNA level, and 2) calming of hepatitis. It is preferable that both effects 1) and 2) are obtained. If an improvement of at least 10% or more, preferably 30% or more, more preferably 50% or more is observed with respect to the value before administration of the pharmaceutical composition of the present invention, it can be said to be a therapeutic effect. In the case of the blood HCV-RNA amount, it is preferable that a decrease of 50% or more is observed with respect to the value before administration.
- the calming of hepatitis can be evaluated by using a decrease in blood alanine aminotransferase level (ALT), improvement in liver tissue findings, and the like as indicators.
- ALT blood alanine aminotransferase level
- the timing of starting administration of the pharmaceutical composition of the present invention is not particularly limited as long as it is determined as a relapsed case or an ineffective case in interferon therapy. That is, the start of administration of the pharmaceutical composition of the present invention may be after having been determined to be a relapsed case or an ineffective case, regardless of whether or not to receive interferon therapy again after being determined to be a relapsed case or ineffective case in interferon therapy. That's fine.
- Interferon-resistant hepatitis C with hepatic steatosis refers to a case of interferon-resistant hepatitis C with hepatic steatosis.
- the presence or absence of liver steatosis can be confirmed by image examination (for example, CT scan, abdominal ultrasound, MRI) or liver biopsy.
- image examination for example, CT scan, abdominal ultrasound, MRI
- liver biopsy when the ratio of adipose occupying 30% or more of the lobule area as a liver histological image and large droplet adipose having a size larger than that of hepatocytes is observed, hepatic steatosis is accompanied. It can be determined that this is a case of interferon-resistant hepatitis C.
- the value obtained by dividing the CT value of the liver by the CT value of the spleen is 0.9 or less, it is an interferon-resistant hepatitis C case with steatosis It can be judged.
- the ratio of resistance to interferon therapy is high, but the pharmaceutical composition of the present invention is particularly effective for such patient groups. Particularly effective means that the degree of the therapeutic effect described above is excellent and / or the incidence of cases that can obtain the therapeutic effect is high.
- the hepatic fat composition of hepatitis C is characterized by a high ratio of C18: 1 fatty acids (oleic acid and vaccenic acid) in the triglyceride fraction, but administration of the pharmaceutical composition of the present invention improves liver steatosis, It can be confirmed that the ratio of C18: 1 fatty acid decreases.
- Interferon-resistant hepatitis C with hypertriglyceridemia refers to a case with hypertriglyceridemia among interferon-resistant hepatitis C.
- Hypertriglyceridemia means that the amount of triglyceride in the blood is 150 mg / dL or more. Although it is known that hypertriglyceridemia may occur as a side effect of interferon therapy, hypertriglyceridemia resulting from interferon therapy is not included in the subject of the present invention.
- the subject to which the pharmaceutical composition of the present invention is administered is a group of patients whose blood triglyceride amount before the start of interferon therapy is 150 mg / dL or more and which are determined to be relapsed or ineffective as a result of interferon therapy.
- the present inventor has found that hepatitis C patients with hypertriglyceridemia are highly resistant to interferon therapy, and that the pharmaceutical composition of the present invention is particularly effective for such patient groups. I found. Until now, administration of ⁇ 3 PUFAs was thought to have no direct effect on the treatment of hepatitis C itself, but by selecting an appropriate patient group, hepatitis C can be treated with ⁇ 3 PUFAs. became.
- hepatitis C treatment The greatest purpose of hepatitis C treatment is to prevent the development of liver cirrhosis and to prevent the onset of hepatocellular carcinoma and liver failure, which are complications associated therewith. Since persistent inflammation of the liver due to viral infection leads to cirrhosis, it is necessary to eliminate the virus or to calm down the hepatitis. Even if the virus cannot be completely extinguished, it is possible to achieve the goal of suppressing the progression to cirrhosis if hepatitis can continue to calm down. Therefore, a drug capable of long-term administration, which can continue the calming of hepatitis for a long time, is preferable. Since the pharmaceutical composition of the present invention is highly safe and has few side effects, long-term administration is possible.
- a new treatment means can be provided with respect to hepatitis C patients, such as elderly people, for whom application of interferon therapy is difficult due to fear of side effects.
- the administration period of interferon is 6 months to 1 year and a half, and long-term administration beyond that is difficult in terms of side effects.
