Ѿ ٳؽ м
ۼϸ
ٳؽ Ѿ ù ž , , , ˾, GERD( ĵ)̴. Ѿ ü Ͽ Ѿ ַμ м ؾ Ѵٴ , ǻ 鼭 ü м ſ ̺ϰ, ٶ ü ڵ ظ ణ̳ ۼߴ. κ ž , ü ̸, ǥ ִ 200 ΰ? Ѱ ˾ƺ ۼϿ.
ۼϴµ ģ ģ Mento̸ ܼҸ Mr.Kachil ڸ ˰Եǰ ɿ Ѿ ǿ ̿ Ĵ κп մϴ.
ϰ ֽñ ٶϴ.
2007 4 . ݵ
ฮ
PPIs 꿡 ȭչ thiol-reactive sulphenamide ȯǾ ȿ Ÿ Ͱ ٸ ȭչ acid activation к մϴ.
뼺̸ ȭչ(pKa=6.86) к ַ ̷ ַ , 翡 Ͽ ȿ Ÿϴ.
Na+/K+-ATPase 鼭 H+/K+-ATPase ϰ մϴ.
K+ պ Ͽ proton(H+) ȯ ν к մϴ.
ȿȿ
•˾ ܱġ,
•
•˾ ܱġ
(Ư)
Circadian rhythm к
ٳؽ(revaprazan) Ͽ к ϹǷ ۿ PPI(Proton Pump Inhibitors, PPIs : , , , ) ʹ ٸ (proton pump antagonist)Դϴ.
, к ۿ ߴ к ۿ, ݵ Ȯ̳ϴ.
ż ۿ
ٳؽ(revaprazan) ȿð 30 ̳ żϿ on-demand therapy ϸ 1 1ȸ ġᰡ մϴ.
ȣۿ Dual action mechanism
ٳؽ(revaprazan) к ۿ ܿ νŸ۶ ϴ COX-2 mRNA ȣ ۿ뿡 ϴ νŸ۶ Ű ֽϴ.
ٳؽ
ٳؽ : PPIs Proton Pump Inhibitor Proton Pump( к ۿϴ ) ۿϿ к Ҿ ʰϴ ̱ ϸ COX2 ȣ ɱ Dual Action ۿ ϴ ο ž , ˾ ĵ ġῡ δ..
Generic Name levaprazan̶ ϸ, PPIs Omeprazole, Lansoprazole, Labeprazole, Pantoprazole, Esomeprazole –prazole(ܼ Protom Pump ۿ к )ʹ ٸ ž̴.
/ ˾, ĵ ϴ ġḦ ؾϴ Ͽ ˾ƺ.
˾ ˾
|
˾ |
˾ |
|
ڰ |
ڰ |
|
|
|
|
û Ǵ ߳ʱ |
ַ ߳ |
|
ַ |
ణ |
ȸ |
|
|
|
˾ | |
굵 |
|
|
Ļ |
Ļ ȭ |
Ļ |
ĵ
: ĵȯ(GERD) ĵ Ͽ ĵ ȭ ʷϴ 츦 Ѵ.(׳ ܼϰ Ͽ ĵ ٰ ϸ ȴ.)
: ĵ 4 ο 3 Ǿ ִ. 4 Ʒ ġ Ⱦ渷 δ ĵ Ǵ κ, Ϻνĵ ־ Ĺ ĵ Ųٷ Ѿ ʵ ϴ Ѵ. Ϻνĵ Ͽ ̳ (pepsin) ĵ Ųٷ Ѿ ĵ ڱϿ Ű, ϸ ĵ ˾ Ű Ѵ.(Ѹ Ǿ ִ ̻ ٴ¼Ҹ.)
[/˾ Ʋ ȭ˾(Peptic Ulcer Disease) .]
ȭ ˾ ġ
- ˾
: 굵 Ǵ к .
: 1 ġ = H2RAs + + Sucrafate.
(4,6,8 ġ =70,80.90%)
2 ġ = PPIs (2~4ַ ġȿ)
- ˾
: ȭ.
