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軟骨無形成症の小児参加者における SAR442501 の安全性、忍容性、薬物動態、薬力学、および有効性 (upreACH-2)

2026年6月1日 更新者：Sanofi

軟骨無形成症の小児参加者における皮下SAR442501の安全性、忍容性、薬物動態、薬力学、および有効性を評価するための第2相、非盲検、多施設、2段階逐次コホート、用量漸増研究

これは、出生から12歳までの軟骨無形成症の小児を対象としたSAR442501の安全性、忍容性、有効性を評価するための第2相、非盲検、多施設共同研究である。

調査の概要

状態

終了しました

条件

介入・治療

詳細な説明

最長約 275 週間: 3 週間のスクリーニング + 52 週間の一次治療期間 + 最大約 216 週間の延長治療期間 + 4 週間の追跡調査。

研究の種類

介入

入学 (実際)

16

段階

  • フェーズ2

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究場所

  • イタリア
    • Lombardy
      • Milan、Lombardy、イタリア、20122
        • Investigational Site Number : 3800002
    • Roma
      • Rome、Roma、イタリア、00168
        • Investigational Site Number : 3800001
  • オーストラリア
    • Victoria
      • Parkville、Victoria、オーストラリア、3052
        • Investigational Site Number : 0360001
  • スペイン
    • Basque Country
      • Vitoria-Gasteiz、Basque Country、スペイン、01008
        • Investigational Site Number : 7240002
    • Catalunya [Cataluña]
      • Esplugues de Llobregat、Catalunya [Cataluña]、スペイン、08950
        • Investigational Site Number : 7240001
  • 中国
      • Shanghai、中国、200120
        • Investigational Site Number : 1560002
      • Wuhan、中国、430030
        • Investigational Site Number : 1560001
  • 韓国
    • Seoul-teukbyeolsi
      • Seoul、Seoul-teukbyeolsi、韓国、03080
        • Investigational Site Number : 4100001
      • Seoul、Seoul-teukbyeolsi、韓国、06351
        • Investigational Site Number : 4100002

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 子

健康ボランティアの受け入れ

いいえ

説明

包含基準:

  • 参加者はFGFR3遺伝子に変異が確認されたACHを持っている必要があります
  • 参加者および/または親または法定代理人は、身体的能力を最大限に発揮してすべての研究手順を実行する意欲と能力がなければなりません。
  • 署名済みのインフォームドコンセントを与えることができる親または法定代理人、および該当する場合には同意を与えることができる参加者。

除外基準:

  • 軟骨形成不全症（またはN540K変異）またはACH以外の低身長症（例、21トリソミー、偽軟骨形成症）がある
  • 参加者は、登録後6か月以内（第0週/第1日/訪問2）に、参加者の身長または体のプロポーションに影響を与えることを目的とした、ヒト成長ホルモンを含む薬物または治験薬の投与を受けている。
  • 成長板閉鎖の病歴がある。
  • 登録後3か月以内の長骨骨折（0週目/1日目/来院2回目）
  • 角膜または網膜の障害/角膜症の現在の証拠。
  • 参加者は以前に大後頭孔に関する外科的介入を受けている(ステージ 2 のみ)。
  • 高リン血症。

上記の情報は、臨床試験への参加の可能性に関連するすべての考慮事項を含むことを意図したものではありません。

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：順次割り当て
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：コホート1
薬：SAR442501
注射用溶液;皮下注射
実験的：コホート 2
薬：SAR442501
注射用溶液;皮下注射
実験的：コホート3
薬：SAR442501
注射用溶液;皮下注射