- the pharmaceutical composition of the present invention has no upper limit of the administration period, and can be administered permanently as long as a therapeutic effect is obtained.
- ⁇ 3 PUFAs may be administered during the interferon administration period, but the combined administration of interferon and ⁇ 3 PUFAs intended to reduce the side effects is a pharmaceutical composition of the present invention. Excluded from the embodiment of the object.
- the improvement of the effective rate of interferon therapy in the present invention is intended for hepatitis C patients who are going to receive interferon therapy.
- the pharmaceutical composition of the present invention can improve the effective rate of interferon therapy in hepatitis C patients. Improving the effective rate of interferon therapy for hepatitis C patients means that the effective rate of interferon therapy is increased as compared to the case where the pharmaceutical composition of the present invention is not administered. Regarding the determination of the interferon therapy and its effective rate, 2. As described in the section.
- the pharmaceutical composition of the present invention exhibits its effect by changing the sensitivity of hepatitis C patients to interferon therapy by incorporating ⁇ 3PUFAs, which are active ingredients, into in vivo tissues and cells. Since interferon therapy is performed over several weeks to several months, the effect of ⁇ 3 PUFAs can be fully demonstrated by the end of interferon therapy by starting administration of the pharmaceutical composition of the present invention simultaneously with the start of interferon therapy. More preferably, the pharmaceutical composition of the present invention is administered for at least 2 weeks prior to the administration. Preferably it is 1 month or more, More preferably, it is 3 months or more, More preferably, it is 6 months or more.
- administration of the pharmaceutical composition of the present invention improves the susceptibility of hepatitis C patients to interferon therapy, so the administration period of interferon can be shortened.
- interferon therapy it is known that 1) after the start of interferon administration, the effective rate increases as the timing of blood HCV-RNA negative becomes earlier, and 2) the effective rate increases with longer interferon administration period.
- the pharmaceutical composition of the present invention 1) the time when the blood HCV-RNA level decreases or becomes negative after the start of interferon administration is accelerated, and / or 2) it is high even when the interferon administration period is short An effective rate can be obtained.
- the timing of initiating administration of the pharmaceutical composition of the present invention may be at the start of interferon therapy for hepatitis C, but is preferably at least 2 weeks or more before starting interferon therapy, more preferably 1 month or more, and more preferably Is more than 3 months ago, particularly preferably more than 6 months ago.
- the interferon therapy may be an interferon therapy to be received from now on, and may be the first time or may be the second time or later. In particular, it is particularly desirable to try to receive another interferon therapy.
- administration of the pharmaceutical composition of the present invention can be continued even after interferon therapy is entered.
- the subject to which the pharmaceutical composition of the present invention is administered is not particularly limited as long as it is a hepatitis C patient who is going to receive interferon therapy, but interferon such as hepatic steatosis and hypertriglyceridemia before starting interferon therapy. It is preferred to target patient groups that have been found to have factors that are predicted to be resistant to therapy. The present inventor has found that the effective rate of interferon therapy is improved by administering ⁇ 3 PUFAs and performing interferon therapy in hepatitis C patients with hypertriglyceridemia.
- the pharmaceutical composition of the present invention is the above-mentioned 2. With the intention of both the effects described in this section and the effects described in this section, it can be administered to cases that have been determined to be relapsed or ineffective in interferon therapy. That is, after it is determined that the patient has relapsed or is ineffective in interferon therapy, 2.
- the pharmaceutical composition of the present invention is administered with the effect described in the section. At this time, a sufficient decrease in the amount of HCV-RNA in the blood is observed only with the pharmaceutical composition of the present invention, and if it becomes SVR, re-interferon therapy is no longer necessary.
- hepatitis C when the therapeutic effect of hepatitis C is not recognized by administration of the pharmaceutical composition of the present invention, or when the therapeutic effect is recognized but SVR is not reached, another interferon therapy may be combined.
- a high effective rate By changing the internal environment of a hepatitis C patient by administration of the pharmaceutical composition of the present invention, a high effective rate can be obtained in the subsequent interferon therapy. It is particularly effective in interferon-resistant hepatitis C with hepatic steatosis and interferon-resistant hepatitis C with hypertriglyceridemia.
- composition and administration method The dosage and administration period of ⁇ 3PUFAs used in the pharmaceutical composition of the present invention are set to an amount and a period sufficient to exert the intended effect.