: .
Ư̻ : ˾纸 ġ ð .( ū ȯΰ )
- ĵ
: 굵 , Ǵ к .
: ġ = H2RAs + + Sucrafate + + PPIs
ȭ ˾ ĵ ġ Ư
- H2RAs
Generic Name : cimetidine, ranitidine, famotidine, nizatidine, roxatine.
ġⰣ : = 4~6
˾ = 8
(˾ ũⰡ 1cm ̻ 12)
ǥ ۿ : - ݵ(rebound hypersecretion)
[ݵ̶? : ü ü ۿ кϴ . к Ǵ° ƴ кϰ Ǵ°.]
- PPIs
Generic Name : Omeprazole, Lasoprazole
ġⰣ : ˾ ġ 2 H2RAs 4 .
ǥ ۿ : Ư ۿ .
( ߵɼ ƿ.)
[PPI = Proton pump inhibitor(к )]
-
Generic Name : (̹ Ȱϸ ݹ ˼ ^^)
ġⰣ : Ư Ⱓ . ȭŰ Ͽ H2RAs Ǵ PPIs .
ǥ ۿ : Ư ۿ .
[ : к ȭν 굵 ˾ ġϳ ū ȿ ܼ Ӿ ؼ , ٸ ױ˾(к ) Ͽ Ӿ ؼ.]
- ( Ƽ)
: Sucrafate, Misoprostol
Sucrafate : 꿡 , ˾ ȣ . ջ ģȭ ġⰣ 4~8. Misoprostol : к . (ڱ Ŵ ӻΰ ؼ ȵ.)
[ : ϰ ȭ ϸ . Ư ʱ ʹ , ٳؽ м .]
ȭ ˾ ĵ ġ Ư
ĵ, /忰 ġῡ ⺻ 2 Ģ ִ.
- ȭ : Ǵ ȭ.
- ȭ : ȣ
ΰ Ģ Ͽ Case ǻ ó ϸ, ó Ʋ.
Ϲ ȭ˾, ĵ ġ ȿ Ͽ ȭ 1 1 ȭ Ͽ ȣ ÿ .
H.Pylori ȯ Clarithromycin + Amoxicilin PPIs óϴ 3 H.Pylori ڸ ġ.
ٳؽ м
ٳؽ Target ΰ?
ٳؽ PPIs ۿ 켱 Target PPIs ̶ , PPIs 2ó 1 ó Ǿ, ٳؽ Ÿ PPIs+H2RAs ̶ , ȭ COX2 Ȱۿ뵵 PPIs + H2RAs + Ķ ִ.(, ̴ ٸ H2RAs, PPIs Ÿ ٸ , +ķ Ѵ.)
[COX2 : NSAIDs. (ҿ 迭 ϰ .) COX2 Ҹ ü Ͽ ҿ ȿ θ dz, ȭ ˾ Ű ۿ ִ. ɰ ۿ Ű ǴܵǾ ȭ ʹ ̱ ǰǾû Ͽ ̱ ǸŰ .]
