MIYAZAKI Taiga

写真a

Affiliation

Faculty of Medicine School of Medicine Department of Internal Medicine, Hematology, Respirology, Rheumatology, Infectious Diseases, and Neurology

Title

Professor

External Link

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Papers 【 display / non-display

  • A Multicenter Randomized Controlled Trial To Evaluate the Efficacy and Safety of Nelfinavir in Patients with Mild COVID-19. Reviewed

    Miyazaki T, Hosogaya N, Fukushige Y, Takemori S, Morimoto S, Yamamoto H, Hori M, Ozawa Y, Shiko Y, Inaba Y, Kurokawa T, Hanaoka H, Iwanami S, Kim K, Iwami S, Watashi K, Miyazawa K, Umeyama T, Yamagoe S, Miyazaki Y, Wakita T, Sumiyoshi M, Hirayama T, Izumikawa K, Yanagihara K, Mukae H, Kawasuji H, Yamamoto Y, Tarumoto N, Ishii H, Ohno H, Yatera K, Kakeya H, Kichikawa Y, Kato Y, Matsumoto T, Saito M, Yotsuyanagi H, Kohno S

    Microbiology spectrum   11 ( 3 )   e0431122   2023.5

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    Authorship:Lead author, Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Microbiology Spectrum  

    Nelfinavir, an orally administered inhibitor of human immunodeficiency virus protease, inhibits the replication of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) in vitro. We conducted a randomized controlled trial to evaluate the clinical efficacy and safety of nelfinavir in patients with SARS-CoV-2 infection. We included unvaccinated asymptomatic or mildly symptomatic adult patients who tested positive for SARS-CoV-2 infection within 3 days before enrollment. The patients were randomly assigned (1:1) to receive oral nelfinavir (750 mg; thrice daily for 14 days) combined with standard-of-care or standard-of-care alone. The primary endpoint was the time to viral clearance, confirmed using quantitative reverse-transcription PCR by assessors blinded to the assigned treatment. A total of 123 patients (63 in the nelfinavir group and 60 in the control group) were included. The median time to viral clearance was 8.0 (95% confidence interval [CI], 7.0 to 12.0) days in the nelfinavir group and 8.0 (95% CI, 7.0 to 10.0) days in the control group, with no significant difference between the treatment groups (hazard ratio, 0.815; 95% CI, 0.563 to 1.182; P = 0.1870). Adverse events were reported in 47 (74.6%) and 20 (33.3%) patients in the nelfinavir and control groups, respectively. The most common adverse event in the nelfinavir group was diarrhea (49.2%). Nelfinavir did not reduce the time to viral clearance in this setting. Our findings indicate that nelfinavir should not be recommended in asymptomatic or mildly symptomatic patients infected with SARS-CoV-2. The study is registered with the Japan Registry of Clinical Trials (jRCT2071200023). IMPORTANCE The anti-HIV drug nelfinavir suppresses the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. However, its efficacy in patients with COVID-19 has not been studied. We conducted a multicenter, randomized controlled trial to evaluate the efficacy and safety of orally administered nelfinavir in patients with asymptomatic or mildly symptomatic COVID-19. Compared to standard-of-care alone, nelfinavir (750 mg, thrice daily) did not reduce the time to viral clearance, viral load, or the time to resolution of symptoms. More patients had adverse events in the nelfinavir group than in the control group (74.6% [47/63 patients] versus 33.3% [20/60 patients]). Our clinical study provides evidence that nelfinavir, despite its antiviral effects on SARSCoV-2 in vitro, should not be recommended for the treatment of patients with COVID-19 having no or mild symptoms.