- the dosage may be appropriately increased or decreased depending on the frequency of administration, the degree of symptoms, body weight, age, and the like.
- EPA-E and / or DHA-E is preferably 0.1 to 10 g / day, more preferably 0.3 to 6 g / day, and further preferably 0.6 to 4 g / day. More preferably, 0.9 to 2.7 g / day is administered in 1 to 3 divided doses. However, the whole amount may be administered once to several times as necessary or desired.
- the administration time is preferably during or after meals, more preferably immediately after meals (within 30 minutes).
- the administration period is at least 2 weeks or more, preferably 3 months or more, more preferably 1 year or more, and further preferably 3 years or more. Further, for example, it can be appropriately changed such as administration every other day, administration for 2 to 3 days per week, and the like.
- EPA ethyl ester When EPA ethyl ester is orally administered continuously to healthy adult males, the EPA plasma concentration reaches a steady state in one week. Moreover, the EPA / AA (arachidonic acid) ratio is often used as one index from a pharmacological and clinical viewpoint. Plasma EPA / AA exceeds 1.0 in one week of administration, and is about twice that before administration. As an indicator of continuous administration, the dose and administration interval are set so that the blood concentration of ⁇ 3 PUFAs in the first week after administration can be maintained and / or the plasma EPA / AA ratio is 1.0 or more. Adjust it.
- the pharmaceutical composition of the present invention exerts its action by a unique action mechanism that it is taken in as a fatty acid component of in vivo tissue. It is considered that ⁇ 3PUFAs exerts an action of suppressing intracellular virus activation through a reaction on the host side other than the immune system by changing the lipid composition of the cell membrane lipid raft. Therefore, the amount taken into the tissue in the living body is set to such an extent that ⁇ 3 PUFAs can exert the intended effect, and can be set lower than the normal ⁇ 3 PUFAs dose generally used as a pharmaceutical.
- the daily dose is preferably 0.1 g or more and less than 2 g, more preferably 0.2 g or more and less than 1.5 g, further preferably 0.3 g or more. Is 0.9 g or less, more preferably 0.1 g or more and 0.3 g or less.
- the active ingredient is administered as it is, or a suitable carrier or medium generally used, excipient, binder, lubricant, coloring agent, flavoring agent, and sterilization as necessary.
- a suitable carrier or medium generally used, excipient, binder, lubricant, coloring agent, flavoring agent, and sterilization as necessary.
- An appropriate pharmaceutical preparation can be prepared by appropriately combining with additives such as a soothing agent, a soothing agent, a flavoring agent, a flavoring agent, a preservative, an antioxidant, a buffering agent and a coloring agent.
- Additives include, for example, lactose, partially pregelatinized starch, hydroxypropylcellulose, macrogol, tocopherol, hydrogenated oil, sucrose fatty acid ester, hydroxypropylmethylcellulose, titanium oxide, talc, dimethylpolysiloxane, silicon dioxide, carnauba wax, etc. sell.
- ⁇ 3 PUFAs are highly unsaturated, at least one selected from the group consisting of antioxidants such as butyrated hydroxytoluene, brechated hydroxyanisole, propyl gallate, gallic acid, pharmaceutically acceptable quinones and ⁇ -tocopherols. It is desirable to include an effective amount of seed as an antioxidant.
- the dosage form of the formulation varies depending on the combined form of the active ingredient of the present invention and is not particularly limited.
- oral formulations include tablets, film-coated tablets, capsules, microcapsules, granules, fine granules,
- oral liquid preparations, syrups, jellies, inhalants parenteral preparations include, for example, ointments, suppositories, injections (emulsifying, suspending, non-aqueous) or milk for use. It is an external preparation such as solid injection, infusion preparation, transdermal absorption agent, etc.
- turbid or suspended form used in turbid or suspended form, and is administered to patients regardless of oral and intravenous or intraarterial, inhalation, rectal, vaginal or external use.
- simple oral preparations are desirable, and oral administration in capsules such as soft capsules and microcapsules, or tablets and film-coated tablets is particularly preferred.
- it may be orally administered as an enteric preparation or sustained-release preparation, and is preferably administered orally as a jelly agent to dialysis patients or patients who have difficulty swallowing.
- the pharmaceutical composition of the present invention can contain a second drug in addition to ⁇ 3 PUFAs.
