{"id":210,"date":"2019-06-15T12:42:25","date_gmt":"2019-06-15T03:42:25","guid":{"rendered":"http:\/\/spell.umin.jp\/thespellblog\/?p=210"},"modified":"2019-06-19T10:52:29","modified_gmt":"2019-06-19T01:52:29","slug":"sglt-2%e9%98%bb%e5%ae%b3%e8%96%ac%e3%81%aecredence-trial%e6%96%9c%e3%82%81%e8%aa%ad%e3%81%bf","status":"publish","type":"post","link":"https:\/\/spell.umin.jp\/thespellblog\/?p=210","title":{"rendered":"SGLT-2\u963b\u5bb3\u85ac\u306eCREDENCE Trial\u659c\u3081\u8aad\u307f"},"content":{"rendered":"
\"\"<\/div>\n

\u4e00\u6628\u65e5\u306eNEJM\u306bSGLT-2\u963b\u5bb3\u85ac\u3067\u3042\u308b\u30ab\u30ca\u30b0\u30ea\u30d5\u30ed\u30b8\u30f3\u306e\u814e\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u52b9\u679c\u3092\u691c\u8a3c\u3057\u305fRCT\u3067\u3042\u308bCREDENCE Trial\u306e\u7d50\u679c\u304cNEJM\u306b\u767a\u8868\u3055\u308c\u305f\uff0e
\nhttps:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1811744<\/a>
\nSGLT-2\u963b\u5bb3\u85ac\u306e\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13\u3067\u306f\uff0cEMPA-REG OUTCOME\uff0cCANVAS program\uff0cDECLARE-TIMI 58\u306b\u7d9a\u3044\u30664\u672c\u76ee\u3067\u3042\u308b\uff0e<\/p>\n

\u307e\u3060\u659c\u3081\u8aad\u307f\u3057\u304b\u3057\u3066\u3044\u306a\u3044\u304c\uff0ceGFR 30\uff5e90\u304b\u3064\u5c3f\u4e2d\u30a2\u30eb\u30d6\u30df\u30f3300\uff5e5000mg\/gCr\uff08\u3064\u307e\u308a\u7cd6\u5c3f\u75c5\u6027\u814e\u75be\u60a33\u671f\uff09\u306eRAS\u963b\u5bb3\u85ac\u4f7f\u7528\u4e2d\u306e30\u6b73\u4ee5\u4e0a\u306e2\u578b\u7cd6\u5c3f\u75c5\u60a3\u8005\u3092\u5bfe\u8c61\u306b\u3057\u3066\uff0c\u30ab\u30ca\u30b0\u30ea\u30d5\u30ed\u30b8\u30f3100mg\u3068\u30d7\u30e9\u30bb\u30dc\u3092\u6bd4\u8f03\u3057\u3066\uff0c2.6\u5e74\u9593\u3067\u814e\u30a2\u30a6\u30c8\u30ab\u30e0\u30923\u5272\u6e1b\u3089\u3057\u305f\u3068\u3044\u3046\u7d50\u679c\u3067\u3042\u308b\uff0e\u76ee\u6a19\u30a4\u30d9\u30f3\u30c8\u767a\u75c7\u6570\u306b\u9054\u3057\u305f\u3053\u3068\u3067\u8a66\u9a13\u306f\u65e9\u671f\u4e2d\u6b62\u3055\u308c\u305f\uff0e<\/p>\n

