Chihaya Hospital

Higashimurayama-shi, Japan

Chihaya Hospital

Higashimurayama-shi, Japan

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PubMed | Shin Kokura Hospital, National Hospital Organization, Chihaya Hospital, Kyushu Central Hospital and 8 more.
Type: | Journal: Antiviral research | Year: 2016

Older patients with chronic hepatitis C virus (HCV) infection have historically been designated difficult-to-treat. We evaluated the efficacy and safety of sofosbuvir (nucleotide NS5B polymerase inhibitor) plus ribavirin for patients with HCV genotype 2 infection in a real-world clinical setting, with the focus on elderly patients aged65. This large, multicenter study consisted of 446 Japanese HCV genotype 2 patients (303 treatment-nave and 143 treatment-experienced), including 190 (42.6%) aged65 and 90 (20.2%) with compensated cirrhosis. Efficacy was assessed by the sustained virological response 12 weeks post-treatment (SVR12). The overall SVR12 rate was 95.7% (427/446), and the SVR12 rate of patients aged65 was 95.3% (181/190). For treatment-nave patients, almost all with compensated cirrhosis (95.6%, 43/45) achieved SVR12, irrespective of age. For treatment-experienced patients, cirrhosis undermined the treatment outcome, both for the aged 65 (SVR12: 80.0%, 20/25) and <65 (85.0%, 17/20) patient groups when compared to non-cirrhosis patients (65: 95.7%, 45/47 and<65: 96.2%, 50/52). The most common adverse effect was anemia (hemoglobin <10g/dL), especially for patients aged65 with the inosine triphosphate pyrophosphatase CC genotype at rs1127354 (26.2%, 33/126). Notably, ribavirin reduction was not related to treatment failure. Only three (0.7%) patients, all aged65, discontinued treatment, but all achieved SVR12. Sofosbuvir plus ribavirin for HCV genotype 2 was effective for patients aged 65, especially those who were treatment-nave or treatment-experienced/non-cirrhosis.


PubMed | Shin Kokura Hospital, National Hospital Organization, Chihaya Hospital, Kyushu Central Hospital and 8 more.
Type: | Journal: Hepatology research : the official journal of the Japan Society of Hepatology | Year: 2016

The aim of this study was to evaluate the efficacy and safety of 24-week daclatasvir (NS5A inhibitor) plus asunaprevir (NS3/4A protease inhibitor) treatment for elderly patients with HCV genotype 1b infection.This prospective, multicenter study consisted of 321 Japanese HCV genotype 1b patients who were interferon-ineligible/intolerant or non-responders to interferon-based regimens, including 103 (32.1%) aged75 and 127 (39.6%) with cirrhosis. Sustained virological response (SVR) at 24weeks after the end of treatment and adverse effects were analyzed according to age.The overall SVR rate was 90.3%. 94.5% (69/73), 88.3% (128/145), and 90.3% (93/103) of the patients aged<65, 65-74, and75, respectively, achieved SVR. For the entire cohort, pre-existent NS5A resistance-associated variants (RAVs) and prior simeprevir failure were independently associated with treatment failure. According to the analysis of the patients without these unfavorable pretreatment factors, 90.8% (89/98) aged75 achieved SVR, although this was significantly lower than for those aged<65 (98.5%, 66/67) (P<0.05). The frequency of adverse effects was comparable for the<75 and75 age groups, the most common being an elevated alanine aminotransferase level (>150 U/L, 8.7%), however, no decompensating events were seen.Daclatasvir plus asunaprevir for HCV genotype 1b was well tolerated and effective for patients without pre-existent NS5A RAVs or simeprevir failure, irrespective of fibrosis status. However, it was less effective for very old patients aged75 than for those aged<65. This article is protected by copyright. All rights reserved.