- the second drug is not particularly limited, but preferably does not diminish the effects of the present invention. Examples include liver protectants, hypoglycemic agents, antihyperlipidemic agents, antihypertensive agents, antioxidants, and anti-inflammatory agents. Illustrated.
- the pharmaceutical composition of the present invention can contain a pharmaceutically acceptable excipient in addition to the active ingredient.
- a pharmaceutically acceptable excipient in addition to the active ingredient.
- known antioxidants, coating agents, gelling agents, flavoring agents, flavoring agents, preservatives, antioxidants, emulsifiers, pH adjusting agents, buffering agents, coloring agents and the like may be contained.
- the pharmaceutical composition of the present invention can be formulated according to a conventional method.
- the powder of ⁇ 3 PUFAs is, for example, in water containing (A) EPA-E, (B) dietary fiber, (C) starch hydrolyzate and / or low saccharified reduced starch hydrolyzate, and (D) a water-soluble antioxidant.
- the oil emulsion is obtained by a known method such as drying under high vacuum and pulverization (Japanese Patent Laid-Open No. 10-99046).
- EPA-E powder granules, fine granules, powders, tablets, film-coated tablets, chewable tablets, sustained release tablets, orally disintegrating tablets (OD tablets), etc. are obtained according to conventional methods.
- EPA-E is emulsified in a water-soluble polymer solution such as hydroxypropylmethylcellulose, and the resulting emulsion is sprayed onto an additive such as lactose to obtain a powder (Japanese Patent Laid-Open 8-157362) and can be obtained by known methods such as tableting. If it is an orally disintegrating tablet, it can be produced according to known methods, for example, JP-A-8-333243, and if it is an oral film preparation, for example, JP-A-2005-21124.
- the pharmaceutical composition of the present invention may be a combination or set agent of ⁇ 3 PUFAs and ribavirin or interferon.
- the pharmaceutical composition of the present invention is desirably released and absorbed so that the pharmacological action of the active ingredient can be expressed.
- the compounding agent of the present invention is excellent in the release of active ingredients, is excellent in the absorption of active ingredients, is excellent in the dispersibility of the active ingredients, is excellent in the storage stability of the compounding agent, and is excellent in patient convenience or compliance. It is desirable to have at least one effect of the preparation.
- the pharmaceutical composition of the present invention is effective for treating hepatitis C in animals, particularly mammals.
- Mammals include, for example, domestic animals such as humans, cows, horses, and pigs, and domestic animals such as dogs, cats, rabbits, rats, and mice, and are preferably humans.
- Example 1 Therapeutic effect of EPA-E on hepatitis C with hepatic steatosis> The therapeutic effect of EPA-E is confirmed in patients who have been diagnosed with chronic hepatitis C with liver steatosis and who have been ineffective after 3 months of interferon therapy. After being determined to be ineffective for interferon therapy, the drug is withdrawn for about 1 month, and then EPA-E is orally administered for 2 months or more for 3 months or more. During this time, new administration of drugs that are thought to change liver function is prohibited. Administration of interferon during the study period is prohibited.
- ALT activity and / or HCV-RNA amount (Cobas amplicar monitor method) at 3 and 6 months before administration of EPA-E was quantified, and compared with the pre-dose value. And / or a decrease of 10% or more in the amount of HCV-RNA can be confirmed. Further, instead of ALT activity, improvement in liver tissue findings, reduction in lipid droplets, or reduction in the ratio of 18: 1 fatty acid (particularly oleic acid) in the liver fat triglyceride fraction may be confirmed.
- the dosage, interval and period of administration of interferon are appropriately determined according to the patient's condition, side effects and the like. After completion of interferon therapy, the HCV-RNA amount negative rate at 6 months is calculated. It can be confirmed that the EPA-E administration group shows a higher negative rate than the EPA-E non-administration group.
- EPA-E non-administration group neither EPA nor a derivative thereof is administered during the test period. Thereafter, interferon therapy is performed on all groups for 3 months or longer. The dosage, interval and period of administration of interferon are appropriately determined according to the patient's condition, side effects and the like. After completion of interferon administration, alanine aminotransferase (ALT) activity and HCV-RNA level (Cobas amplicar monitor method) are measured, and a liver tissue test is performed. At this time, EPA-E is continuously administered to the EPA-E administration group even during the interferon administration period.