    DOI: 10.1128/spectrum.04311-22

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    PubMed

  • Modified Pitt bacteremia score for predicting mortality in patients with candidaemia: A multicentre seven-year retrospective study conducted in Japan. Reviewed

    Nakada-Motokawa N, Miyazaki T, Ueda T, Yamagishi Y, Yamada K, Kawamura H, Kakeya H, Mukae H, Mikamo H, Takesue Y, Kohno S

    Mycoses   64 ( 12 )   1498 - 1507   2021.12

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    Authorship:Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Mycoses  

    Background: Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteraemia. Objectives: To develop a scoring system for predicting mortality in candidaemia patients. Methods: Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: In total, 422 candidaemia patients were included. Higher PBS, dialysis and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS were 0.74 (95% confidence interval [CI]: 0.68–0.80) and 0.76 (95% CI: 0.71–0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01–0.46, p =.04) and IRI (0.04, 95% CI: 0.02–0.06, p =.0008). When patients were stratified by mPBS into low (scores 0–3), moderate (4–7) and high risk (≥8), there were significant differences among the survival curves (p <.0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76) and 69.4% (34/49), respectively. Conclusions: mPBS can be a useful tool for predicting mortality in candidaemia patients.

    DOI: 10.1111/myc.13380

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    PubMed

  • Incomplete antiviral treatment may induce longer durations of viral shedding during SARS-CoV-2 infection Reviewed

    Kim K.S., Iwanami S., Oda T., Fujita Y., Kuba K., Miyazaki T., Ejima K., Iwami S.

    Life Science Alliance   4 ( 10 )   2021.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Life Science Alliance  

    The duration of viral shedding is determined by a balance between de novo infection and removal of infected cells. That is, if infection is completely blocked with antiviral drugs (100% inhibition), the duration of viral shedding is minimal and is determined by the length of virus production. However, some mathematical models predict that if infected individuals are treated with antiviral drugs with efficacy below 100%, viral shedding may last longer than without treatment because further de novo infections are driven by entry of the virus into partially protected, uninfected cells at a slower rate. Using a simple mathematical model, we quantified SARS-CoV-2 infection dynamics in non-human primates and characterized the kinetics of viral shedding. We counterintuitively found that treatments initiated early, such as 0.5 d after virus inoculation, with intermediate to relatively high efficacy (30-70% inhibition of virus replication) yield a prolonged duration of viral shedding (by about 6.0 d) compared with no treatment.

    DOI: 10.26508/LSA.202101049

    Scopus

  • Detection of significant antiviral drug effects on COVID-19 with reasonable sample sizes in randomized controlled trials: A modeling study Reviewed

    Iwanami S., Ejima K., Su Kim K., Noshita K., Fujita Y., Miyazaki T., Kohno S., Miyazaki Y., Morimoto S., Nakaoka S., Koizumi Y., Asai Y., Aihara K., Watashi K., Thompson R.N., Shibuya K., Fujiu K., Perelson A.S., Iwami S., Wakita T.

    PLoS Medicine   18 ( 7 )   2021.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:PLoS Medicine  

    Background Development of an effective antiviral drug for Coronavirus Disease 2019 (COVID-19) is a global health priority. Although several candidate drugs have been identified through in vitro and in vivo models, consistent and compelling evidence from clinical studies is limited. The lack of evidence from clinical trials may stem in part from the imperfect design of the trials. We investigated how clinical trials for antivirals need to be designed, especially focusing on the sample size in randomized controlled trials Methods and findings A modeling study was conducted to help understand the reasons behind inconsistent clinical trial findings and to design better clinical trials. We first analyzed longitudinal viral load data for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) without antiviral treatment by use of a within-host virus dynamics model. The fitted viral load was categorized into 3 different groups by a clustering approach. Comparison of the estimated parameters showed that the 3 distinct groups were characterized by different virus decay rates (p-value < 0.001). The mean decay rates were 1.17 d-1 (95% CI: 1.06 to 1.27 d-1), 0.777 d-1 (0.716 to 0.838 d-1), and 0.450 d-1 (0.378 to 0.522 d-1) for the 3 groups, respectively. Such heterogeneity in virus dynamics could be a confounding variable if it is associated with treatment allocation in compassionate use programs (i.e., observational studies). Subsequently, we mimicked randomized controlled trials of antivirals by simulation. An antiviral effect causing a 95% to 99% reduction in viral replication was added to the model. To be realistic, we assumed that randomization and treatment are initiated with some time lag after symptom onset. Using the duration of virus shedding as an outcome, the sample size to detect a statistically significant mean difference between the treatment and placebo groups (1:1 allocation) was 13,603 and 11,670 (when the antiviral effect was 95% and 99%, respectively) per group if all patients are enrolled regardless of timing of randomization. The sample size was reduced to 584 and 458 (when the antiviral effect was 95% and 99%, respectively) if only patients who are treated within 1 day of symptom onset are enrolled. We confirmed the sample size was similarly reduced when using cumulative viral load in log scale as an outcome. We used a conventional virus dynamics model, which may not fully reflect the detailed mechanisms of viral dynamics of SARS-CoV-2. The model needs to be calibrated in terms of both parameter settings and model structure, which would yield more reliable sample size calculation. Conclusions In this study, we found that estimated association in observational studies can be biased due to large heterogeneity in viral dynamics among infected individuals, and statistically significant effect in randomized controlled trials may be difficult to be detected due to small sample size. The sample size can be dramatically reduced by recruiting patients immediately after developing symptoms. We believe this is the first study investigated the study design of clinical trials for antiviral treatment using the viral dynamics model.

