リソース:関節リウマチ用Prosorba column








 日本語版註)plasmapheresis (plaz'ma-fe-re'sis) [plasma + G. aphairesis, a withdrawal].血漿しゃ(瀉)血,血漿搬出,プラスマフェレーシス(全血液を生体から取り出し遠心沈殿によって分離された細胞成分を生理食塩水または他の代用血漿に懸濁して再びその生体に戻すこと.このようにして細胞成分を減らさずに自分自身の血漿蛋白を除くことができる).
 註2)特発性血小板減少性紫斑病[ITP: idiopathic thrombocytopenic purpura]は難病指定されている。
 註3)[FDA承認日]3/15/99但し、最初の承認はDec 23,1987[ITC]、[一般名称]Extracorporeal Immunoadsorption Protein A Column体外免疫吸着A蛋白カラム、[適応]1) use in the therapeutic removal of immunoglobulin G (IgG) and IgG-containing circulating immune complexes from plasma in patients with idiopathic thrombocytopenic purpura (ITP) having platelet counts less than 100,000mm3 and 2) for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis (RA) in adult patients with long-standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
 詳細は● Premarket Approval Decisions for March 1999のProsorba参照。(添付文書など)又はメーカーサイトCypress Products

【日本語版コメント】
 本剤は医療用具としてFDA承認(適応追加)された。 悪性関節リウマチ患者には有効な治療法がなかったので、非常に高価ながら朗報だと思うのだが...
 
【市場】
 米国で関節リウマチ患者は人口1%, 210万人。 Prosorba(R) columnは98.10.29にFDA諮問パネルが承認勧告、99.3.16承認。 重症関節リウマチ患者に朗報。 従来のRA薬物治療耐性例に有効。 腎透析と同様の手法で血液から過剰な抗体を除去する働きをもつ。[●Arthritis Foundation - The Prosorba(R) Column]
 米国RA患者は250万人、うち70%が女性で最多年齢帯は10-60才。 Prosorbaの対象となるのは25万人。[●Corporate Strategy]

【疫学資料】
悪性関節リウマチ[■難病情報データベース]|交付件数= 5,019
 悪性関節リウマチmalignant rheumatoid arthritis(MRA)とは、明らかな慢性関節リウマチ(RA)が存在し、心、肺、消化管、神経などの内臓病変の症状を呈し、予後の悪い病気に対して、Bevans(1954)が名づけた病気である。
[頻度] 我が国における悪性関節リウマチの患者数は全慢性関節リウマチ患者の0.5〜1.0%、全国で約2000〜3000人といわれている。 発症年齢は50歳代にピークをもち、慢性関節リウマチよりやや高齢である。また、性別では慢性関節リウマチに比べて男性にもみられる率が高く、男女比は1:2である。
[予後]悪性関節リウマチの予後は悪く、診断確定1年後の予後は死亡34%、悪化32%、不変18%、寛解16%といわれる。 死因は心不全、感染症、呼吸不全が主なもの。
特発性血小板減少性紫斑病|交付件数= 26,233

【サイプレス社】
 サイプレス社は1981年創立。 1998年売上$2.7百万、従業員56人。 Prosorba columnは主力品。 血小板膜Cyplex等を開発中。 http://www.cypressbio.com






[1058]●製品 Prosorba (Cypress Bioscience)


●承認データ:FDA

情報ソース● Premarket Approval Decisions for March 1999
 Below are Premarket Approvals (PMA), Product Development Protocols (PDP),
 Supplement andNotice Decisions for March 1999. This list is generated on
 a monthly basis.
A pdf document that contains the "Approval letter and Summary
of Safety and Effectiveness" is being added to this listing for each PMA.

PMA ORIGINAL APPROVALS

APPLICATION NUMBER :●P850020/S011
DATE of APPROVAL   : 3/15/99
DEVICE TRADE NAME  : Prosorba Column
COMPANY NAME       :Cypress Bioscience, Inc.
 CITY, STATE, & ZIP: San Diego, CA 92121
[DEVICE DESCRIPTION / INDICATIONS] Approval for the Prosorba(R) Column. This device is indicated for:
1) use in the therapeutic removal of immunoglobulin G (IgG) and IgG-containing circulating immune complexes from plasma in patients with idiopathic thrombocytopenic purpura (ITP) having platelet counts less than 100,000mm3 and 2) for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis (RA) in adult patients with long-standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
Updated June 25, 1999
--------------------------------------------------

情報ソース●Prosorba(R) Column
Prosorba(R) Column
P850020 S011
Decision Date: 3-15-1999
This document is in a Portable Document Format (PDF) and is divided
into 3 parts.
read this document.
Part 1 - Approval Order
Part 2 - Summary of Safety and Effectiveness★有効性・安全性[全19p]
Part 3 - Labeling添付文書[全17p]
Posted April 15, 1999

情報ソース●April 1997 PMA Monthly Approval List
Premarket Approval Listing for April 1997
Below are the original and supplement premarket approvals (PMAs) for April 1997.
This list is generated on a monthly basis and contains all of the originals and
supplements approved that month under the PMA process.
A pdf document that contains the "Approval letter and Summary of Safety and
Effectiveness" is being added to this listing for each PMA. The PMA number will appear as a link if this document is available. Information about the PDF Reader is available.
PMA ORIGINAL APPROVALS
APPLICATION NUMBER/
DATE of APPROVAL DEVICE TRADE NAME COMPANY NAME
CITY, STATE, & ZIP DEVICE DESCRIPTION/ INDICATIONS
P850020/S009
4/17/97
Prosorba Column Cypress Bioscience, Inc.
Redmond, WA 98052
Approval for consolidation of manufacturing operations at Cypress Bioscience, Redmond, WA.
(Updated June 30, 1998)





●http://www.cypressbio.com/package.htm
[Brief Device description]
The PROSORBA column employs approximately 200 mg of protein A covalently bound to an inert silica matrix that is contained within a 300 ml polycarbonate housing. Each column contains 123 ± 2 grams of this matrix. Protein A is a component of certain strains of the Staphylococcus bacterium and it has propensity to bind immunoglobulin G (IgG) and IgG bound to an antigen, i.e., circulating immune complex.
PROSORBA columnはポリカーボネート300ml以内を含有する不活性シリカ基質に共有結合させたプロテインA約200mgから成る。 各カラムはこの基質123 ± 2gを含有。 プロテインAはブドウ球菌の成分であり、免疫グロブリンG(IgG)及び抗原と結合したIgGに結合する。


[ Complete Device Description ]
The PROSORBA column employs approximately 200 mg of protein A covalently bound to an inert silica matrix that is contained within a 300 ml polycarbonate housing. Each column contains 123 ± 2 grams of this matrix. Protein A is a component of certain strains of the Staphylococcus bacterium and it has the propensity to bind immunoglobulin G (IgG) and IgG bound to an antigen, i.e., circulating immune complex. Treated plasma that has been passed through the device can then be returned to the patient.

The Functional Components:

Protein A is a cell surface molecule discovered in staphylococcal bacteria that has specific binding affinity for the FC region of immunoglobulin proteins. This multi-domained protein can bind several immunoglobulins simultaneously or several sites on a given immunoglobulin simultaneously, and is believed to be an important part of the bacteria’s immune escape repertoire.

The Properties:

The implementation requires the use of a plasmapheresis device. The PROSORBA column is intended to present a covalently immobilized protein A matrix to the patient plasma, after which the plasma and cellular components are reinfused to the patient.

The Principles of Operation:
The principles of operation of the PROSORBA column are represented by the following four main steps in the use of the device: a) priming the PROSORBA column b) separating the plasma c) passing the plasma through the PROSORBA column, and d) reinfusing the treated plasma back into the patient.