- ALT alanine aminotransferase
- HCV-RNA level Cobas amplicar monitor method
- the dose, interval and period of administration of interferon are appropriately determined depending on the patient's condition, side effects and the like.
- the amount of blood HCV-RNA during the interferon administration period is measured.
- the time of blood HCV-RNA level negative after the start of interferon administration is counted and compared in both groups. It can be confirmed that the EPA-E administration group has a tendency to make the blood HCV-RNA negative level earlier than the EPA-E non-administration group. For example, it can be seen that the ratio of becoming negative by 12 weeks after the start of interferon administration is improved.
- Example 3 ⁇ Improvement of the effective rate of both interferons in hepatitis C patients with hypertriglyceridemia>
- interferon therapy interferon + ribavirin combination therapy
- the amount of virus reduction (administration) 3 days after the start of interferon therapy was 2.042.
- the average virus reduction was 1.732, and in patients with hepatitis C with hypertriglyceridemia, interferon The effectiveness of therapy was found to be low. Therefore, in patients with hepatitis C with hypertriglyceridemia, 1800-2700 mg of EPA-E was orally administered daily and interferon therapy was performed. As a result, the virus reduction amount averaged 2.375, and EPA-E improved the effective rate of interferon therapy for hepatitis C patients with hypertriglyceridemia. In addition, when the statin preparation was used in combination with EPA-E, the average amount of virus reduction was 2.382, which was the same as that for EPA-E alone.
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Abstract
Description
(1)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有することを特徴とする、インターフェロン抵抗性C型肝炎治療用医薬組成物。
(2)インターフェロン抵抗性C型肝炎が肝脂肪変性を伴っていることを特徴とする、上記(1)に記載の医薬組成物。
(3)インターフェロン抵抗性C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、上記(1)に記載の医薬組成物。
(4)インターフェロン療法が無効であった患者に適用することを特徴とする、上記(1)乃至(3)のいずれかに記載の医薬組成物。
(5)インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(1)乃至(4)のいずれかに記載の医薬組成物。
(6)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有することを特徴とする、C型肝炎患者におけるインターフェロン療法の有効率を改善するための医薬組成物。
(7)C型肝炎が肝脂肪変性を伴っていることを特徴とする、上記(6)に記載の医薬組成物。
(8)C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、上記(6)に記載の医薬組成物。
(9)インターフェロン療法が無効であった患者に適用することを特徴とする、上記(6)乃至(8)のいずれかに記載の医薬組成物。
(10)インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(6)乃至(8)のいずれかに記載の医薬組成物。