    DOI: 10.1371/journal.pmed.1003660

    Scopus

  • Revisiting the guidelines for ending isolation for covid-19 patients Reviewed

    Jeong Y.D., Ejima K., Kim K.S., Iwanami S., Bento A.I., Fujita Y., Jung I.H., Aihara K., Watashi K., Miyazaki T., Wakita T., Iwami S., Ajelli M.

    eLife   10   2021.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:eLife  

    Since the start of the COVID-19 pandemic, two mainstream guidelines for defining when to end the isolation of SARS-CoV-2-infected individuals have been in use: the one-size-fits-all approach (i.e. patients are isolated for a fixed number of days) and the personalized approach (i.e. based on repeated testing of isolated patients). We use a mathematical framework to model within-host viral dynamics and test different criteria for ending isolation. By considering a fixed time of 10 days since symptom onset as the criterion for ending isolation, we estimated that the risk of releasing an individual who is still infectious is low (0–6.6%). However, this policy entails lengthy unnecessary isolations (4.8–8.3 days). In contrast, by using a personalized strategy, similar low risks can be reached with shorter prolonged isolations. The obtained findings provide a scientific rationale for policies on ending the isolation of SARS-CoV-2-infected individuals.

    DOI: 10.7554/eLife.69340

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Books 【 display / non-display

  • 臨床と研究

    住吉 誠、宮崎泰可( Role: Contributor ,  【各種疾患における薬剤選択と使い方】肺炎・気管支炎)

    大道学館  2024.3 

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    Responsible for pages:101(3):279-285   Book type:Scholarly book

  • 最新の臨床WEB

    坪内拡伸( Role: Contributor ,  喘息発作)

    南江堂  2024.3 

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    Total pages:web   Responsible for pages:web   Book type:Scholarly book

  • 最新の臨床WEB

    坪内拡伸( Role: Contributor ,  アレルギー性気管支肺真菌症(ABPM))

    南江堂  2024.3 

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    Total pages:web   Responsible for pages:web   Book type:Scholarly book

  • ウイルス感染の数理モデルとシミュレーション―データを定量的に理解する―

    平山達朗、宮崎泰可( Role: Contributor ,  生物コラム10 新型コロナウイルスの臨床について)

    共立出版  2024.2 

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    Total pages:304   Book type:Scholarly book

  • 神経内科 

    塩見一剛( Role: Contributor ,  専門医試験問題 解答と解説 第2集)

    南江堂  2024.2 

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    Total pages:201   Book type:Textbook, survey, introduction

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MISC 【 display / non-display

  • 話題のくすり「イサブコナゾール」.