解説


■■●chdf血液浄化法について

本資料は愛媛大学医学部麻酔・蘇生学教室 T先生よりご提供いただきました(1997年9月)。
目 次
持続的血液濾過透析(CHDF)
血漿交換(PE)
血液吸着(HA)と血漿吸着(PA)

持続的血液濾過透析 CHDF(Continuous hemodiafiltration)
1.原理と目的
血液透析は,半透膜を介しての拡散と限外濾過の原理により成立ち,主に小分子量の物質の除去に優れている。一方,血液濾過は膜を介した限外濾過の際に水とともに血漿中に含まれるその膜の有するcut off point以内の分子量物質を除去するもので,主に中〜大分子量の物質の除去に優れている。血液濾過透析は両者の長所をうまく組みあわせて小〜中〜大分子量の物質を満遍なく除去しようとする方法である。
2.フィルタ
原則的には,CHFで用いるものと同種類で,膜面積は0.3〜0.6m2あればよいが,透析を重視すればdiffusionによる物質交換を期待して,膜面積を1.2m2程度にする場合がある。
素材は,PAN(polyacrylonitrile)膜,PMMA(polymethyl-methacrylate)膜,PS(polysulfone)膜などがあるが,どれが最も優れているかは結論はでていない。当科ではPAN膜(旭メディカル製,パンフロー06)を使用している。
3.抗凝固剤
以前はヘパリンを使用していたが,出血傾向の人には用いることができなかった。 現在は,メシル酸ナファモスタット(フサン)や低分子ヘパリンをもちいることで出血傾向のある患者でも施行可能となった。血中半減期はヘパリンおよび低分子ヘパリンが数時間,フサンが8分といわれている。ヘパリンおよび低分子ヘパリンは,プロタミンで中和可能である。ヘパリンはATVと結合し,抗トロンビン(Ua)作用と抗活性化第]因子(]a)作用を表すため出血を促進するが,低分子ヘパリンには抗トロンビン(Ua)作用がないため出血は促進しない。フサンも大量に投与すると出血を促進する。現在至適投   与量は検討中であるが,0.3mg/kg/hrがいいという報告あり。この量で,フィルタは約24時間もつ。当科では0.4〜0.6mg/kg/hrで使用しているがこの量ではフィルタは36〜48時間もつ。
4.透析液
透析液中の微細異物や細菌産物がフィルタのporeを通過して血中に入る可能性があるので,必ず無菌でなければならない。また,bufferをいれないとアシドーシスになる。Bufferとしてはbicarbonateがベストである。acetateあるいはlactateを用いている施設もある。Lactateは肝で代謝されるため,肝不全患者では用いることができない。Acetateの代謝は全身の臓器で行なわれ,最大300mmol/hrの代謝速度があり,lactateの2倍以上の代謝速度である。当科では,bicarbonate製剤を用いている。
5.Blood access
ダブルルーメンカテーテル(クイントンR)を内頚静脈,鎖骨下静脈,大腿静脈などから挿入する。
6.回路の設定
血液ポンプ…60 ml/min,濾過ポンプ…0.70 L/hr,
補液ポンプ…0.35 L/hr,透析ポンプ…0.30 L/hr
これで0.05L/hrの除水ができる。
参考文献
・血液浄化法−最近の進歩−.ICUとCCU 13:189,1989
・血液浄化法.ICUとCCU 14:795,1990
・持続的血液濾過透析.集中治療 5:549,1993
・ 持続的血液濾過透析.日本臨床 49:315,1991

血漿交換 PE(Plasma exchange)
1.原理と目的
血液を血球成分と血漿成分に分離し,患者血漿を廃棄し,健常人の血漿(多くはFFP)ないしは血漿製剤を補充することにより,治療効果をあげようとする方法で,他の血液浄化法に比し,大きな分子量の物質まで除去可能である。したがって,蛋白に結合している物質やエンドトキシン,免疫複合体等の病因物質の除去も可能であるが,同時にアルブミンや凝固因子等も廃棄される。
2.フィルタ
膜型血漿分離器は,膜面積0.2〜0.8m2,膜孔径0.2〜0.6μmで,分子量15万〜20万dalton以下の物質は透過する。
素材は,PE(polyethylene),PMMA(polymethylmethacrylate),PS(polysulfone)などがある。当科ではPE膜を用いたプラズマフローOP−05(旭メディカル社製)を使用している。
3.抗凝固剤
以前はヘパリンを使用していたが,出血傾向の人には用いることがでなかった。現在は,メシル酸ナファモスタット(フサン)や低分子ヘパリンをもちいることで出血傾向のある患者でも施行可能となった。血中半減期はヘパリンおよび低分子ヘパリンが数時間,フサンが8分といわれている。ヘパリンおよび低分子ヘパリンは,プロタミンで中和可能である。ヘパリンはATVと結合し,抗トロンビン(Ua)作用と抗活性化第]因子(]a)作用を表すため出血を促進するが,低分子ヘパリンには抗トロンビン(Ua)作用がないため出血は促進しない。フサンも大量に投与すると出血を促進する。現在至適投与量は   検討中であるが,血漿分離の際にフサンも一緒に除去されるため,血液透析施行時よりも多めの量が必要で,0.5〜1.0mg/kg/hr必要である。
4.Blood access
ダブルルーメンカテーテル(クイントン氈jを内頚静脈,鎖骨下静脈,大腿静脈などから挿入する。
5.回路
血液ポンプ,血漿廃棄用ポンプ,血漿補充用ポンプ,血漿分離フィルター,動静脈回路があればよい。
設定  血液ポンプ…100 ml/min
血漿廃棄用ポンプ…1.5 L/hr
血漿補充用ポンプ…1.5 L/hr
血漿補充はFFPを用いる。FFPは溶解後3時間以内に使用する。
1回の血漿交換に40単位(3200ml)使用する。したがって,1回の血
漿交換に要する時間は約2時間である。

6.PEの適応
他の血液浄化法では除去不可能な分子量の大きな蛋白結合性物質やEndotoxin,免疫複合体等の比較的分子量の大きな物質の除去を目的としているので,急性肝不全,急性膵炎,Septic shock,自己免疫疾患などが適応となる。
7.PEの問題点
FFPによる感染,FFP中の高濃度のNaやcitrateによる高Na血症やmetabolic alkalosis,高価な治療費(1回30万円)
8.CPE(continuous PE)+CHDF

血液吸着(hemoadsorption,HA)と血漿吸着(plasma adsorption,PA)
1.目的
吸着療法(adsorption)は,吸着の原理を応用して体内,血中に存在する種々の病因物質を除去する方法で,その病因物質が吸着剤で吸着可能で,かつその物質を取り除くことで病気が改善する可能性がある疾患に対して施行する。
2.吸着療法の種類と原理
a.血液吸着(hemoadsorption,HA)  現在,血液吸着で最も広く使われている吸着剤は活性炭である。活性炭の表面は発達した多孔性構造で,非常に大きな表面積(約1000m2/g)をもち,その表面にはカルボキシル基や水酸基等の活性点が存在し,様々な物質を吸着する。活性炭の分子量に対する吸着特性は,分子量 100以上10000以下の物質の吸着率が高く,透析では除去しにくい尿毒   素や蛋白結合性の高い薬物の除去に優れている。この活性炭をカラムに充填し,血液と接触させることで血液内の病因物質を除去する方法が血液吸着である。血液が活性炭に直接接触すると,赤血球が破壊されたり,白血球が刺激されて各種mediatorを放出したり,凝固系が亢進して血液凝固をおこすため,活性炭の表面をコーティングしているが,このコーティング剤の材質,厚みによって吸着性能が大きく左右される。
b.血漿吸着(plasma adsorption,PA)  吸着の原理はHAと同じだが,血漿分離器を用いて血漿のみを吸着カラムに潅流させるので,赤血球の破壊,白血球の刺激,血液凝固などが少ない。
2.吸着剤
HAとしては,活性炭の表面をヒドロキシメタクリレートでコーティングしたもの(DHP−1,クラレ)を薬物中毒に使用し,ポリスチレンとポリプロピレンの合成線維にポリミキシンBを固定した吸着剤(トレミキシン,東レ)をエンドトキシン血症に用いる。
PAとしては,ノンコーティングの活性炭(プラソーバN-350,旭メディカル)を肝性昏睡に,トリプトファンをポリビニルアルコールゲルに固定したもの(イムソーバIM-TR350,旭メディカル)を重症筋無力症の治療などに使用している。他にも,免疫複合体を吸着する  カラムは色々市販されている。
3.抗凝固剤
活性炭は,メシル酸ナファモスタット(フサン)や低分子ヘパリンを吸着してしまうので,ヘパリンを用いる。イオン交換樹脂はヘパリンを吸着してしまうので,フサンを用いる。ヘパリンは1000〜2000単位/hr,フサンは40〜60mg/hrの速度で使用する。
4.Blood access
ダブルルーメンカテーテル(クイントンR)を内頚静脈,鎖骨下静脈,大腿静脈などから挿入する。
5.回路
HAでは血液ポンプ,動静脈回路,吸着カラムがあればよいが,PAでは,血液ポンプ,動静脈回路,吸着カラムに血漿分離ポンプ,血漿分離フィルターがいる。
設定  血液ポンプ…100〜200 ml/min
血漿分離ポンプ…30〜40 ml/min
■救急・災害医療ホ−ムペ−ジ全国救急医療関係者のページ