\u305f\u3060\uff0c\u4f8b\u306b\u3088\u3063\u3066\u7d20\u76f4\u306b\u53d7\u3051\u5165\u308c\u308b\u306b\u306f\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3042\u308b\uff0e
\n\u814e\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\uff0c\u30af\u30ec\u30a2\u30c1\u30cb\u30f3\u500d\u52a0\uff0c\u672b\u671f\u814e\u75be\u60a3\uff08eGFR<15\uff0c\u900f\u6790\u5c0e\u5165\uff09\uff0c\u814e\u6b7b\u4ea1\uff0c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u306e\u8907\u5408\u30a2\u30a6\u30c8\u30ab\u30e0\u3067\u3042\u308a\uff0c\u6709\u610f\u306b\u6e1b\u3063\u305f\u306e\u306f\uff0c\u30af\u30ec\u30a2\u30c1\u30cb\u30f3\u500d\u52a0\u3068\u672b\u671f\u814e\u75be\u60a3\uff0c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u3067\u3042\u308a\uff0ceGFR<15\u3068\u900f\u6790\u5c0e\u5165\u3068\u814e\u6b7b\u4ea1\u306b\u306f\u6709\u610f\u5dee\u306f\u3064\u3044\u3066\u3044\u306a\u3044\uff0e\u305f\u3060\uff0c\u52b9\u679c\u63a8\u5b9a\u5024\u304c25\uff5e40%\u6e1b\u5c11\u3068\u6bd4\u8f03\u7684\u63c3\u3063\u3066\u3044\u308b\u306e\u3067\uff0c\u30a4\u30d9\u30f3\u30c8\u6570\u306e\u4e00\u756a\u591a\u3044\u30af\u30ec\u30a2\u30c1\u30cb\u30f3\u500d\u52a0\u304c\u5f15\u3063\u5f35\u3063\u3066\u3044\u308b\u3068\u3044\u3046\u308f\u3051\u3067\u3082\u306a\u3055\u305d\u3046\u3067\u3042\u308b\uff0e<\/p>\n

Primary outcome HR 0.70(0.59-0.82) p=0.00001
\nsCr\u500d\u52a0 HR 0.60(0.48-0.76) p<0.001
\n\u672b\u671f\u814e\u75be\u60a3 HR 0.68(0.54-0.86) p=0.002
\neGFR<15 HR 0.60(0.45-0.80) NA
\n\u900f\u6790\u5c0e\u5165 HR 0.74(0.55-1.00) NA
\n\u814e\u6b7b\u4ea1 NA NA
\n\u5fc3\u8840\u7ba1\u6b7b\u4ea1 HR 0.78(0.63-1.00) 0.05<\/p><\/blockquote>\n

\u6ce8\u76ee\u3059\u308b\u3079\u304d\u306f\u30b5\u30d6\u89e3\u6790\u3060\uff0e
\n\u4ea4\u4e92\u4f5c\u7528\u306e\u691c\u5b9a\u3067\u306f\u6709\u610f\u5dee\u306f\u306a\u3044\u3082\u306e\u306e\uff0c\u6709\u610f\u5dee\u304c\u3064\u3044\u3066\u3044\u308b\u306e\u306feGFR 45\uff5e60\u672a\u6e80\u306830\uff5e45\u672a\u6e80\uff0c\u5c3f\u4e2d\u30a2\u30eb\u30d6\u30df\u30f3\u304c1000mg\/gCr\u4ee5\u4e0a\u306e\u5c64\u3060\u3051\u3067\u3042\u308b\uff0eeGFR\u306b\u3064\u3044\u3066\u306f60\uff5e90\u672a\u6e80\u3067\u306f\u6709\u610f\u5dee\u304c\u898b\u3089\u308c\u3066\u3044\u306a\u3044\uff0e\u3057\u304b\u3057\uff0ceGFR\u5024\u306b\u3088\u308b\u814e\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u5bfe\u3059\u308b\u30cf\u30b6\u30fc\u30c9\u6bd4\u306b\u7528\u91cf\u53cd\u5fdc\u95a2\u4fc2\u304c\u898b\u3089\u308c\u3066\u3044\u306a\u3044\uff0e40\uff5e60\u672a\u6e80\u306e\u5c64\u306b\u3060\u3051\u5927\u304d\u306a\u52b9\u679c\u304c\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u304c\u3042\u308b\u306e\u3060\u308d\u3046\u304b\uff0e<\/p>\n

eGFR\u306b\u3088\u308b\u30b5\u30d6\u89e3\u6790
\n30\uff5e45\u672a\u6e80\uff1aHR 0.75 (0.59\u20130.95)
\n45\uff5e60\u672a\u6e80\uff1aHR 0.52 (0.38\u20130.72)
\n60\uff5e90\u672a\u6e80\uff1aHR 0.82 (0.60\u20131.12)<\/p><\/blockquote>\n