ȭ ȯ
[ : ]
No |
з |
2006 |
2005 | ||||
|
|
|
|
|
| ||
1 |
|
|
4.8% |
11.5% |
652 |
4.1% |
12.7% |
2 |
H2-Antagonist |
924.8 |
7.2% |
15.6% |
862.3 |
11.9% |
16.8% |
3 |
PPI |
732.2 |
50.3% |
12.4% |
487.1 |
26.2% |
9.5% |
4 |
|
|
24.1% |
13.0% |
620.6 |
34.6% |
12.1% |
5 |
|
1457.9 |
30.2% |
24.6% |
1283 |
18.5% |
25.0% |
6 |
Other |
1358.4 |
11.1% |
22.9% |
1222.3 |
8.0% |
23.8% |
Total |
5926.2 |
15.6% |
100.0% |
5127.4 |
15.0% |
100.0% |
IMS data 2006
ٳؽ Ÿٽ = H2RAs + PPI 1650 + ( ȭ)
з |
и |
ǰ |
|
H2RAs |
Cimetidine |
ŸƮ , |
|
amotidine |
|
| |
niperotidine |
ƾ |
ȭ | |
ranitidine |
Ź , |
۶ | |
nizatidine |
õ İ |
| |
roxatidine |
ϻİ, |
ѵ | |
PPIs |
lansprazole |
İ |
|
omeprazole |
μİ, |
ƽƮ | |
pantoprazole |
|
|
H2RAs
[ : ]
ǰ |
и |
ȸ |
|
|
|
ť |
Ranitidine |
ϵ |
161.7 |
9.6% |
17.5% |
Ź |
Ranitidine |
GSK |
94.9 |
-7.8% |
10.3% |
|
Famotidine |
|
89.9 |
12.9% |
9.7% |
ŸƮ |
Cimetidine |
|
38.3 |
-4.8% |
4.1% |
õ |
Nizatidine |
|
28.5 |
10.2% |
3.1% |
ϻ |
Roxatidine |
ѵ |
24.5 |
-23.4% |
2.7% |
Others |
|
|
486.7 |
11.5% |
52.6% |
Total |
924.5 |
7.2% |
100.0% |
IMS data 2006
PPIs
[ : ]
ǰ |
и |
ȸ |
|
|
|
ĸƮ |
Rabeprazole |
Ἶ |
160.4 |
44.7% |
21.9% |
|
Pantoprazole |
|
120.9 |
16.7% |
16.5% |
|
Lansoprazole |
|
96.2 |
107.4% |
13.1% |
ؽÿ |
Esomeprazole |
AZN |
68.0 |
45.8% |
9.3% |
|
Lansoprazole |
ѹ |
62.0 |
132.3% |
8.5% |
Others |
|
|
224.7 |
77.8% |
30.7% |
Total |
732.2 |
50.3% |
100.0% |
IMS data 2006
ٳؽ ȭ ȭ ϴ ȭ ˾ ĵ ġ ʾҴ ž H2RA PPIs + Ÿ ϸ Ը 1650 + ̴. ִ.
1. PPIs : PPIs Ϻ ð ó , 2006 50.3% Ѵ(ٳؽ 1 ó) .
2. ϰ ġ ȿ : H2RAs ġȿ Ÿ ó ǻ ȯ ġ ڽ ɷ̸, ġ ȴ.
3. ٳؽ ٳؽ ó游 ھȭ ȭ ȯ ప δ .
4. COX2 NSAIDs 迭 ҿ Ͽ ˾ ġῡ Ź ȿ δ.
5. ó : 1 ó̶ ̴ H2RAs ħ ִ. PPIs 1 ó Ǹ鼭 2005 50%Ͽ, PPIs ˸ , Ǵܵ. ̷ PPIs 忡 ħ ̰ PPIs 强 Ѵٸ Ƶ ù 2007 100 ̰ Ѱ濵 ǥ 200뵵 ǥ Ȯ ִ. ö 2009 Ŀ 400 ̻ . ٸ ̷ ΰ?
Ƹ(ѹ) :
- 4 100 .
- Ⱓ 500
- Ը 8000 ̻.
- Ϸε ž( ο簡 Ʋ)
- ȭ ٽũ 20% Ѱ.
- Ư ü ӻ .(ž ȭڰ ̹ ǰ ȿ뼺 .)
Ƽ():
- õ ž ڸ ȭϴ ġ
- Ⱓ 400.
- Ը 800 + ķ ( ȭθ Ұ)
- Ź ž
- 500 ӻ(ӻ ȿ Ҽ ִ ̸, Ѿ˰ . Ư ӻڷῡ ٰϿ ֽ ǰ Ƿ .)
ٳؽ () :
- 2 °. ( )
- : ȹ .
- Ը 1650 +
- ̶ ż ߵ ο ˾ġ (PPIs+H2RAs + ȭθ )
- PPIs 1 ѱἾ ĸƮ 1562
- ٳؽ 1036 .