■●Arthritis Foundation - The Prosorba(R) Column
米国で関節リウマチ患者は人口1%, 210万人。 Prosorba(R) columnは98.10.29にFDA諮問パネルが承認勧告、99.3.16承認。 重症関節リウマチ患者に朗報。 従来のRA薬物治療耐性例に有効。 腎透析と同様の手法で血液から過剰な抗体を除去する働きをもつ。
●Summary
Based on current information, the Arthritis Foundation believes that results for the Prosorba(R) column are encouraging. It appears that the device, which removes antibodies from patients' blood, may be helpful in the treatment of the most severely affected rheumatoid arthritis patients. The device received recommendation for approval on October 29, 1998, by a Food and Drug Administration Advisory Panel and received final approval from the FDA on March 16, 1999.

●Full Statement
In people with rheumatoid arthritis, the immune system attacks the joints throughout the body, but scientists are unclear about what triggers this reaction. It is known that there is a genetic predisposition to developing RA. The Prosorba column is a device similar to a kidney dialysis machine that removes excess antibodies from a patient's blood. Initial scientific studies have shown that treatment with the Prosorba column is particularly suited to the most severe cases of RA. Patients who become resistant to drug treatments for RA responded positively after using the Prosorba column.

The Prosorba column is not a new device. It has been marketed in the United States for 10 years as a treatment for ideopathic thrombocytopenic purpura (ITP). ITP is a condition in which the body produces antibodies that destroy its own blood platelets and cause serious bleeding. The Prosorba column is sold in Canada, certain European countries, China and Mexico. The machine is manufactured by Cypress Bioscience Inc.

One percent of Americans, or 2.1 million people, suffer from rheumatoid arthritis. It affects almost three times as many women as men. The Arthritis Foundation recommends a comprehensive treatment program for RA that includes consultation with a rheumatologist, appropriate use of medications, education about RA, appropriate amounts of rest and exercise, and learning how to self-manage the disease.







データ


難病情報データベース特定疾患一覧表(平成11年4月現在)
特発性血小板減少性紫斑病|交付件数= 26,233
悪性関節リウマチ|交付件数= 5,019
Rare Disease Database - alphabetical listing※希少疾患アルファベットリスト
Rare Disease Database※希少疾患データベース
----------------------------------------------
特発性血小板減少性紫斑病
 特発性血小板減少性紫斑病 idiopathic thrombocytopenic purpura(ITP)は、明らかな原因がなく、また基礎疾患がないにもかかわらず血小板が減少する病気である。そのために紫斑や出血症状がみられる。血小板の減少は血小板の破壊が亢進するためであり、これは抗血小板抗体が出現するためと考えられている。すなわち病因には自己免疫機序が関与していると考えられるが、病因の詳細はまだ不明である。

頻度
 本邦における有病率は人口10万人あたり3〜5例、年間の新患発生数は1700〜4100人と推定される。
 ITPは急性型と慢性型があるが、急性型は小児に好発し、男女ほぼ同数にみられる。慢性型は成人とくに20歳前後に多く、男女比は1:3で女性に多発する。

臨床像
1. 出血症状
 紫斑が主要症状である。その程度は血小板数減少の程度とほぼ比例する(表1)。
 点状出血、斑状出血がよくみられる。透明なガラス板で圧迫しても消褪しないところから出血と判定できる。
 その他、鼻出血、歯肉出血、血尿、性器出血(女性)などもみられるが、下血、関節出血は多くない。ときに激症例で脳出血をみることもある。

2. 貧血
 出血が持続すると貧血の症状をみる。

3. 脾腫
 ITPでは脾臓の関与は重要であるが、臨床的に脾を触知することはあまりなく、触知しても軽度である。

検査所見
1. 末梢血液検査
 ITPでは血小板減少は必発である。ふつう10万以下であれば減少とみなすが、本症では初診時、90%の症例で5万以下である。さらにその半数の症例で、2万以下の高度減少を示す。
 塗抹標本で血小板の形態を調べると、直径4μm以上の大型のものがみられることがある。
 赤血球と白血球には原則として異常を認めない。しかし出血が長期間続いたり、大量出血が起これば、当然貧血はみられることになる。

2. 骨髄像
 巨核球の数は正常または増加をみる。一般に大型の巨核球が多く、また、巨核球周縁の血小板附着像に欠しいのが特徴である。
 骨髄像全体として低形成を示さない。

3. 出血に関する検査
 血小板減少に伴い出血時間延長、毛細血管抵抗減弱、血餅退縮低下などがみられる。
 しかし、全血凝固時間、プロトロンビン時間、部分トロンボプラスチン時間(PTT)など凝固系検査は正常である。

4. 特殊検査
(1)血小板寿命:51Cr標識血小板を静注して寿命をみると、正常では約10日であるが、ITPでは2〜3日以下と著明に短縮する。

(2)血小板抗体:ITP患者の1/2〜1/3で血中に抗血小板抗体が認められる。最近では患者の血小板に結合した免疫グロブリン(PAIgG)を測定する方法が開発された。

診断
 紫斑を主とする出血症状があり、それが血小板減少に基づくものであり、そして他に原因疾患がみあたらない、という3点につく(表2)。骨髄所見で低形成なく、巨核球は正常か増加していることを確認すれば、診断はそう難しいものではない。
 ただ注意しなければならないものにSLEがある。定型的なSLEは問題ないが、血小板減少のみではじまるSLEでしばしば最初ITPと診断することがある。これは止むを得ないことで、このような症例では経過を追うことになる。

予後
 急性型は2〜6週で約80%が軽快する。慢性型は数年ないし十数年の経過を辿り、軽快・増悪をくり返し、20〜30%は難治性となる。
 死亡率は8〜10%であるが、重要臓器の出血以外、治療による合併症も含まれる。
--------------------------------------------------------------------------------●悪性関節リウマチ
 悪性関節リウマチmalignant rheumatoid arthritis(MRA)とは、明らかな慢性関節リウマチ(RA)が存在し、心、肺、消化管、神経などの内臓病変の症状を呈し、予後の悪い病気に対して、Bevans(1954)が名づけた病気である。

頻度
 我が国における悪性関節リウマチの患者数は全慢性関節リウマチ患者の0.5〜1.0%、全国で約2000〜3000人といわれている。
 発症年齢は50歳代にピークをもち、慢性関節リウマチよりやや高齢である。また、性別では慢性関節リウマチに比べて男性にもみられる率が高く、男女比は1:2である。