Miyasaka Y.,Chihaya Hospital | Mochidome N.,Chihaya Hospital | Kobayashi K.,Chihaya Hospital | Ryu S.,Chihaya Hospital | And 2 more authors.
Surgery Today | Year: 2013

Purpose: The perioperative outcomes of laparoscopic colorectal surgery in elderly patients were compared with those of open surgery in elderly patients and those of laparoscopic surgery in nonelderly patients to evaluate the feasibility and efficacy of laparoscopic surgery in elderly patients with colorectal cancer.Methods: The data of the patients who underwent surgical resection for colorectal cancer between January 2007 and September 2012 were retrospectively collected. The clinical backgrounds and outcomes of elderly patients (≥70 years of age) who underwent laparoscopic surgery (EL group) were compared with those of elderly patients who underwent open surgery (EO group) and those of nonelderly patients (<70 years of age) who underwent laparoscopic surgery (NL group).Results: Compared with the EO group, the EL group showed significantly less blood loss (15 versus 100 ml), fewer postoperative complications (10.7 versus 36.7 %), earlier resumption of an oral diet (4 versus 5 days) and shorter postoperative hospital stays (16 versus 28 days). A case-matched analysis showed similar results. All perioperative outcomes were equivalent between the EL and NL groups.Conclusions: Laparoscopic colorectal surgery in elderly patients with cancer was not only superior to open surgery in elderly patients, but also equivalent to laparoscopic surgery in nonelderly patients in terms of the postoperative outcomes. © 2013, Springer Japan.


Furusyo N.,Kyushu University | Ogawa E.,Kyushu University | Nakamuta M.,National Hospital Organization | Kajiwara E.,Steel Memorial Yawata Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims This study was performed to evaluate the efficacy of a triple therapy in older Japanese patients; telaprevir (TVR) was added to pegylated interferon α2b and ribavirin. Methods This prospective study enrolled 120 genotype 1b patients with chronic hepatitis C who received 12 weeks of triple therapy followed by a 12-week dual therapy that included pegylated interferon α2b and ribavirin. Patients were categorized according to age: group A, 64 patients aged >60 and group B, 56 patients aged ≤60. Serum HCV RNA levels were monitored by COBAS TaqMan HCV test. Results The rates of undetectable HCV RNA at week 4 (rapid virological response, RVR) were 73.4% in group A and 73.2% in group B. No significant difference in sustained virological response (SVR) was found between groups A (76.6%) and B (83.9%) (p = 0.314). The SVR rates for patients with interleukin 28B (IL28B) (rs8099917) TT allele (89.4% and 91.9% for groups A and B) were significantly higher than for those with the IL28B TG/GG allele (41.2% and 68.4%, respectively) (both p <0.05). Multivariate analysis extracted IL28B TT and RVR as independent factors associated with SVR. Adverse effects resulted in treatment discontinuation by 12.5% in each group. Hemoglobin decrease significantly differed between groups A and B: the decrease to ≥100 g/L, to 85 - <100 g/L, and to <85 g/L, was 9.4%, 40.6%, and 50% in group A patients, respectively, and 41.1%, 25%, and 33.9% in group B patients, respectively (p = 0.0006). Conclusions TVR-based triple therapy can be successfully used to treat older patients with genotype 1b chronic hepatitis C. © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Ogawa E.,Kyushu University | Furusyo N.,Kyushu University | Nakamuta M.,National Hospital Organization | Kajiwara E.,Steel Memorial Yawata Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims Anemia is a common adverse effect of telaprevir (TVR) in combination with pegylated interferon (PegIFN)α and ribavirin (RBV) therapy. It occurs at a higher incidence with the TVR relative to PegIFNα and RBV alone. We herein evaluate the baseline and on-treatment predictors of the development of severe anemia by chronic hepatitis C virus (HCV) patients receiving TVR-based triple therapy. Methods This prospective, multicenter study consisted of 292 patients (median age: 62 years) infected with HCV genotype 1. All received 12 weeks of TVR in combination with 24 weeks of PegIFNα2b and RBV. The definition of severe anemia during antiviral treatment is hemoglobin (Hb) <85 g/L. Results 101 (34.6%) patients developed severe anemia during the treatment period. Multivariable logistic regression analysis of possible pretreatment predictors of the development of severe anemia extracted baseline Hb <135 g/L (Hazard ratio [HR], 2.53; p = 0.0013), estimated glomerular filtration rate <80 ml/min/1.73 m2 (HR, 1.83; p = 0.0265), and inosine triphosphatase (ITPA) CC genotype (rs1127354) (HR, 2.91; p = 0.0024). For patients with ITPA CC (n = 227), multivariable logistic regression analysis of possible pretreatment and on-treatment predictors of the development of severe anemia extracted Hb level at week 2 (HR, 0.96; p = 0.0085) and the initial four weeks of weight-adjusted TVR (HR, 1.05; p = 0.0281). Conclusions Anemia remains a risk for all patients treated with TVR-based triple therapy. However, ITPA polymorphism (rs1127354) is useful for predicting the development of severe anemia and will be helpful in the management of treatment. © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Ogawa E.,Kyushu University | Furusyo N.,Kyushu University | Kajiwara E.,Steel Memorial Yawata Hospital | Takahashi K.,Hamanomachi Hospital | And 10 more authors.
Journal of Hepatology | Year: 2013