- 1019 ߸Ͱ ( Ͱ̶? ȯڿ ǻ簡 ӻ ְ Ǵ Ե ʰ ϴ ӻ)
ȸ翡 Ͽ ߵǾ 2 ǰ ʷ ٳؽ ڸ .
- ȿ Ȯ : ѹ Ƹ ̹ θ Ϸε̶ ž ȿ ̹ Ȼ· 忡 Ͽ. ٳؽ ο ž ȿ ߿ϴٴ ϰ, ȭ˾ ȭ Ƽ ȯڸ ӻ Ͽ(Ƽ 2 ȯڸ ӻ )
- ο ž : Ƽ õ ž, ȭ, ۿ, ջ ġ ̶ ȭ پ ȿ ο ôϿ. ٳؽ ϴ ǰ ȭŰ DUAL ACTION MECHANISM ο ô ִ.
̷ ٳؽ ִ.
ܼ ܿ ٸ ִµ
- ȭ ˾忡 Ƽ Ը ũ.(2 ̻)
- Ѿ ǰ ̹ ſ پ . ( Ư ž, ű ſ Ư ִ.)
̷ Ư ٳؽ ȿ( ) Ͽ, Ȯ Ұ ϸ 뷫 ȿ ڸ .
ƾǰ Ƽ
[ : ]
|
2007 |
2008 |
2009 |
(ֱ 3⼺) |
4528.75 |
4981.63 |
5479.79 |
ٳؽ () |
100.00 |
178.00 |
250.98 |
ٳؽ () |
200.00 |
356.00 |
501.96 |
ٳؽ Ѹ() |
4628.75 |
5159.63 |
5730.77 |
ٳؽ Ѹ() |
4728.75 |
5337.63 |
5981.75 |
(ٳؽ ) |
720.98 |
793.07 |
872.38 |
(ٳؽ ) |
736.90 |
821.41 |
912.34 |
(ٳؽ ) |
752.82 |
849.75 |
952.29 |
(ֱ 3 ) |
16% |
16% |
16% |
Ѹ / ٳؽ () |
2.16% |
3.45% |
4.38% |
Ѹ / ٳؽ () |
4.23% |
6.67% |
8.39% |
X ٳؽ () |
15.92 |
28.34 |
39.96 |
X ٳؽ () |
31.84 |
56.68 |
79.91 |
ְ |
155,000 |
ֽļ |
8,638,027 |
|
2007 |
2008 |
2009 |
EPS() |
8530.85 |
9509.26 |
10561.88 |
EPS() |
8715.15 |
9837.31 |
11024.44 |
PER() |
18.17 |
16.30 |
14.68 |
PER() |
17.79 |
15.76 |
14.06 |
- Ƽ ٳؽ ȿ .
- (Ѿ ֳε )
- (Ѿ ǥ)
- ٳؽ Ź ־ ܼ Ѿ ٳؽ Ѿ 3Ⱓ Ͽ ߿ ٳؽ Ͽ .
PPIs
[ : ]
|
2007 |
2008 |
2009 |
(ֱ 3⼺) |
4528.75 |
4981.63 |
5479.79 |
ٳؽ () |
200.00 |
356.00 |
501.96 |
ٳؽ () |
300.00 |
534.00 |
752.94 |
ٳؽ Ѹ() |
4728.75 |
5337.63 |
5981.75 |
ٳؽ Ѹ() |
4828.75 |
5515.63 |
6232.73 |
(ٳؽ ) |
720.98 |
793.07 |
872.38 |
(ٳؽ ) |
752.82 |
849.75 |
952.29 |
(ٳؽ ) |
768.74 |
878.09 |
992.25 |
(ֱ 3 ) |
16% |
16% |
16% |
Ѹ / ٳؽ () |
4.23% |
6.67% |
8.39% |
Ѹ / ٳؽ () |
6.21% |
9.68% |
12.08% |
X ٳؽ () |
31.84 |
56.68 |
79.91 |
X ٳؽ () |
47.76 |
85.01 |
119.87 |
ְ |
155,000 |
ֽļ |
8,638,027 |
|
2007 |
2008 |
2009 |
EPS() |
8715.15 |
9837.31 |
11024.44 |
EPS() |
8899.45 |
10165.37 |
11487.00 |
PER() |
17.79 |
15.76 |
14.06 |
PER() |
17.42 |
15.25 |
13.49 |
- Ƽ 2 ٳؽ ȿ .