    髙城一郎, 宮崎泰可

    日本病院薬剤師会雑誌   60 ( 2 )   178 - 180   2024.2

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    Publishing type:Article, review, commentary, editorial, etc. (scientific journal)  

  • 市中肺炎 Reviewed

    住吉 誠、宮崎泰可

    日本内科学会雑誌   112 ( 11 )   2053 - 2058   2023.11

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  • 特集 呼吸器感染症のアンメットニーズを探る IV.COVID-19 コロナ禍での深在性真菌症の疫学と病態

    住吉 誠、宮崎泰可

    呼吸器ジャーナル   71 ( 4 )   560 - 566   2023.11

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  • 肺炎球菌感染症に対する予防戦略 −宮崎県の現状と今後の展望を含めて−

    宮崎泰可

    宮崎県医師会医学会誌   47 ( 1 )   7 - 11   2023.3

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    Publishing type:Article, review, commentary, editorial, etc. (scientific journal)  

  • Candida auris

    平山達朗、宮崎泰可

    臨床と微生物 特集 Priority Pathogen List (PPL) に取り上げられる耐性菌   50 ( 1 )   74 - 79   2023.1

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    Publishing type:Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Presentations 【 display / non-display

  • 肺炎に類似する症状や胸部画像所見を呈した悪性リンパ腫の一例

    増田樹、山本哲平、小田康晴、唐澤賢祥、上運天綾子、北村彩、北村瑛子、住吉誠、坪内拡伸、柳重久、宮崎泰可

    第92回日本呼吸器学会・日本結核 非結核性抗酸菌症学会九州支部 春季学術講演会  2024.3.16 

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    Event date: 2024.3.16

    Presentation type:Oral presentation (general)  

  • 過敏性肺炎の合併が示唆され、進行性の肺線維化をきたした自己免疫性肺胞蛋白症の一例

    長濱薫、末原照大、横尾優希、山成康洋、北村瑛子、住吉誠、小田康晴、坪内拡伸、柳重久、宮崎泰可

    第92回日本呼吸器学会・日本結核 非結核性抗酸菌症学会九州支部 春季学術講演会  2024.3.16 

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    Event date: 2024.3.16

    Presentation type:Oral presentation (general)  

  • 医原性免疫不全関連リンパ増殖性疾患が再燃し、びまん性大細胞型B 細胞リンパ腫を発症した関節リウマチ

    佐々木悠、岩尾浩昭、工藤理紗、木村賢俊、力武雄幹、相澤彩子、仮屋裕美、 川口 剛、松田基弘、宮内俊一、髙城一郎、梅北邦彦、宮崎泰可、大栗伸行、 盛口淸香

    第67回九州リウマチ学会  2024.3.2 

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    Event date: 2024.3.2 - 2024.3.3

    Presentation type:Oral presentation (general)  

  • 肺門部リンパ節のEBUS―TBNA で診断が得られた播種性MAC 症の一例

    釘宮啓一、小田康晴、松本健吾、幣光太郎、宮崎泰可

    第64回日本肺癌学会九州支部学術集会・第47回日本呼吸器内視鏡学会九州支部総会  2024.3.1 

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    Event date: 2024.3.1 - 2024.3.2

    Presentation type:Oral presentation (general)  

  • 心臓転移をきたした肺癌の1例

    栗原淳、北村彩、小田康晴、黒木麻由、佐藤勇一郎、永井琢哉、住吉誠、坪内拡伸、柳重久、宮崎泰可

    第64回日本肺癌学会九州支部学術集会・第47回日本呼吸器内視鏡学会九州支部総会  2024.3.2 

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    Event date: 2024.3.1 - 2024.3.2

    Presentation type:Oral presentation (general)  

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Grant-in-Aid for Scientific Research 【 display / non-display

  • 尿中蛋白質断片の網羅的解析による日和見感染症の新規診断法の開発

    Grant number:22K08583  2022.04 - 2025.03

    独立行政法人日本学術振興会  科学研究費基金  基盤研究(C)

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    Authorship:Principal investigator 

  • 病原真菌カンジダにおける多剤耐性機序の解明とその克服

    Grant number:19K07540  2019.04 - 2022.03

    科学研究費補助金  基盤研究(C)

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    Authorship:Principal investigator 

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