Background & Aims: The effects of pegylated interferon (PegIFN) α and ribavirin (RBV) treatment of chronic hepatitis C on the incidence of hepatocellular carcinoma (HCC) have not been well established. This study investigated the impact of treatment outcome on the development of HCC by chronic hepatitis C patients treated with PegIFNα2b and RBV. Methods: This large-scale, prospective, multicenter study consisted of 1013 Japanese chronic hepatitis C patients with no history of HCC (non-cirrhosis, n = 863 and cirrhosis, n = 150). All patients were treated with PegIFNα2b and RBV and the follow-up period started at the end of the antiviral treatment (median observation period of 3.6 years). The cumulative incidence rate of HCC was estimated using the Kaplan-Meier method, according to treatment outcome. Results: Forty-seven patients (4.6%) developed HCC during the observation period. In the non-cirrhosis group, the 5-year cumulative incidence rates of HCC for the sustained virological response (SVR) (1.7%) and transient virological response (3.2%) (TVR: defined as relapse or breakthrough) groups were significantly lower than those of the non-virological response (NVR) group (7.6%) (p = 0.003 and p = 0.03, respectively). A significantly low rate of incidence of HCC by TVR patients in comparison with NVR patients was found for patients aged 60 years and over, but not for those under 60 years of age. In the cirrhosis group, the 5-year cumulative incidence rates of HCC for the SVR (18.9%) and TVR groups (20.8%) were also significantly lower than those of the NVR group (39.4%) (p = 0.03 and p = 0.04, respectively). Conclusions: SVR and complete viral suppression during treatment with relapse (TVR) were associated with a lower risk of HCC development when compared with NVR.


Dohmen K.,Chihaya Hospital | Tanaka H.,Chihaya Hospital | Haruno M.,Chihaya Hospital
Fukuoka igaku zasshi = Hukuoka acta medica | Year: 2013

