C型慢性肝炎に対する二重濾過血漿交換療法を用いたウイルス除去療法(VRAD)(<特集>アフェレシスの新しい適応をめぐって)

概要

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Double filtration plasmapheresis (DFPP) can selectively remove high-molecular substances including hepatitis C virus (HCV) according to the second membrane pore size. We introduce a new therapeutic method for HCV by DFPP (virus removal and eradication by DFPP, VRAD) following combined interferon (IFN) and ribavirin therapy. VRAD achieved a high complete early virological reduction (cEVR), and sustained virological response (SVR) even in chronic hepatitis C patients having a high HCV-RNA of difficult-to-treat genotype 1b. SVR occurred in 77.8% of 60 VRAD cases in the phase III trial. DFPP was approved as a therapeutic modality for chronic hepatitis C patients having a high HCV-RNA with genotype 1b by health insurance in Japan since April, 2008. A recent nationwide study in 181 subjects revealed that the cEVR rate after 12 weeks of VRAD treatment was 57.5% of total cases (70.0% of 60 naive cases, 57.1% of 35 relapsers, and 41.9% of 62 non-responders to previous IFN therapy). Adverse events were reported as mild and transient even in the elderly population (over 60 years old), and in 23% of all VRAD cases. VRAD has been applied for liver transplanted patients to prevent HCV infection and to treat fibrosing cholestatic hepatitis.
2010-10-31