\u9a5a\u304f\u3079\u304d\u3053\u3068\u306f\uff0c\u672c\u7814\u7a76\u306f\u7cd6\u5c3f\u75c5\u6b74\u304c\u5e73\u574715.8\u5e74\u3067\u5e73\u5747HbA1c 8.3%\u306e\u5e73\u5747\u5e74\u9f6263.0\u6b73\u306e2\u578b\u7cd6\u5c3f\u75c5\u60a3\u8005\u304c\u5bfe\u8c61\u3067\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u3092\u6301\u3064\u8005\u304c50.4%\u3044\u308b\uff0e
\n\u3053\u308c\u307e\u3067\uff0c\u7cd6\u5c3f\u75c5\u7f79\u60a3\u6b74\u304c\u9577\u3044\u60a3\u8005\u306b\u306f\u6297\u7cd6\u5c3f\u75c5\u85ac\u306e\u5408\u4f75\u75c7\u4e88\u9632\u52b9\u679c\u306f\uff08\u8a66\u9a13\u958b\u59cb\u524d\u306b\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u826f\u597d\u3060\u3063\u305f\u60a3\u8005\u3092\u9664\u304d\uff09\u8a3c\u660e\u3055\u308c\u3066\u3044\u306a\u3044\uff08ACCORD\uff0cADVANCE\uff0cVERT\u306a\u3069\uff09\u306e\u3067\uff0c\u3053\u306e\u7d50\u679c\u306f\u610f\u5916\u3067\u3042\u308b\uff0e<\/p>\n

Supplementary appendix\u306b\u8a73\u3057\u3044\u60a3\u8005\u80cc\u666f\u304c\u51fa\u3066\u3044\u308b\u306e\u3067\u898b\u3066\u307f\u308b\u3068\uff0c\u4ed6\u306e\u6297\u7cd6\u5c3f\u75c5\u85ac\u4f7f\u7528\u6b74\u306f\uff0c\u30a4\u30f3\u30b9\u30ea\u30f3\u304c65.5%\uff0cSU\u85ac\u304c28.8%\uff0c\u30d3\u30b0\u30a2\u30ca\u30a4\u30c9\u304c57.8%\uff0cGLP-1\u53d7\u52d5\u614b\u4f5c\u52d5\u85ac\u304c4.2%\uff0cDPP-4\u963b\u5bb3\u85ac\u304c17.1%\u3067\u3042\u308b\uff0e\u307e\u305f\u4ed6\u306e\u85ac\u5264\u306e\u4f7f\u7528\u6b74\u306f\uff0c\u30b9\u30bf\u30c1\u30f3\u304c69.0%\uff0c\u6297\u8840\u5c0f\u677f\u85ac\u307e\u305f\u306f\u6297\u51dd\u56fa\u85ac\u304c59.6%\uff0c\u03b2\u906e\u65ad\u85ac\u304c40.2%\uff0c\u5229\u5c3f\u85ac\u304c46.7%\u3060\u3063\u305f\uff0e\u304b\u306a\u308a\u85ac\u7269\u6cbb\u7642\u304c\u5165\u3063\u3066\u3044\u308b\u60a3\u8005\u304c\u5bfe\u8c61\u3068\u306a\u3063\u3066\u3044\u308b\uff0e
\n\u5408\u4f75\u75c7\u306f\uff0c\u7db2\u819c\u75c7\u304c42.8%\uff0c\u795e\u7d4c\u969c\u5bb3\u304c48.8%\u3068\uff0c\u3053\u308c\u307e\u305f\u591a\u3044\uff0e<\/p>\n

\u6628\u5e7411\u6708\u306b\u767a\u8868\u3055\u308c\u305fSGLT-2\u963b\u5bb3\u85ac\u306eSR\u3067\u306f\uff0cEMPA-REG OUTCOME\uff0cCANVAS program\uff0cDECLARE-TIMI 58\u306e\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3067\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306e\u3042\u308b\u60a3\u8005\u3067\u306f\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u6291\u5236\u52b9\u679c\u304c\u898b\u3089\u308c\u305f\u304c\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306e\u306a\u3044\u30cf\u30a4\u30ea\u30b9\u30af\u60a3\u8005\u3067\u306f\u898b\u3089\u308c\u306a\u304b\u3063\u305f\uff0e
\nhttps:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0140-6736(18)32590-X<\/a>
\n\u4eca\u56de\u306eCREDENCE Trial\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306b\u3088\u308b\u30b5\u30d6\u89e3\u6790\u3067\u306f\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306e\u3042\u308b\u60a3\u8005\u3067\u306fHR 0.70\uff080.56\uff5e0.88\uff09\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306e\u306a\u3044\u60a3\u8005\u3067\u306fHR 0.69\uff080.54\uff5e0.88\uff09\u3068\u5909\u308f\u3089\u306a\u3044\uff0e
\n\u3053\u308c\u307e\u3067\u306e\u77e5\u898b\u3068\u7570\u306a\u308b\u306e\u3067\uff0c\u9055\u548c\u611f\u306e\u3042\u308b\u7d50\u679c\u3067\u3042\u308b\uff0e
\n\u3072\u3087\u3063\u3068\u3057\u305f\u3089\uff0c\u4f75\u7528\u85ac\u306e\u5897\u6e1b\u306b\u3088\u308b\u5f71\u97ff\u304c\u4ea4\u7d61\u3057\u3066\u3044\u308b\u306e\u304b\u3082\u3057\u308c\u306a\u3044\uff0e<\/p>\n