病因
 慢性関節リウマチと同様に真の原因は不明だが、体質、素因、自己免疫の関与が示唆される。
 悪性関節リウマチ患者の慢性関節リウマチ家族内発症の頻度は14%と高いのだが、遺伝性疾患といわれるほどの強い関連性は認められていない。
 HLAとの関連では慢性関節リウマチと同様にDR4と相関するが、その相関性は慢性関節リウマチより強いといわれる。
 免疫学的な異常については、リウマトイド因子の高値陽性、抗核抗体陽性、血清低補体価、免疫複合体高値、抑制性Tリンパ球機能低下など多彩な所見が認められている。

病理
 悪性関節リウマチは基本的には慢性関節リウマチに壊死性血管炎を伴ったものをさす。悪性関節リウマチにみられる血管病変は以下の3型に分類される。
(1)RA型(32%):血管壁にリウマトイド結節様病変を示す壊死性血管炎。
(2)PN型(56%):多発性動脈炎(PN)様のフィブリノイド血管炎。
(3)EA型(12%):閉塞性動脈内膜炎(endoarteritis、EA)で、内膜の増殖のみのものも含む。
 悪性関節リウマチのPN型と古典的なPNとの違いが問題になるが、組識学的にはほとんど区別がつかない。しかし悪性関節リウマチのPN型は古典的PNに比べて発症の頻度は低く、腎血管にはほとんどみられない点が異なるとされている。

臨床像
1. 慢性関節リウマチの既往
 罹病年数の長い慢性関節リウマチをすでにもっている。多くはclasicalないしdefiniteRAで、骨・関節の変化も強くみられる(stageV以上)。
2. 全身症状
 発熱、体重減少、易疲労感、食欲不振などがみられる。
3. 皮膚症状
 皮下結節、紫斑、潰瘍、壊疽などがみられる。
4. 肺病変
 間質性変化、胸膜炎、肺線維症などがみられる。
5. 心病変
 心肥大、心外膜炎、冠状動脈炎による狭心症ないしは心筋梗塞をみる。
6. 神経症状
 多発性単神経炎による知覚異常、下垂手、尖足などがみられる。
7. 消化器症状
 腸間膜動脈の血管病変による腸梗塞、イレウス症状を呈することがある。
8. その他
 眼科的には上強膜炎と虹彩炎を認めることがある。

 以上のようにPNの臨床症状とよく似ているが、腎病変と中枢神経症状の稀な点がPNと異なる。
 悪性関節リウマチの臨床症状出現頻度を表1に示す。

検査所見
(1)リウマトイド因子高値陽性
(2)赤沈亢進、CRP陽性
(3)血清補体値低下
(4)白血球増加、好酸球増加、血小板増加
(5)血中免疫複合体増加
(6)高γグロブリン血症
(7)関節・胃X線所見。慢性関節リウマチのstageV以上を呈することが多く、骨・関節の破壊像を認める。
 悪性関節リウマチの検査所見陽性頻度を表2に示す。

予後
 悪性関節リウマチの予後は悪く、診断確定1年後の予後は死亡34%、悪化32%、不変18%、寛解16%といわれる。
 死因は心不全、感染症、呼吸不全が主なものである。







臨床ガイドラインなど









総説記事・文献









ニュース・トピックス


Drug firm hopeful on new arthritis treatment (1/28/1998)★関節炎治療薬Prosorba Column
Cypress社によると、中等度以上のRA[dvanced arthritis] 患者は 200,000 - 500,000人。
Posted January 28, 1998

Drug firm hopeful on new arthritis treatment
--
LOS ANGELES (Reuters) - A California biotechnology company said Tuesday it was hopeful the government would approve a new rheumatoid arthritis treatment it had developed that worked in people who did not respond to existing drugs.
The treatment is not a miracle cure. It requires that patients spend two hours a week at a doctor's office while their blood is drawn out of their body and filtered. But Cypress Bioscience, developer of what it calls the Prosorba Column, said treatment with it might be the only option left for patients with an advanced form of the painful condition.
Cypress said it did not understand exactly why the Prosorba Column worked, although it had something to do with removing certain antibodies from the blood. The company has marketed the product for more than 10 years as a treatment for a rare autoimmune disease but only recently discovered it was also effective against rheumatoid arthritis.

While some patients with rheumatoid arthritis have found relief through drugs, the disease tends to progress over time, leading to severe symptoms that drugs no longer affect.
Cypress said it had tested the Prosorba Column on patients who had suffered from rheumatoid arthritis for an average of more than 15 years and for whom an average of five treatments had failed. Some of those patients needed a cane to walk.
Cypress Chief Executive Officer Dr. Jay Kranzler estimated that between 200,000 and 500,000 advanced arthritis patients in the United States could benefit from the treatment.
The San Diego-based company first needs to win the backing of the Food and Drug Administration, and there is no guarantee that it will. But company officials said they were optimistic about a positive review due to the strong clinical data.
A pivotal study of the Prosorba Column was recently halted a year ahead of schedule because of a strong showing of efficacy in separate research centers around the country.
The treatment did not work on all patients. Only about 33.3 percent of a group of 48 tested showed reduced joint pain and swelling with the initial treatment. But those results were viewed as dramatic because they were achieved in a group of patients that was very difficult to treat.
Cypress plans to apply to the FDA by this summer and, if it wins approval, bring the Prosorba Column to market sometime next year.





■Infoseek Search results for: Prosorba

Arthritis Foundation - The Prosorba(R) Column
Based on current information, the Arthritis Foundation believes that results for the Prosorba(R) column are encouraging. It appears that the device, which removes antibodies from patients blood, ...
Date: 17 Jun 1999, Size 4.5K, http://www.arthritis.org/resource/statements/prosorba.asp
Hiroshi Fukunishi's Home Page
Last Update June 9th 1999 @ My PHOTO GALLERY The South-Hyogo Earthquake Nippombashi Rambling My Family Links @ e-mail: hiroshi.fukunishi@nifty.ne.jp @
Date: 9 Jun 1999, Size 1.8K, http://member.nifty.ne.jp/fukunishi/
Treatment of Chronic ITP
Initial treatment (steroids/splenectomy) in an uncomplicated patient can be managed by a family practitioner or general internist with experience in this area. If the patient is actively bleeding or has failed ...
Date: 24 Aug 1997, Size 3.2K, http://seconde.scripps.edu/itp/therapy.html
Idiopathic thrombocytopenic purpura (ITP)
immune thrombocytopenic purpura; ITP Definition: A bleeding disorder resulting from a shortage of platelets with characteristic bleeding under the skin. Causes, incidence, and risk ...
Date: 10 Apr 1999, Size 9.2K, http://www.healthanswers.com/database/ami/converted/000535.html
Survey Results
Surveys were sent to a small, random group of people with ITP. Twenty-eight forms were completed and returned. These results are the tabulated answers. Not everyone answered all the questions, so some results may be ...
Date: 19 Mar 1999, Size 2.9K, http://www.itppeople.com/surveyres.htm
Novel agents target arthritis 6; course
The millions of Americans who suffer from the joint pain and swelling of rheumatoid arthritis are being offered new options that can actually slow disease progression.
Date: 12 Jun 1999, Size 45.0K, http://www.msnbc.com/news/204800.asp
Biopharmaceuticals Companies in the U.S. Market
This list presents companies significantly involved with biophamaceutical products in the U.S. market, December 31, 1998. This includes all manufacturers and U.S. marketers of approved ...
Date: 29 Mar 1999, Size 35.1K, http://www.biopharma.com/companies.html
Welcome To Fresenius Hemotechnology, Inc.
Fresenius Hemotechnology, Inc. is a subsidiary of Fresenius AG. We are a hemotechnology company dedicated to bringing innovative technology to medical professionals in blood management.
Date: 22 Apr 1999, Size 9.1K, http://www.freseniusht.com/
Cypress Bioscience: Prosorba, new treatment for rheumatoid arthritis
Cypress Bioscience, Inc (CYPB)., corporate profile and info on the Prosorba Column, a new, FDA-approved, drug free, treatment for rheumatoid arthritis and idiopathic thrombocytopenic ...
Date: 5 May 1999, Size 4.7K, http://www.cypressbio.com/
Rheumatoid Arthritis Drug Information
Rheumatoid Arthritis Drug Information
Date: 10 Dec 1998, Size 32.7K, http://itsa.ucsf.edu/~toddw/rheumatoid.html