- (Ѿ ǥ)
- (Ƹ ù Ǹ )
- ٳؽ Ź ־ ܼ Ѿ ٳؽ Ѿ 3Ⱓ Ͽ ߿ ٳؽ Ͽ .
ᱹ ܼ Ȯ ٳؽ ȿ ϱ , ڿ ۿ ִٰ ǴѴ. Ÿ ѹ̳ ž ߸ ž 濵ȿ , ̷ 濵 ȿ 밨 ְ ݿ ȴٶ ̴.
ѹ ְ
2004~2005 ̾ ؼ ñ ٰ .
200512 FTA ֵ ְ ϶ Ͽ, FTA ü ü Ÿ ſ ̺ ̶ ݾ ڵ ν ϱ Ͽ, 2007 ְ ¿ ҿܵǾ ֵ鿡 ż ִٴ ٳؽ ο ܱ ְ 20 ̻ .
强 κп Ͽ ߾ ϴµ .. ߵ ð 쫒ٴ ̴.
д е鿡 ̳ ǰ ܼ κп ؼ ̾߱ ڸ
- ȭ ˾ ̰ (α )
- α 밡 (κ ȭ ۿ . ȭ ü ۿ Ÿµ 庴̳ ջ ̷ ۿ ܼ ġ ġ ġ ġḦ ۿ ִ ȭ õ ۿ ִ 㰡 ް ؼ ȭ ˾ ߵȴ.)
- ȭ Ľ ̵ ˾ . (̰ ѹ ü ؼ ̴.
д ̰ ȿ κ̳ ְ κ ְ ̷ Ƽ 亯 ʰڽϴ.
ڷ PDF ۼǾ ø ڷḦ ٿ ʴ Ͽ
Visual ڷ ذǴ ø ϰڽϴ.
̳
ұ ߴµ. ٰ PPIs ֽϴٸ.
PPIs ۿ ־. H2RAs tidine 迭 PPis prazole 迭
̾ϴ. Ѱ ƿ 迭 ü Ʋٴ ...
H2RAs PPIs ȭ ˾ ְ
PPIs H2RAs ϰ ֽϴ.
ᱹ ̷ Ѱ ʴٰ Ǵ.
ٸ ã Ƽ ȭ ˾ ġ̰( )
ο ġ̰ ȭ ִ ܿ
ٸ ִٴ ؼ Ƽ ҽϴ.
ʴ° ɻ
ó (ٳؽ + ) 3ġ 1 ȳ ó .
3ϳѴ Ϳ κ ȯڰ δؾ .. ū ٰ Ǵ
˴ϴ...
ȿǥ Ⱥ ϰ...
ѿ Ƽ ִٰ .. Ƽ δ ȭ ̰ ִ 쵵 ٴ ٸ
鵵 3ʱ ص ȸٰ ϴ d/cĿ ̴...
Ƽ ǥ ɼ PPIs H2RAs ...
˾ ġϴ Ƽ ȿ ϱ...
ĵ ˾ ȭ ϼ ۿ ...
Ư ž պ DC(drug commitee) ° ˷ ֽϴ.. FDAα ݻõϰ.. SK (ž1ȣ) ž() ӻ ó濡 Ȱ° ˷ , ӻϿ쵵 ְ, ߸ PMS öϰ ϴ ž ߸Ÿ Ǹ 2-300 ⺻ Ѵٰ ˴ϴ..κ multicenter study ϱ .. ߰ Ǿ ..
° 200 400 ̷ ǥ.
žళ̶ ó Ÿ ϰ Ǵ ĺ
ϱ ߴ
ľǵǴ ߴ ˰ ; Դϴ.
ñޱ..
̷ ۾ ؾ߸ 2 ž 3 ž൵ ִ ĺ
ߴٶ ְ, ̷ ͵ Ѿุ
̶ ϴ.
