Guillain–Barré症候群のC5モノクローナル抗体治療

抄録

Guillain–Barré syndrome (GBS) is an immune–mediated neuropathy that causes acute flaccid paralysis. Immunoglobulin and plasma exchange are established treatments for GBS ; however, a substantial number of patients, particularly those with severe disease, have poor recovery and residual deficits. Recent studies suggest that complement activation plays a pivotal role in GBS–associated axonal degeneration, and eculizumab is a humanized monoclonal antibody that specifically binds to complement component 5 and potently inhibits complement activation.

This clinical trial aims to evaluate the efficacy and safety of eculizumab for treatment of GBS.

The Japanese Eculizumab Trial for GBS (JET–GBS) is a prospective, multicenter, placebo–controlled, double–blind, randomized phase II study conducted at 13 tertiary neurology centers and is funded by the Japan Agency for Medical Research and Development. A total of 34 GBS patients unable to walk independently within 2 weeks from symptom onset (Hughes functional grade 3–5) were randomized at a 2 : 1 ratio to receive either intravenous eculizumab (900mg/day) or placebo once weekly for 4 weeks, followed by 20 weeks of follow–up. The primary endpoint for efficacy is the proportion of patients who regain their ability to walk without aid at 4 weeks after the first dose of the study treatment, while primary safety outcomes are the incidence of adverse events and serious adverse events during the trial. Enrollment for the trial began in August 2015, and follow–up of the last patient was completed in October 2016. This study is the first to investigate the efficacy and safety of eculizumab for GBS. In case of a positive result, we will plan a phase III trial to investigate this issue in a larger number of patients.

Registered with CLINICALTRIAL : UMIN Clinical Trials Registry UMIN 000018171 ; https:/upload.umin.ac.jp/cgi–open–bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&language=J&recptno=R000020978 (Archived by WebCite at http://www.webcitation.org/6lTiG8ltG). Clinical Trials.gov NCT02493725 ; https://clinicaltrials.gov/ct2/show/NCT02493725 (Archived by WebCite at http://www.webcitation.org/6lVJZXKSL).