Ursodeoxycholic acid (UDCA) is currently the only available pharmacological treatment for asymptomatic primary biliary cirrhosis (aPBC). Fibrates may be useful for treating aPBC patients who exhibit incomplete responses to UDCA. The mechanism of action of such fibrates involves the regulation of the expression of various kinds of lipids and proteins through the activation of peroxisome proliferator-activated receptor-alpha (PPAR-alpha ), which increases the phospholipid output into the bile and reduces the cytotoxicity of hydrophobic bile acids. Among these fibrates, the binding activity of fenofibrate to PPAR-alpha is stronger than that of bezafibrate. Because the majority of PBC patients exhibit a slow progression of their disease, and since the administration of UDCA plus fibrate may further delay the liver deterioration, cardiovascular risk factors, such as dyslipidemia may thus have a bigger impact on the long-term survival of PBC patients. The aim of this study was to evaluate the effects of fenofibrate in patients with aPBC who are refractory to UDCA and to simultaneously compare the effectiveness of fenofibrate with that of bezafibrate. This study included 14 patients with aPBC treated with fenofibrate (80 mg/day) plus UDCA (fenofibrate group) for 48 weeks and seven patients with aPBC treated with bezafibrate (400 mg/day) plus UDCA (bezafibrate group) for 48 weeks. The data for the aPBC patients in both groups were analyzed to compare the effects of fenofibrate and bezafibrate. In the patients in the fenofibrate group, the serum alkaline phosphatase (ALP), gamma-glutamyl transpeptitase (gamma GTP) and serum IgM levels decreased from 522.5 +/- 181.4 to 236.8 +/- 47.8 IU/l, 197.1 +/- 98.4 to 47.2 +/- 37.5 IU/l and 337.6 +/- 160.6 to 174.5 +/- 101.1 mg/dl (p < 0.0001), respectively. In the patients in the bezafibrate group, the serum levels of ALP, gamma GTP and IgM decreased from 595.9 +/- 247.8 to 238.0 +/- 80.4 IU/l, 188.3 +/- 85.6 to 46.3 +/- 31.9 IU/l and 304.7 +/- 165.2 to 155.1 +/- 45.4 mg/dl (p < 0.0001), respectively. The serum levels of triglycerides (TG) and low-density lipoprotein cholesterol (LDL) significantly decreased in both groups and the LDL levels significantly decreased in the patients in the fenofibrate group compared to those in the bezafibrate group (p = 0.0357). In addition, the serum uric acid levels of the patients in the fenofibrate group decreased significantly (from 4.7 +/- 1.4 to 3.6 +/- 0.9 mg/dl, p < 0.0001), while those in the patients in the bezafibrate group did not change from 4.1 +/- 0.6 to 4.1 +/- 0.4 mg/dl. Combination therapies with fenofibrate plus UDCA and bezafibrate plus UDCA induce significant biochemical improvements in patients with aPBC. However, the ability of fenofibrate to reduce the LDL and uric acid levels in aPBC patients is superior to that of bezafibrate. As a result, the use of fenofibrate might translate into a decreased risk of developing cardiovascular events and renal failure in patients with aPBC.


Ogawa E.,Kyushu University | Furusyo N.,Kyushu University | Nakamuta M.,National Hospital Organization | Kajiwara E.,Steel Memorial Yawata Hospital | And 10 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2013

Background Antiviral treatment is recommended for chronic hepatitis C patients with advanced fibrosis to reduce and prevent cirrhosis-related complications. Aim To evaluate the efficacy and safety of telaprevir (TVR)-based triple therapy for patients with advanced fibrosis in a clinical practice setting. Methods This prospective, multicentre study consisted of 102 patients with advanced fibrosis (METAVIR score F3-4) who were infected with HCV genotype 1b. All received 12 weeks of TVR in combination with 24 weeks of pegylated interferon (PEG-IFN) α2b and ribavirin (RBV). Results The sustained virological response (SVR) rate was 69.6% (71 of 102). Notably, for treatment-naïve and prior relapse patients the SVR rate was over 80%. Previous treatment response, interleukin 28B polymorphism (rs8099917) and rapid virological response (undetectable HCV RNA at week 4) were independently associated with SVR. To achieve SVR, an adequate dosage of PEG-IFNα2b (≥1.2 μg/kg/week) and RBV (≥7.5 mg/kg/day) is preferable; however, the mean weight-adjusted TVR dosage had little impact on treatment outcome. Although severe blood cytopaenia and a dermatological disorder were frequently found, the rate of discontinuation due to adverse effects was 12.7%. The inosine triphosphatase CC allele (rs1127354) was independently associated with the development of severe anaemia, and lower serum albumin level (<35 g/L) was associated with the occurrence of infection. Conclusions The great gain in the SVR rate by telaprevir-based triple therapy offsets the problems with adverse effects; thus, it should be considered as a potent treatment protocol for patients with advanced fibrosis, especially for those with treatment-naïve and prior relapse. © 2013 John Wiley & Sons Ltd.


