末梢神経の治療の進歩

抄録

Zika virus infection became epidemic in many countries in South or Central America in 2015–2016. Guillain–Barré syndrome (GBS) after Zika virus infection in French Polynesia was reported. The duration to peak from neurological onset was 6 days (range 4–9), and 12 patients (29%) required mechanical ventilation in 42 GBS patients after Zika virus infection. The electrophysiological study showed decline of distal compound muscle action potential. Zika virus is a possible trigger of GBS. The result regarding Inhibition of Complement in GBS study (ICA–GBS study) was reported from UK. However, the number of enrolled patients was not enough for evaluation of the efficacy of eculizumab. A similar study was also performed in Japan, in which the target number of patients was already enrolled. Safety and efficacy of thalidomide in patients with POEMS syndrome were reported. Oral thalidomide (200mg/day) or placebo for six cycles (24 weeks) was randomly administered in 25 patients (thalidomide ; n＝13, placebo ; n＝12) with POEMS syndrome. These patients were not eligible for autotransplantation. One patient in placebo group was excluded, and the remaining patients were analyzed. For primary endpoint, the reduction rate of serum VEGF were 0.39 in the thalidomide group and −0.02 in the placebo group (p＝0.04). Thalidomide significantly reduced serum VEGF levels and improved the motor nerve velocity during 72 weeks including open–label period. Thalidomide is effective for POEMS syndrome patients who are not eligible for autotransplantation.