(11)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つが、インターフェロン療法に先立つ少なくとも2週間前より投与されることを特徴とする、上記(6)乃至(10)のいずれかに記載の医薬組成物。
(12)イコサペント酸、ドコサヘキサエン酸、α-リノレン酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物を前記有効成分として含有することを特徴とする、上記(1)乃至(11)のいずれかに記載の医薬組成物。
(13)イコサペント酸エチルエステルを前記有効成分として含有することを特徴とする、上記(1)乃至(12)のいずれかに記載の医薬組成物。
(14)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有する医薬組成物を投与する、インターフェロン抵抗性C型肝炎治療方法。
(15)インターフェロン抵抗性C型肝炎が肝脂肪変性を伴っていることを特徴とする、上記(14)に記載の方法。
(16)インターフェロン抵抗性C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、上記(14)に記載の方法。
(17)インターフェロン療法が無効であった患者に適用することを特徴とする、上記(14)乃至(16)のいずれかに記載の方法。
(18)インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(14)乃至(17)のいずれかに記載の方法。
(19)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有する医薬組成物を投与する、C型肝炎患者におけるインターフェロン療法の有効率を改善する方法。
(20)C型肝炎が肝脂肪変性を伴っていることを特徴とする、上記(19)に記載の方法。
(21)C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、上記(19)に記載の方法。
(22)インターフェロン療法が無効であった患者に適用することを特徴とする、上記(19)乃至(21)のいずれかに記載の方法。
(23)インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(19)乃至(22)のいずれかに記載の方法。
(24)ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つが、インターフェロン療法に先立つ少なくとも2週間前より投与されることを特徴とする、上記(19)乃至(23)のいずれかに記載の方法。
(25)イコサペント酸、ドコサヘキサエン酸、α-リノレン酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物を前記有効成分として含有する医薬組成物を投与する、上記(14)乃至(24)のいずれかに記載の方法。
(26)イコサペント酸エチルエステルを前記有効成分として含有する医薬組成物を投与する、上記(14)乃至(25)のいずれかに記載の方法。
(27)インターフェロン抵抗性C型肝炎を治療するための医薬の製造のためのω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物の使用。
(28)前記インターフェロン抵抗性C型肝炎が肝脂肪変成を伴うことを特徴とする、上記(27)に記載の使用。
(29)前記インターフェロン抵抗性C型肝炎が高グリセリド血症を伴うことを特徴とする、上記(27)に記載の使用。
(30)前記医薬をインターフェロン療法が無効であった患者に適用することを特徴とする、上記(27)乃至(29)のいずれかに記載の使用。
(31)前記医薬をインターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(27)乃至(30)のいずれかに記載の使用。
(32)C型肝炎患者におけるインターフェロン療法の有効率を改善するための医薬の製造のための、ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物の使用。
(33)前記C型肝炎患者が肝脂肪変成を伴うことを特徴とする、上記(32)に記載の使用。
(34)前記C型肝炎患者が高グリセリド血症を伴うことを特徴とする、上記(32)に記載の使用。
(35)前記医薬をインターフェロン療法が無効であった患者に適用することを特徴とする、上記(32)乃至(34)のいずれかに記載の使用。
(36)前記医薬をインターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、上記(32)乃至(35)のいずれかに記載の使用。
(37)前記医薬がインターフェロン療法に先立つ少なくとも2週間前より投与されることを特徴とする、上記(32)乃至(36)のいずれかに記載の使用。
(38)前記ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物がイコサペント酸エチルエステルである、上記(27)乃至(37)のいずれかに記載の使用。
1.ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステル
多価不飽和脂肪酸(PUFAs)は、分子内に複数の炭素-炭素二重結合を有する脂肪酸と定義され、二重結合の位置により、ω3、ω6などに分類される。例えば、ω3は脂肪酸のメチル末端から数えて最初の二重結合炭素が3つ目のものであり、ω6は脂肪酸のメチル末端から数えて最初の二重結合炭素が6つ目のものである。ω3PUFAsとしては、α-リノレン酸、EPA、DHA等が例示される。本明細書において、「PUFAs」の語は、特に断らない限りは、多価不飽和脂肪酸だけではなく、その製薬学上許容される塩、エステル、アミド、リン脂質、またはグリセリド等に例示される多価不飽和脂肪酸誘導体を含む意味で使用される。