Ѿ ƽô Ű ˾ ʹ
ؼ ǸŰ Ǵ ˾ƺ ;µ
˼մϴٸ ȤõŸ ϽǼ ?
ٸ 뷫 θ, ؼ дϴ...
imsڷ ϽŰͺϱ.. ľǰҰԴϴ.
IMSŸ 9 Ǿ ݱ ǰ Ȳ Ҽ ͳ
ᱹ 9 ٷ Ѵٴ ε.
뷫 ؼ ֽǼ ִٸ ſ ϴ. ^^
PPT ڷ ÷Ƚϴ.
ܹ ﰡϿ ֽñ ٶϴ.
־ Ҿµ, ̷ žళ ־. Դٰ Ѿ ־µ, Ʈ Ǿϴ.
Ǽ̴ٴ ̳... ^^
ȭ 4 26 ϸ ٳؽ 1б 14 Ǿֽϴ.
1б 3 Ѱ Ѵٸ 100
ϸ ѹ Ƹ 4 ø ...
ٵ ĵ մϴ.
° ...
100︸ Ѱܵ Ǹϴٰ ϴ ǥġ ϴ...
100 ҰŶ Դϴ.
ϴ° 150 ̻ ϴµ..
б ̰ ǰϴ ǰ ^^
ä å
ΰ?
PPI ؼ ؾ κ ֽϴ.1. ð ؾ ó氡ѵ..κ ̾ óϱ ؼ ð ˻縦 ؾ մϴ. ¿ ó κ 谨ǰ ֽϴ. PPI κ ٷ ð̶ 庮 ִٰ մϴ.
2. ٸ PPI ؼ ȿ ?
ž̶ ؼ ְ ȣ ռٴ ƴҰԴϴ.
̿ ؼ ӻʰ ð Ǿ ɼ ִٰ ϴ. Ȳ Ÿ
PPI پ ǻ Ȯ ϴµ װ ʴٰ ϴ. Ÿ PPI Ͽ Ƽ ȯڵ δ ٿֵ ƴϸ ŸPPI Ͽ ʹ پ ȿ ε ΰ ð Ʈ ʽϴ.
Ƽ ó þ δ ˾翡 ȿ ҽŰ 翬 ð̶ 庮 ̵ ǻ ó Ҽ ֵ ᵥ ֽϴ.
翬 ӿ ұϰ ˾翡 ȿ ð ص ó Ҽ ִ ȣϴ° 翬 ʰڽϱ?
ȯ þۿ о߸ ٳؽ ĿѴٴ° ټ ϰ ֽϴ.
ٳؽ , , ˾ 1 ó Դϴ.( ð ʿ PPIԴϴ.)
ٸ PPIS ĵ ٳؽ ̺κп
߰ ϸ ϴ.
ä Ͻ ½ϴ. Բ Ͻ 2. ĵ ؼ ߰ Ǵ Ҹ ó Ҽ ٰ մϴ. 1 ó̶ ū ̰ Ƽ մϴ. (ʼҾԴϴ..;;)
߸˾ҳ. ұϰ ٺ ̱ Դϴ.ð ̵ óҼ ִٰ ϼ ó ؼ ʽϴ.
ŸԵ ƴ ̶ Ҽ ְ, ò
. Ȯ ̾Ƴ ϴ. Ѱ ǰ Ǹ ȴٴ° ʹ
ε ۿϱ ... 200 400 ϴٰ ϰ.
ڶ մϴ.
Ű ϴ ߰ ˴ٽ ֿȸ 500 ¥
бų ̶ մϴ. ̸鿣
߿ 츮 ̰, âϰڴٴ ־.
ٳؽ Դϴ. ̰, ȼ ִ ǰ
ϴ. ǥ ̷ Դϴ.
û ڶϴ 迡 ٸ üٵ
Ͽ찡 Ѿ ް ٸ ǥ ù
200 ƴ ̶ Ͻϴ. ׳ ܼ ϼ ó ʴٴ ȣ δ ϴ.