Two cases of secondary hyperparathyroidism in which parathyroid hormone was maintained with long-term administration of maxacalcitol

マキサカルシトール (22-oxacalcitriol, OCT) の長期投与により副甲状腺ホルモン (PTH) を管理し得た二次性副甲状腺機能亢進症の2症例を経験したので報告する. 症例1. M. H. 62歳, 男性. 透析歴30年. 原疾患は慢性腎炎. 症例2. H. K. 51歳, 男性. 透析歴26年. 原疾患は慢性腎炎. 症例1へはOCT投与前に経口ビタミンDパルス療法を実施したが十分な効果が得られなかった. 1994年12月後期第II相臨床試験よりOCT投与を開始した. 投与前値はHS-PTH 71900pg/mL, intact-PTH 898pg/mL, ALP 310IU/Lであった. 症例2へは96年3月第III相一般臨床試験より投与開始した. 投与前値はHS-PTH 56000pg/mL, intact-PTH 851pg/mL, ALP 160IU/Lであった. 開始時の投与量は治験に従い, 両症例ともにOCT 1回10μgを毎透析後に静注した. その後は補正カルシウム, リン, PTHをみながら投与量を調節した. 治験終了後, 両症例ともに患者, 治験審査委員会, 厚生省 (当時) の許可を得て2000年9月まで長期継続を行った. 症例1は97年8月頃より, また症例2は97年11月頃よりそれぞれHS-PTHが20000pg/mL以下となり, 以後安定して推移した. OCT投与量は最終的には1回5μgが両症例ともにふさわしかった. またOCT投与中, 過度のPTH抑制と高カルシウム血症の発現に注意を払う必要があった.

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