C型肝炎に対するインターフェロン療法の治療効果は、治療終了後6ヵ月の時点で、C型肝炎ウイルス(HCV)検査で血液中のHCV-RNA量が陰性化したかどうかを調べることによって判断される。インターフェロン投与終了後6ヶ月時点での血液中のHCV-RNA量が陰性であれば、著効例と判断され、HCVが駆除されて完治した(完全緩解)とみなされる。この状態を持続ウイルス陰性化(SVR)という。一方、インターフェロン投与中にHCV-RNA量の陰性化を見たものの、投与終了後6ヶ月時点で陰性化していない場合は、再燃例(一過性有効例)と判断される。また、インターフェロン投与中にHCV-RNA量の陰性化が認められなかった場合は無効例と判断される。インターフェロン療法の有効率は、著効例の事例数を全体の事例数で、HCV-RNA量陰性化率は、HCV-RNA量陰性化事例数を全体の事例数で、それぞれ除して求めることができる。ここで、血液中のHCV-RNA量の陰性化とは、HCV-RNA定性検査法(検出限界:50IU/mL)を用いる場合は、血液中のHCV-RNAが検出されないことをいう。HCV-RNA量の測定法として、定量法(アンプリコアHCVモニター法、オリジナルPCR法、ハイレンジPCR法、RT-PCR法など)を用いる場合は、それぞれの測定法の検出感度に応じたカットオフ値を設定することにより陰性化を判断することができる。
本発明におけるインターフェロン療法の有効率の改善は、インターフェロン療法を受けようとするC型肝炎症例を対象とする。
本発明の医薬組成物に用いられるω3PUFAsの投与量および投与期間は対象となる作用を現すのに十分な量および期間とされるが、その剤形、投与方法、1日当たりの投与回数、症状の程度、体重、年齢等によって適宜増減することができる。
<肝脂肪変性を伴ったC型肝炎に対するEPA-Eの治療効果>
肝脂肪変性を伴ったC型慢性肝炎と診断され、インターフェロン療法を3ヶ月以上実施しても無効であった患者を対象にして、EPA-Eの治療効果を確認する。
インターフェロン療法無効と判断された後、おおよそ1ヶ月間休薬し、その後、EPA-Eを1日2700mg、3ヶ月間以上経口投与する。この間肝機能に変化を及ぼすと考えられる薬剤の新たな投与は禁止する。また、試験期間中のインターフェロンの投与は禁止する。EPA-E投与前、投与3ヶ月目および6ヶ月目のアラニンアミノトランスフェラーゼ(ALT)活性、および/またはHCV-RNA量(コバスアンプリカーモニター法)を定量し、投与前値と比較すると、ALT活性および/またはHCV-RNA量の10%以上の低下を確認できる。
また、ALT活性に代えて、肝組織所見の改善、脂肪滴の減少、あるいは肝脂肪トリグリセリド分画中の18:1脂肪酸(特にオレイン酸)比率の低下を確認してもよい。
<インターフェロン療法に対する感受性の向上>
(2-1)再治療例における有効率の改善
インターフェロン療法実施後、無効または再燃と判断されたC型肝炎患者を対象とし、再治療例におけるEPA-E投与によるインターフェロン療法の有効率の改善を確認する。
被検患者にEPA-E投与群とEPA-E非投与群を設定する。EPA-E投与群には、インターフェロン療法無効または再燃と判断された後、EPA-Eを1日1800~2700mg、3ヶ月間経口投与する。EPA-E非投与群には、EPAまたはその誘導体のいずれをも、試験期間中投与しない。その後、両群に対して再度のインターフェロン療法を実施する。インターフェロンの投与量、投与間隔および投与期間等は、患者の状態、副作用等によって適宜決定する。インターフェロン療法終了後、6ヶ月時点でのHCV-RNA量陰性化率を算出する。
EPA-E投与群は、EPA-E非投与群に比べ高い陰性化率を示すことを確認できる。
インターフェロン療法が計画されている患者を対象とし、肝脂肪変性を伴うC型肝炎患者に対するEPA-E投与によるインターフェロン療法の有効率の改善を確認する。
被検患者にEPA-E投与群とEPA-E非投与群を設定する。さらに、画像検査または肝生検により肝脂肪化の程度を確認し、EPA-E投与群とEPA-E非投与群の両群について、それぞれ、脂肪肝群と非脂肪肝群を設定する。EPA-E投与群には、インターフェロン療法に先立ち、EPA-Eを1日1800~2700mg、少なくとも1ヶ月間経口投与する。EPA-E非投与群には、EPAまたはその誘導体のいずれをも、試験期間中投与しない。その後、全群に対してインターフェロン療法を3ヶ月間以上実施する。インターフェロンの投与量、投与間隔および投与期間等は、患者の状態、副作用等によって適宜決定する。インターフェロン投与終了後、アラニンアミノトランスフェラーゼ(ALT)活性、HCV-RNA量(コバスアンプリカーモニター法)を測定し、肝組織試験を実施する。このとき、EPA-E投与群には、インターフェロン投与期間中も、EPA-Eを継続投与する。
肝脂肪変性を伴ったC型肝炎に対するEPA-Eの効果は、肝脂肪変性を伴わないC型肝炎に対する効果よりも、優れていることが確認できる。また、肝脂肪変性を伴ったC型肝炎において、インターフェロン+EPA投与の効果は、インターフェロンのみ投与よりも、優れていることが確認できる。
インターフェロン療法実施後、無効または再燃と判断されたC型肝炎患者を対象とし、EPA-E投与による血中HCV-RNA量の陰性化時期の早期化を確認する。