リンク&リソース









主要サイト


■●Cypress Bioscience, Inc. - Hoover's Company Capsule
サイプレス社は1998年売上$2.7百万、従業員56人。 Prosorba columnは主力品。 血小板膜Cyplex等を開発中。 http://www.cypressbio.com
Cypress Bioscience, Inc.
4350 Executive Dr., Ste. 325
San Diego, CA 92121
Phone: 619-452-2323
Fax: 619-452-1222
http://www.cypressbio.com

Cypress Bioscience makes medical devices to treat immune system diseases, and also developes therapies for blood platelet disorders. The company's flagship product Prosorba column treats rhuematoid arthritis by drawing blood from the patient, separating plasma from red blood cells, filtering out harmful particles, then returning the plasma to the patient. Cypress's pipeline products include Cyplex, an infusible platelet membrane that replaces platelet transfusion and lasts longer than donated platelets. Medical supplier Fresenius owns Prosorba production facilities and helps market Prosorba products. Paramount Capital, an asset manager controlled by Dr. Lindsay Rosenwald, owns nearly a quarter of Cypress.
Top Competitors:
Fiscal Year-End: December1998 Sales (mil.): $2.7
1-Yr. Sales Growth: (18.2%)1998 Net Inc. (mil.): ($9.1)
1-Yr. Net Inc. Growth: --1998 Employees: 56
1-Yr. Employee Growth: 43.6%In-depth Financials



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PROSORBA(R) Column Approved by FDA for Use in Rheumatoid Arthritis★リンク切れ
Breakthrough Treatment -- First Available Non-Drug Alternative

PROSORBA(R) is a registered trademark of Cypress Bioscience, Inc.

=======================================================
■■●About Cypress
Cypress Bioscience, Incorporated
Cypress tree branch - cool huh?
Corporate History
Corporate Strategy
Board of Directors
Executive Officers
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Cypress Bioscience, Inc., San Diego, CA develops, manufactures and markets medical devices and therapeutics for the treatment of certain types of immune disorders - Rheumatoid Arthritis (RA) and Idiopathic Thrombocytopenic Purpura (ITP) - and is engaged in the development of novel therapeutic agents for the treatment of blood platelet disorders.

Recently, the company's leading product, the PROSORBA(R) column, was approved by the FDA for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDS).

Since 1987, the Column has been approved and available for the treatment of patients with Idiopathic Thrombocytopenic Purpura (ITP), an immune-mediated bleeding disorder. Additionally, the Company is developing Cyplex™ Infusible Platelet Membranes as a potential alternative to traditional platelet transfusions.
Last modified: March 25, 1999
=======================================================
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=======================================================
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●1999 Events
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American Society for Apheresis - Apr. 21-24, San Antonio, TX
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 Last modified: April 07, 1999
=======================================================
Nasdaq - News :Cypress Bioscience Announces Second Quarter 1999 Financial Results; Holds Conference Call
Cypressは1999.3にFresenius Hemotechnology Inc. (FHI)[独Fresenius AG子会社;apheresis設備・ディスポーザブルの大手]と提携。 米国、欧州、ラテンアメリカ、日本などでのFHIがProsorbaの製造・販売の権利を持つ。
1999年第2四半期Prosorba column売上は$585,000(前年同期$493,000)。 1999年第1四半期は$588,000。 Prosorba columnのRA適応追加は1999.3月、DMARDs無効例に有効だが知名度は低い(Cypress社)
SAN DIEGO--(BW HealthWire)--July 19, 1999--Cypress Bioscience
Inc. (Nasdaq:CYPB) announced today its financial results for the
second quarter of 1999.
For the quarter, the company reported a net loss of $1.7 million,
or $0.04 per share, compared to a net loss of $2.7 million or $0.07
per share in 1998. Net loss for the six months ended June 30, 1999 was
$4.8 million, or $0.11 per share, compared to a net loss of $4.7
million or $0.12 per share for the same period in 1998.

In March 1999, Cypress entered into an agreement with Fresenius
Hemotechnology Inc. (FHI), a U.S. subsidiary of Fresenius AG
(Fresenius) of Bad Homburg, Germany. FHI is a leading provider of
apheresis equipment and disposables. The agreement provides Fresenius
with an exclusive license to manufacture and distribute the Prosorba
column in the U.S., Europe, Latin America, and subject to certain
conditions, Japan and certain other countries. Operating revenues in
the second quarter of 1999 were made up of expense reimbursement from
the sale of Prosorba(R) columns by FHI. As such, it is not directly
comparable to revenues recorded in the prior period.
Prosorba column sales for the second quarter of 1999 totaled
$585,000 compared to $493,000 in 1998. This increase in Prosorba
column sales was attributed to initial sales of the product for use in
rheumatoid arthritis (RA). Sales of the Prosorba column during the
second quarter of 1999 were down slightly from first quarter 1999
sales of $588,000. This resulted from increases in sales of the
Prosorba column for RA that did not entirely offset decreased sales
for the idiopathic thrombocytopenic purpura (ITP) indication.

"At the time of launch into the rheumatoid arthritis market three
months ago, Prosorba column awareness was low. We are building
awareness and generating interest in the RA community and educating
the rheumatologists about how to incorporate this novel approach to
managing RA into their practice. As we anticipated, this process takes
time," said Carl Bobkoski, president and chief operating officer of
Cypress. "While it requires multiple sales calls to go from first
contact to patient treatment, the unique characteristics of the
non-drug Prosorba column have been well received by rheumatologists,
many of whom have identified Prosorba column candidates within their
practice."

In April 1999, Fresenius exercised its option to acquire the
Prosorba column manufacturing facility and related assets, located in
Redmond, Wash., for $5.2 million. The purchase price paid to Cypress
consisted of cash of $1.2 million and an offset of $4.0 million from
the previous draw down of an interest-free line of credit provided by
Fresenius.

In connection with this transaction, Fresenius purchased from the
company inventory for $2.0 million that resulted in a gain to Cypress
of $693,000. The purchase price of the manufacturing facility and
related assets may result in a gain to Cypress. The potential gain was
deferred since the company is responsible for reimbursing Fresenius
for certain operating costs associated with this facility during 1999.

The net book value of the property and equipment sold to
Fresenius totaling $1.4 million was recorded on the balance sheet as
"Assets of Business Transferred." The purchase price of the property
and equipment sold totaling $3.2 million was recorded as "Liabilities
of Business Transferred." When the obligation to Fresenius lapses at
year end, the assets sold will be removed from the company's balance
sheet and the excess of the purchase price over the net book value of
the assets sold plus reimbursement of certain operating costs will be
recorded as a gain from sale of assets, if any.

In April 1999, the company launched sale of the Prosorba column
for the treatment of moderate to severe RA in adult patients with long
standing disease who have failed or are intolerant of
disease-modifying anti-rheumatic drugs (DMARDs). Operating revenues
for six months ending June 30, 1999 were $1.0 million, compared to
operating revenues of $1.2 million for the same period in 1998.
Operating revenues for the six months ended June 30, 1998 included
$204,000 of grant income.

Operating expenses for the six month period ended June 30, 1999
and 1998 were $6.7 million and $6.0 million, respectively. As a result
of Fresenius' purchase of the Redmond manufacturing plant, the company
will not incur production costs for the Prosorba column after April
1999. Accordingly, operating expenses for the six months ended June
30, 1999 were not comparable to the prior period. The increase to
operating expense of $0.7 million during the six months period in 1999
compared to 1998 resulted from higher sales and marketing expenses
offset by lower production and research and development expenses. The
decrease in research and development expenses was due to completion of
Phase III clinical studies of the Prosorba column for RA. The increase
in sales and marketing expense resulted from the hiring of a sales
force and other activities associated with the launch of the Prosorba
column for RA in April 1999.