PubMed | Hamanomachi Hospital, Chihaya Hospital and Kyushu University
Type: Journal Article | Journal: Foot & ankle international | Year: 2016

Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not been assessed in comparison to resection arthroplasty.We retrospectively evaluated 23 feet in 17 patients with rheumatoid forefoot deformities who underwent surgery between January 2010 and December 2013. The patients included 1 male (1 foot) and 16 females (22 feet), with a mean age of 62 years. The mean length of follow-up was 28 months. The patients were treated by 3 surgeons. One surgeon performed joint-preserving procedures (JP group) to the feet in which (1) no pain with motion existed, and (2) the range of motion in the first metatarsophalangeal (MTP) joint was greater than 30 degrees (n = 10); otherwise, resection arthroplasty with arthrodesis of the first MTP joint was performed (n = 3). The other surgeons performed resection arthroplasty in all cases (n = 10) (RA group, n = 13 in total). The clinical outcomes of the patients were evaluated using the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toe scales.There were no significant differences in the preoperative total JSSF scores for either the hallux (54.5 and 61.4 points) or the lesser toe (45.2 and 57.4 points) between the RA and JP groups, respectively. Postoperatively, the total JSSF scores for both the hallux (79.4 and 88.2 points) and lesser toes (73.6 and 87.7 points) showed significant improvement in both the RA and JP groups, respectively; however, the JP group showed a greater postoperative improvement. The scores relating to the function category on the hallux scale and the alignment category on the lesser toe scale were significantly higher in the JP group.With regard to the function of the hallux and the alignment of the lesser toes, the joint-preserving procedures for rheumatoid forefoot deformities resulted in better clinical outcomes than resection arthroplasty.Level III, comparative case series.


PubMed | Shin Kokura Hospital, National Hospital Organization, Chihaya Hospital, Kyushu Central Hospital and 7 more.
Type: Comparative Study | Journal: Journal of gastroenterology and hepatology | Year: 2016

The addition of hepatitis C virus (HCV) NS3/4A protease inhibitors to pegylated-interferon alpha (PEG-IFN) and ribavirin (triple therapy) has greatly improved treatment outcome. The aim of this study was to compare the effectiveness and safety of simeprevir-based or telaprevir-based triple therapy for non-cirrhotic patients in real-world clinical practice.This multicenter study consisted of 835 consecutive Japanese HCV genotype 1b patients treated in a clinical setting, 716 of whom were enrolled (simeprevir=256 and telaprevir=460). Logistic regression was carried out after propensity score matching to assess the sustained virological response at week 12 after the end of treatment (SVR12).In the propensity-matched cohort (253 matched pairs), the SVR12 rates of the patients who underwent simeprevir-based or telaprevir-based triple therapy were 85.0% and 84.2%, respectively, by intention-to-treat analysis. Prior treatment response to PEG-IFN/ribavirin and IL28B genotype was independently associated with SVR12 in both groups. No significant differences in the SVR12 rates stratified by prior treatment response to PEG-IFN/ribavirin were found between the simeprevir (treatment-nave 89.1%, prior relapse 94.3%, prior partial response 65.0%, and prior null response 33.3%) and telaprevir (treatment-nave 87.8%, prior relapse 90.1%, prior partial response 68.4%, and prior null response 50.0%) groups. The incidence of adverse effects, such as anemia, severe rash, and the elevation of serum creatinine, was markedly higher in the telaprevir group.Considering the effectiveness and safety, simeprevir-based triple therapy will continue to be a useful treatment option in Japan for treatment-nave or prior relapse patients with a favorable IL28B genotype.

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