被検患者にEPA-E投与群とEPA-E非投与群を設定する。EPA-E投与群には、インターフェロン療法無効あるいは再燃と判断された後、EPA-Eを1日1800~2700mg、少なくとも2週間経口投与する。EPA-E非投与群には、EPAまたはその誘導体のいずれをも、EPA-E投与群と同じ期間投与しない。その後、両群に対して再度のインターフェロン療法を実施する。インターフェロンの投与量、投与間隔および投与期間等は、患者の状態、副作用等によって適宜決定される。インターフェロン投与期間中の血中HCV-RNA量を測定する。インターフェロン投与開始後の血中HCV-RNA量陰性化時期を集計し、両群で比較する。
EPA-E投与群は、EPA-E非投与群に比べ、血中HCV-RNA量陰性化時期が早期化する傾向を確認できる。例えば、インターフェロン投与開始後12週までに陰性化する割合が向上することが認められる。
<高トリグリセリド血症を伴ったC型肝炎患者におけるインターフェロン両方の有効率の改善>
インターフェロン療法(インターフェロン+リバビリン併用療法)を受けたC型肝炎患者について、治療開始前の血中トリグリセリド濃度が100mg/dL未満であった患者群においては、インターフェロン療法開始3日後のウイルス減少量(投与前血中HCV-RNA量の常用対数値と開始3日後の血中HCV-RNA量の常用対数値の差)は平均で2.042であった。
これに対し、治療開始前の血中トリグリセリド濃度が150mg/dL以上であった患者群においてはウイルス減少量は平均で1.732であり、高トリグリセリド血症を伴うC型肝炎患者においては、インターフェロン療法の有効率が低いことが判明した。
そこで、高トリグリセリド血症を伴うC型肝炎患者を対象とし、EPA-Eを1日1800~2700mg経口投与しインターフェロン療法を行った。
その結果、ウイルス減少量は平均で2.375となり、EPA-Eは高トリグリセリド血症を伴うC型肝炎患者のインターフェロン療法の有効率を改善した。
なお、EPA-Eに加えスタチン製剤を併用した場合におけるウイルス減少量は平均で2.382であり、EPA-Eのみの場合と同等であった。
Claims (13)
- ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有することを特徴とする、インターフェロン抵抗性C型肝炎治療用医薬組成物。
- インターフェロン抵抗性C型肝炎が肝脂肪変性を伴っていることを特徴とする、請求項1に記載の医薬組成物。
- インターフェロン抵抗性C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、請求項1に記載の医薬組成物。
- インターフェロン療法が無効であった患者に適用することを特徴とする、請求項1乃至3のいずれかに記載の医薬組成物。
- インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、請求項1乃至4のいずれかに記載の医薬組成物。
- ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つを有効成分として含有することを特徴とする、C型肝炎患者におけるインターフェロン療法の有効率を改善するための医薬組成物。
- C型肝炎が肝脂肪変性を伴っていることを特徴とする、請求項6に記載の医薬組成物。
- C型肝炎が高トリグリセリド血症を伴っていることを特徴とする、請求項6に記載の医薬組成物。
- インターフェロン療法が無効であった患者に適用することを特徴とする、請求項6乃至8のいずれかに記載の医薬組成物。
- インターフェロン療法が一過性有効であったものの再燃した患者に適用することを特徴とする、請求項6乃至9のいずれかに記載の医薬組成物。
- ω3多価不飽和脂肪酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つが、インターフェロン療法に先立つ少なくとも2週間前より投与されることを特徴とする、請求項6乃至10のいずれかに記載の医薬組成物。
- イコサペント酸、ドコサヘキサエン酸、α-リノレン酸、その製薬学上許容しうる塩およびエステルからなる群から選ばれる少なくとも1つの化合物を前記有効成分として含有することを特徴とする、請求項1乃至11のいずれかに記載の医薬組成物。
- イコサペント酸エチルエステルを前記有効成分として含有することを特徴とする、請求項1乃至11のいずれかに記載の医薬組成物。
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CA2738985A CA2738985A1 (en) | 2008-09-30 | 2009-09-30 | Therapeutic agent for hepatitis c |
US13/121,645 US9006285B2 (en) | 2008-09-30 | 2009-09-30 | Therapeutic agent for hepatitis C |
JP2010531892A JPWO2010038796A1 (ja) | 2008-09-30 | 2009-09-30 | C型肝炎治療剤 |
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EP (1) | EP2343066A4 (ja) |
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US20110184064A1 (en) | 2011-07-28 |
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JPWO2010038796A1 (ja) | 2012-03-01 |
US9006285B2 (en) | 2015-04-14 |
EP2343066A4 (en) | 2012-08-29 |
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