Upon signing of the Fresenius agreement, Cypress received a total
of $1.5 million from Fresenius consisting of the purchase of 297,530
shares of Cypress common stock for $1.0 million, and $500,000 for the
purchase of a three-year warrant to buy 342,466 shares of common stock
at $7.50 per share. In March and April 1999, Cypress received proceeds
of $5.2 million from the exercise of warrants to purchase 2.6 million
shares of common stock. At June 30, 1999, the company had cash, cash
equivalents, and short-term investments of $13.0 million.

Cypress Bioscience Inc. will hold a conference call on Tuesday,
July 20, 1999 at 10:00 a.m. EST. To join the call dial 888/221-6607
toll free, or 703/834-7676 for international calls.

Cypress Bioscience Inc. develops and markets medical devices and
therapeutics for the treatment of certain types of immune disorders
and is engaged in the development of novel therapeutic agents for the
treatment of blood platelet disorders. The Prosorba column, a
therapeutic medical device, was approved by the U.S. Food and Drug
Administration in March 1999 for use in the therapeutic reduction of
the signs and symptoms of moderate to severe rheumatoid arthritis in
adult patients with long standing disease who have failed or are
intolerant to DMARDS.

It was previously approved in 1987 for use in Idiopathic
Thrombocytopenic Purpura (ITP), an immune bleeding disorder. In
addition to Cypress's lead product, the Prosorba column, the company
is developing Cyplex(TM) (Infusible Platelet Membranes), which is
positioned to become an alternative for traditional platelet
infusions. For more information about the Prosorba column and Cypress,
please visit the company's Web site at www.cypressbio.com.

Except for historical information contained herein, this news
release contains forward-looking statements regarding Cypress
Bioscience Inc.'s operating results or financial condition that
involve risks and uncertainties, including, but not limited to, the
company's and Fresenius' ability to market successfully the Prosorba
column for use as a treatment for RA; whether the company will be
successful in collaborating with Fresenius; and the Company's ability
to develop and receive regulatory approval for Cyplex on a timely
basis, if at all, as well as other risks detailed from time to time in
the company's SEC reports, including its Annual Report on Form 10-K
for the year ended Dec. 31, 1998 and its most recent Quarterly Report
on Form 10-Q.

 CYPRESS BIOSCIENCE INC. Condensed Financial Data (In thousands, except per share data) Statements of Operations Data Quarter ended Six months ended June 30, June 30, 1999 1998 1999 1998 (unaudited) (unaudited) Operating revenues $ 379 $ 645 $ 977 $ 1,194 Operating expenses 2,932 3,457 6,673 6,039 Gain from sale of inventory 693 -- 693 -- Other income, net 129 72 170 172 Net loss $(1,731) $(2,740) $(4,833) $(4,673) Net loss per share - basic and diluted $ (0.04) $ (0.07) $ (0.11) $ (0.12) Shares used in computing net loss per share - basic and diluted 43,013 38,923 42,691 38,806 Balance Sheet Data June 30, Dec. 31, 1998 1999 1998 (unaudited) Assets Cash, cash equivalents and short-term investments $ 12,959 $ 5,620 Assets of business transferred 1,359 -- Other current assets 575 1,853 Non-current assets 296 1,843 Total assets $ 15,189 $ 9,316 Liabilities and Stockholders' Equity Current liabilities $ 1,460 $ 1,905 Liabilities of business transferred 3,217 -- Long term liabilities 541 566 Stockholders' equity 9,971 6,845 Total liabilities and stockholders' equity $ 15,189 $ 9,316 
CONTACT: Cypress Bioscience Inc. Jay D. Kranzler, Carl Bobkoski, Manda Hall 858/452-2323
=======================================================
Nasdaq - News :Cypress Announces Fresenius AG To Purchase Prosorba Column Manufacturing Facility; Approximately $5.2 Million in Proceeds to Cypress
SAN DIEGO--(BW HealthWire)--April 27, 1999--Cypress Bioscience
Inc. (Nasdaq:CYPB) announced today that Fresenius AG of Bad Homburg,
Germany has exercised the option and acquired the Prosorba(R) column
manufacturing function and related assets, located in Redmond,
Washington.

The acquisition was made by Fresenius's US subsidiary, Fresenius
Hemotechnology Inc. of Concord, Calif. (FHI).
As part of their partnering arrangements, which closed earlier
this year, Cypress granted Fresenius the option to purchase the
Prosorba(R) column manufacturing assets, located in Redmond,
Washington, until the end of 2000.

Associated with this purchase option, Fresenius made available to
Cypress an interest-free line of credit to provide the company with
the working capital required to fund its share of the market launch
and to initiate the scale-up process. Cypress has drawn down to date
approximately $4 million, which will be offset against the purchase
price of the facility. Fresenius has paid an additional amount of
approximately $1.2 million to exercise the purchase option.

"Fresenius's ownership of the manufacturing function will
accelerate the commitment of their proven expertise toward the
scale-up of the Prosorba(R) column to meet anticipated market demand,"
said Jay D. Kranzler, M.D., Ph.D., chairman of the board and chief
executive officer of Cypress Bioscience Inc. "This transaction also
shortens the timeframe for Cypress to reach profitability by reducing
our ongoing operating expenses and capital expenditures."

"Our further investment reflects Fresenius's view of the
promising prospects for the Prosorba(R) column within the rheumatoid
arthritis market place," commented Rainer Baule, president and chief
operating officer, Fresenius Intensive Care and Hemotechnology. The
companies jointly launched the product for the rheumatoid arthritis
application on April 5, 1999.

The agreement between Cypress and Fresenius AG of Bad Homburg,
Germany and FHI provides Fresenius with an exclusive license to
distribute the Prosorba(R) column, a treatment for rheumatoid
arthritis, in the US, Europe and Latin America and, subject to certain
conditions, Japan and select Asian countries.

The terms of the agreement with Fresenius specify joint efforts
to introduce and market the Prosorba(R) column in the U.S., with
Fresenius having exclusive distribution rights and responsibility for
clinical trials and registration overseas. The agreement includes a
50/50 profit split in countries other than the United States.

The profit sharing is 50/50 in the U.S. until Prosorba(R) column
revenue reaches a pre-determined sales threshold, after which time
Cypress will receive 60% of the profits and Fresenius will receive
. In connection with the closing earlier this year, Fresenius made
an up front payment to Cypress of $1.5 million for the purchase by
Fresenius of Cypress common stock and warrants.

Financial terms also include license payments of up to $54
million based on sales.

Cypress Bioscience Inc. develops, manufactures and markets
medical devices and therapeutics for the treatment of certain types of
immune disorders and is engaged in the development of novel
therapeutic agents for the treatment of blood platelet disorders.
The Prosorba(R) column, a therapeutic medical device, was
approved by the FDA in March 1999 for use in the therapeutic reduction
of the signs and symptoms of moderate to severe rheumatoid arthritis
in adult patients with long standing disease who have failed or are
intolerant to disease-modifying anti-rheumatic drugs (DMARDS).

It was previously approved in 1987 for use in Idiopathic
Thrombocytopenic Purpura (ITP), an immune bleeding disorder. In
addition to Cypress's lead product, the Prosorba(R) column, the
company acquired Cyplex(TM) (Infusible Platelet Membranes), which is
positioned to become an alternative for traditional platelet
infusions.

For more information about the Prosorba(R) column and Cypress,
please access the company's Web site at: www.cypressbio.com.

Fresenius AG is one of the leading health care companies
worldwide with products and services for dialysis, the hospital and
the outpatient medical care of patients. In 1998 Fresenius generated
sales of DM 8.444 billion (US $4.593 billion) and a net income of DM
285 million (US $155 million). On Dec. 31, 1998, the Fresenius Group
had more than 39,000 employees.

Fresenius Hemotechnology Inc. is a US subsidiary of Fresenius AG
that focuses on cell separators, autotransfusion devices, blood
filters and products for blood banks and hospitals including
progenitor cell enrichment devices.