\u306a\u304a\uff0c\u4e0b\u80a2\u5207\u65ad\u306a\u3069\u306e\u526f\u4f5c\u7528\u306f\u6709\u610f\u306b\u5897\u3048\u306a\u304b\u3063\u305f\u3068\u3042\u308b\u304c\uff0c\u305f\u304b\u3060\u304b4,000\u4f8b\u7a0b\u5ea6\u306e\u898f\u6a21\u306e\u7814\u7a76\u3067\u3042\u308b\u306e\u3067\uff0c\u526f\u4f5c\u7528\u306b\u3064\u3044\u3066\u306f\u7d50\u8ad6\u304c\u51fa\u3057\u306b\u304f\u3044\u3053\u3068\u306f\u4ed6\u306e\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13\u3068\u540c\u69d8\u3067\u3042\u308b\uff0e<\/p>\n

\u672c\u7814\u7a76\u306e\u7d50\u679c\u3092\u898b\u3066\u3082\uff0c\u7dcf\u5408\u8a3a\u7642\u533b\u3068\u3057\u3066\u306f\uff0c\u73fe\u6642\u70b9\u3067SGLT-2\u963b\u5bb3\u85ac\u306e\u51e6\u65b9\u306f\u63a7\u3048\u308b\u3068\u3044\u3046\u7acb\u5834\u306f\u5909\u308f\u3089\u306a\u3044\u304c\uff0c\u3082\u3057\u672c\u7814\u7a76\u7d50\u679c\u304b\u3089\u4f7f\u3046\u9069\u5fdc\u3092\u8003\u3048\u308b\u3068\u3057\u305f\u3089\uff0ceGFR 45\uff5e60\u306e\uff0c\u5c3f\u4e2d\u30a2\u30eb\u30d6\u30df\u30f3\u304c1000mg\/gCr\u4ee5\u4e0a\u3042\u308b\uff0c\u7db2\u819c\u75c7\u3084\u795e\u7d4c\u969c\u5bb3\u3092\u6301\u30642\u578b\u7cd6\u5c3f\u75c5\u60a3\u8005\u3067\uff0c\u30d3\u30b0\u30a2\u30ca\u30a4\u30c9\uff0c\u30a4\u30f3\u30b9\u30ea\u30f3\uff0c\u30b9\u30bf\u30c1\u30f3\uff0c\u6297\u8840\u5c0f\u677f\u85ac\u307e\u305f\u306f\u6297\u51dd\u56fa\u85ac\uff0c\u03b2\u906e\u65ad\u85ac\uff0c\u5229\u5c3f\u85ac\u3092\u4f7f\u7528\u4e2d\u3067\u3082HbA1c 9.0%\u4ee5\u4e0a\u306e\u60a3\u8005\u306b\u306a\u308b\u3060\u308d\u3046\u304b\uff0e\u304b\u306a\u308a\u9069\u5fdc\u3067\u304d\u308b\u60a3\u8005\u306f\u5c11\u306a\u3044\u306f\u305a\u3060\uff0e
\n\u6a5f\u4f1a\u304c\u3042\u308c\u3070\uff0c\u3082\u3046\u5c11\u3057\u8a73\u3057\u304f\u8aad\u3093\u3067\u307f\u305f\u3044\uff0e<\/p>\n

\"P6041912.JPG\"
\n\uff08\u65e7\u5927\u793e\u99c5<\/a>\u306b\u3066\uff0c2017\/6\/4\u64ae\u5f71\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

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