Except for historical information contained herein, this news
release contains forward-looking statements that involve risks and
uncertainties, including, but not limited to, the company's and its
partner's ability to market successfully the Prosorba(R) column for
use as a treatment for RA; whether the company will be successful in
collaborating with a marketing partner or not; the company's ability
to receive regulatory approval for Cyplex(TM) on a timely basis, if at
all; and whether Cyplex will become a substitute for traditional
platelet infusions, as well as other risks detailed from time to time
in the company's SEC reports, including its report on the most recent
Form 10-K.
CONTACT: Cypress Bioscience Inc.
Jay D. Kranzler, Carl Bobkoski, and Manda Hall
619/452-2323
or
Adam Friedman Associates
Adam Friedman, 212/391-7596
or
The Oxford Group
Mark Corbae, 760/918-0593
=======================================================
■■●Cypress Products
The Prosorba Column
The PROSORBA(R) column
The PROSORBA column is indicated for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).

Click here for more information on the PROSORBA column and Rheumatoid Arthritis (RA)

The PROSORBA column is indicated for use in the therapeutic removal of immunoglobulin G (IgG) and IgG-containing circulating immune complexes from plasma in patients with idiopathic thrombocytopenic purpura (ITP) having platelet counts less than 100,000mm3.
Click here for more information on the PROSORBA column and Idiopathic Thrombocytopenic Purpura (ITP)

The Cyplex Platelet Alternative
CyplexTM Infusible Platelet Membranes*

The Cyplex infusible platelet membranes is an experimental potential substitute for traditional platelet transfusions. It may offer important clinical and logistical advantages over conventional platelet transfusions such as the ability to control bleeding in patients refractory to platelets, a significant problem for cancer patients undergoing chemotherapy and irradiation. After the successful completion of a Phase II efficacy trial, Cypress is planning a Phase IIb clinical trial to determine the correct dosing of the product.
Click here for more information on the Cyplex infusible platelet membranes
*This product is experimental and is not yet approved by the FDA for commercial distribution
Last modified: March 25, 1999
=======================================================
Rheumatoid Arthritis Page★添付文書[RA]
Rheumatoid Arthritis
The Prosorba Column
The PROSORBA(R) column
The PROSORBA column is indicated for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
Information for Patients with Rheumatoid Arthritis
Information for Health Care Professionals Who Treat Rheumatoid Arthritis
Last modified: June 16, 1999
=======================================================
Patients with RA
Patients with RA
The PROSORBA(R) Column for Patients with Rheumatoid Arthritis
The PROSORBA column is indicated for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
Patient Guide - Frequently Asked Questions (FAQ)
Help finding a rheumatologist in your area
If you are currently using the PROSORBA column and wish to enroll in NEW HOPE, our patient support program, click here
If you have further questions about the PROSORBA column, please call toll free 1-800-635-HOPE, 8am-5pm PST, M-F.
Last modified: March 25, 1999
=======================================================
Patient Labeling - FAQ

The PROSORBA(R) Column Patient Guide
Cypress Bioscience, Inc.
Feel free to browse through some of the most commonly asked questions we receive from patients. Please consult your physician if you have questions related specifically to your health.

Directory of Questions:

What is the PROSORBA column?

What is involved in the PROSORBA treatment?

How often is the procedure performed?
How will I know if the procedure is working?
What about side effects?

If I am treated as an outpatient, will I be able to return home after each treatment?

How shall I care for myself after the treatment?

IMPORTANT PATIENT INFORMATION

Your physician has been supplied with full
and complete prescribing information advising him/her of the best way to use the PROSORBA(R) column. The following summary includes an abbreviated version of this information for your review.

For what conditions is the PROSORBA column used?

For what conditions should the PROSORBA column not be used?

What if I have problems after my treatment when I have returned home?

What is the PROSORBA column?
The PROSORBA column is a plastic cylinder about the size of a coffee mug that contains a sand-like substance coated with a special material called Protein A. Protein A is unique in that it binds certain elements from your blood called antibodies. Normally, antibodies protect you from disease. However, sometimes your body produces unwanted antibodies that attack your own body tissues. These unwanted antibodies can result in disease. The PROSORBA column works to counter the effect of these harmful antibodies

What is involved in the PROSORBA column treatment?
Normally, during therapy, blood is drawn from a vein in your arm and is then pumped into an apheresis machine, or cell separator. This machine separates the liquid part of your blood (the plasma) from the blood cells. Your plasma passes through the PROSORBA column, out through another tube and, after being reunited with your blood cells, is returned to your body through a vein in your other arm (see the diagram). The entire procedure treats 4-8 cups of plasma and takes approximately 2 hours.

How often is the procedure performed?
How often you receive these treatments is based upon your condition. Twelve treatments, once per week for 12 weeks are recommended for patients with rheumatoid arthritis (RA). The recommended treatment for patients with idiopathic thrombocytopenic purpura (ITP) is more variable and may range from daily to weekly treatments. Your physician will advise you of the best method of treating your disease.

How will I know if the procedure is working?
Like other therapies, the response to treatment will vary from person to person and your doctor will closely monitor your progress. Not all patients respond to PROSORBA column treatments. Patients with RA should not expect any evidence of improvement until a full course of treatments have been received. This delayed reaction is normal and you should not be concerned that the treatment isn't working. It may take this long for your body to respond. Our clinical study has demonstrated that those patients who do notice improvement may continue to experience reduced symptoms for some months after completion of the treatments. Patients with ITP may show improvement after only a few treatments, but commonly require 6 treatments to obtain the best results.

What about the side effects?
When they occur, the side effects of the PROSORBA column are usually temporary and manageable. The most common side effect is a "flu-like" condition with chills, mild fever, nausea and joint/muscle pain. Your physician may prescribe medications to make you more comfortable. In our clinical study, patients with rheumatoid arthritis often experienced some fatigue and a temporary increase in joint pain and swelling for a day or two after treatment. The process of removing your blood for treatment may cause a temporary drop in your blood pressure. In such cases, the doctor administering the apheresis treatment may decide to slow down the blood flow or give you additional fluids by vein.
As with any medical therapy, you should always report any rash or other unusual symptoms to your doctor as soon as possible. Please read the IMPORTANT PATIENT INFORMATION below.

If I am treated as an outpatient, will I be able to return home after each treatment?
Yes, if you are not already staying overnight in the hospital because of your underlying condition, you will normally return home after each treatment.

How shall I care for myself after the treatment?
It is not unusual to feel tired after this type of treatment. Your physician may recommend rest for some time after the treatment.
Additional Patient Information About the PROSORBA column
IMPORTANT PATIENT INFORMATION
Your physician has been supplied with full and complete prescribing information advising him/her of the best way to use the PROSORBA column. The summary below includes an abbreviated version of this information for your review.

For what conditions is the PROSORBA column used?
The PROSORBA column is approved for use in the treatment of some patients with idiopathic thrombocytopenic purpura (ITP) and for some patients with rheumatoid arthritis (RA) who are not responsive or are intolerant of DMARD therapy. Both diseases are conditions brought about by an abnormal situation in the body's antibody system. Your doctor has made a determination that you may benefit from a course of PROSORBA column treatments.

For what conditions should the PROSORBA column not be used?
Heart conditions or high blood pressure: You should never
participate in a PROSORBA column treatment program if you are currently taking or have recently (within a week or so) taken angiotensin-converting-enzyme medications. These medications are often referred to as "ACE inhibitors" and would normally be prescribed to you if you have been experiencing heart problems or high blood pressure. If you have either of these conditions or related conditions, talk to your doctor before starting the PROSORBA column treatments.
Blood Clotting Problems: Tell your physician if you have experienced strokes or blood clotting.
Pregnancy: The use of the PROSORBA column has not been studied in pregnant women.

What if I have problems after my treatment when I have returned home?
Although rare, unusual reactions to the PROSORBA column do occur. You should always report unusual symptoms to your doctor. Any rash should be reported since it may (rarely) signal a reaction called vasculitis which requires discontinuation of the PROSORBA column treatments.

Distributed Exclusively by: Fresenius Technology, Inc.
110 Mason Circle Suite A Concord, CA 94520-1238; Phone 925:688-0990 Fax 925:688-0999
Customer Service: 800:909-3872, 7am-5pm PST, M-F
www.freseniusht.com
This patient guide is provided as an educational service of: Cypress Bioscience, Inc. , 4350 Executive Drive, Suite 325, San Diego, California 92121
Phone/619:452-2323, Fax/619:452-1222, Email/prosorba@cypressbio.com
Last modified: March 25, 1999
=======================================================
Health Care Professionals Who Treat Rheumatoid Arthritis★添付文書[RA専門家向け]
Information on the PROSORBA(R) Column for Health Care Professionals Who Treat Patients Who Suffer with Rheumatoid Arthritis
The PROSORBA column is indicated for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).

Prescribing information
HTML version - view in your internet browser
PDF file - If you wish to print out the PROSORBA column Prescribing Information, please download the PDF file. (Click icon below, if you need to download a free version of the Adobe Acrobat Reader)
Get Acrobat Reader
Frequently asked questions/patient guide
HTML version - view in your internet browser
PDF file - If you wish to print out the PROSORBA column Patient Guide, please download the PDF file. (Click icon below, if you need to download a free version of the Adobe Acrobat Reader)
Presentation of the clinical data. Click here to download a PowerPoint presentation file (1.7 MB).
Bibliography
Professional programs (coming soon)
About NEW HOPE, our patient support program
How to order the PROSORBA column
For questions about reimbursement and insurance coverage, call the PROSORBA Column Reimbursement Hotline
at 800.255.7277 9am-5pm EST, M-F. For more information click here.
Request a visit from a Cypress Bioscience, Inc Representative
Last modified: March 30, 1999
=======================================================
ITP - The Prosorba Immunoadsorption Column
Idiopathic Thrombocytopenic Purpura
The
PROSORBA(R) column
Clinical Data
Bibliography (Hematology)
Prescribing Information
In addition to Rheumatoid Arthritis, the PROSORBA column is a medical
device used for the treatment of Idiopathic Thrombocytopenic Purpura (ITP), a potentially life-threatening bleeding disorder. It is indicated for use in the therapeutic removal of immunoglobulin G (IgG) and
IgG-containing circulating immune complexes from plasma in patients with idiopathic
thrombocytopenic purpura (ITP) having platelet counts less than 100,000mm3.
The PROSORBA column employs approximately 200 mg of protein A covalently
bound to an inert silica matrix that is contained within a 300 ml polycarbonate housing.
Each column contains 123 ア 2 grams of this matrix. Protein A is a component of certain
strains of the Staphylococcus bacterium and it binds immunoglobulin G (IgG) and IgG bound to an antigen, i.e., circulating immune complex.
 Last modified: March 25, 1999
=======================================================
Corporate Strategy

米国RA患者は250万人、うち70%が女性で最多年齢帯は10-60才。 Prosorbaの対象となるのは25万人。 The Company has embarked on a three-part business strategy:
●Strategy 1
Winning approval for the PROSORBA(R) column in rheumatoid arthritis (RA)
In March 1999, Cypress Bioscience, Inc received FDA approval for the PROSORBA column for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
In January 1998, Cypress successfully completed--a year in
advance--a pivotal Phase III trial studying the use of the PROSORBA column for treating
Rheumatoid Arthritis patients who have not responded to traditional therapies.
Rheumatoid Arthritis is a chronic, often debilitating auto-immune disease in which the body's immune system attacks its own tissue, which can lead to painful inflammation and deformity of the joints. The disease affects more than 2 1/2 million Americans, 70% of them women, most between the ages of 25 and 60. The PROSORBA is targeted toward the over 250,000 patients with the most serious form of the disease.

●Strategy 2
Substantiating the clinical effectiveness of Cyplex™ Infusible Platelet Membranes in controlling bleeding
Cypress Bioscience, Inc. completed a small, open label Phase II trial in 1997, which suggested that the Cyplex infusible platelet membranes were safe and effective when given intravenously to patients with low levels of circulating platelets (thrombocytopenia) to control bleeding. In addition, the trial suggested efficacy of Cyplex infusible platelet membranes even in patients who were resistant to platelet transfusions. Successful demonstration of the ability of Cyplex infusible platelet membranes to control bleeding could position the product as an alternative when platelet infusions fail or cannot be used.

●Strategy 3
Maintaining a presence with the PROSORBA column in hematology
In 1987, the FDA approved the PROSORBA column for the treatment of idiopathic thrombocytopenic purpura (ITP), an immune disorder in which the body produces antibodies that destroy its own healthy platelets, leading to potentially serious bleeding.
While treating patients with ITP has been an important goal for Cypress Bioscience, Inc., the Company will shift its sales focus to the new market opportunity in rheumatology. For those patients in hematology who need PROSORBA column therapy, the Company will be able to continue to supply the product.
Last modified: March 25, 1999
=======================================================
■●Corporate History
1981
Company established.
1983
Initial Public Offering completed.
1987
PROSORBA(R) column approved for idiopathic thrombocytopenic purpura (ITP) by the U.S. Food and Drug Administration (FDA).

1994
Distribution agreement with Baxter Healthcare established.
1995
Achieved positive results with the PROSORBA column in pilot trial for rheumatoid arthritis (RA).
1996
January: New senior management hired. Company reorganized.
February: Raised $14 million in private placement.
April: Company's name changed from IMRE Corp. to Cypress Bioscience, Inc. Patent dispute settled.
May: Marketing rights to PROSORBA column reacquired from Baxter
June: PROSORBA column RA Phase III trial began. Established Scientific Advisory Boards.
July: Corporate headquarters relocated to San Diego.
August: Post-marketing trial with PROSORBA column in ITP begun
October: Raised net proceeds of $7.3 million in private placement.
November: Acquired PRP, Inc. and the Cyplex™ infusible platelet membranes (IPM).
1997
January: Achieved positive results in Phase II trial with Cyplex infusible platelet membranes.
April: Redmond manufacturing facility received Good Manufacturing Practices (GMP) approval by the FDA.
July: Data Safety and Monitoring Board (DSMB) recommended continuation of PROSORBA column Phase III RA trial. Cyplex patent allowance granted.
October: Raised net proceeds of $5.7 million in private placement.

1998
January: DSMB recommended early cessation of the Phase III RA trial due to favorable safety and statistically significant efficacy results.
February: PROSORBA column awarded patents for RA and ITP indications. Signed collaboration agreement with the Dutch Sanquin Blood Supply Foundation for the scale-up and development of Cyplex infusible platelet membranes.
July: Filed PMA supplement for the PROSORBA column in RA.
October: Positive recommendation by the FDA Gastroenterology and Medical Device Panel for the use of the PROSORBA column in moderate to severe rheumatoid arthritis.

Neo Retro 1999.jpg (2916 bytes)
January: Signed letter of intent for collaboration with Fresenius AG in distribution of the PROSORBA column.
March: Received FDA approval for the PROSORBA column for use in the therapeutic reduction of the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long standing disease who have failed or are intolerant to disease-modifying anti-rheumatic drugs (DMARDs).
Signed definitive licensing and distribution agreements for U.S, Europe and Latin America markets with Fresenius AG for the PROSORBA column; agreement includes equity investment and profit sharing.







潟tクミ・メディカルメディア Fukumi Corporation MedicalMedia
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関連●MLリソース:抗炎症剤・関節リウマチ
関連●MLリソース:COX-2阻害薬
関連●MLリソース:NSAIDS
■1999 -----------------------------------------
1058★15/16★99.07.30★069★慢性関節リウマチに対するProsorbaカラム/2p1058追加メモ[83KB]
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作成:1999.8.12 最終更新:99.8.12 小菅博之
The Medical Letter日本語版
●追加メモ to 1058

On Drugs and Therapeutics

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