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Stage 1: Number of Participants With Treatment-Emergent Adverse Events (TEAEs), Treatment-Emergent Serious Adverse Events (SAEs) and Adverse Events of Special Interest (AESIs)
時間枠：From the first dose of study drug administration (Day 1) up to early termination of the study, approximately 58 weeks (Stage 1: SAR442501 Dose A) and 46 weeks (Stage 1: SAR442501 Dose B)
An adverse event (AE) was any untoward medical occurrence in a clinical study participant, temporally associated with the use of study drug, whether or not considered related to the study drug. An SAE was defined as any untoward medical occurrence (whether considered to be related to study drug or not) that at any dose: resulted in death; or was life-threatening; or required inpatient hospitalization or prolongation of existing hospitalization; or resulted in persistent or significant disability/incapacity; or was a congenital anomaly/birth defect; or was an important medical event. An AESI was an AE (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program, for which ongoing monitoring and immediate notification by the Investigator to the Sponsor was required. The TEAEs were defined as events that were newly reported or reported to worsen in severity after the start of study drug up to 5 days post last dose of the study drug.
From the first dose of study drug administration (Day 1) up to early termination of the study, approximately 58 weeks (Stage 1: SAR442501 Dose A) and 46 weeks (Stage 1: SAR442501 Dose B)

二次結果の測定

結果測定
メジャーの説明
時間枠
Stage 1: Change From Baseline to Weeks 26 and 52 in Growth Velocity Z-Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
Post-treatment annualized growth velocity (AGV) was calculated from height measurements collected during the study. AGV was calculated as: AGV (centimeter per year)= (Height at Date 2 - Height at Date 1) divided by interval length in days x 365.25, where interval length in days was calculated as (Date 2 - Date 1+1). Z scores were calculated using LMS methods (Box Cox power L, Median M and Variation S), where appropriate: If L≠ 0: Z= [(AGV/M)^L-1]/(LxS); If L= 0: Z= ln(AGV/M)/S. A Z score of 0 represents the mean AGV of the reference achondroplasia (ACH) population. For AGV Z scores in children with ACH: Higher Z scores represent better outcomes, meaning faster linear growth relative to age and sex matched reference populations. Lower Z scores represent worse outcomes, indicating slower growth compared to reference norms. Baseline value was defined as last available pre dose height measurement meeting statistical analysis plan specified time interval definitions.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Annualized Growth Velocity
時間枠：Baseline (Day 1) and Weeks 26 and 52
The AGV was defined as follows: (Height at Date 2 - height at Date 1) divided by interval length in days x 365.25, where the interval length in days was calculated as (Date 2 - Date 1 +1) days. The post-treatment AGV was calculated from height measurements collected during the study. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Height Z-Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
Post-treatment AGV was calculated from height measurements collected during the study. AGV was calculated as: AGV (centimeter per year)= (Height at Date 2 - Height at Date 1) divided by interval length in days x 365.25, where interval length in days was calculated as (Date 2 - Date 1+1). Z scores were calculated using LMS methods (Box Cox power L, Median M and Variation S), where appropriate: If L≠ 0: Z= [(AGV/M)^L-1]/(LxS); If L= 0: Z= ln(AGV/M)/S. A Z score of 0 represents the mean AGV of the reference population (ACH). For AGV Z scores in children with ACH: Higher Z scores represent better outcomes, meaning faster linear growth relative to age and sex matched reference populations. Lower Z scores represent worse outcomes, indicating slower growth compared to reference norms. Baseline value was defined as last available pre dose height measurement meeting statistical analysis plan specified time interval definitions.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Upper to Lower Body Segment Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The upper to lower body segment ratio was calculated by (standing height or total length - lower body segment length) divided by lower body segment length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Upper to Lower Extremity Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The upper to lower extremity ratio was calculated by (upper arm + forearm length) divided by (upper leg + lower leg length). The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Sitting to Standing Height Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The sitting to standing height ratio was calculated by sitting height divided by standing height, or crown to rump length divided by total length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Arm Span to Height Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The arm span to height ratio was calculated by arm span divided by standing height, or arm span divided by total length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Upper Arm to Forearm Length Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The upper arm to forearm length ratio was calculated by upper arm length divided by forearm length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Upper Leg to Lower Leg Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The upper leg to lower leg length ratio was calculated by upper leg length divided by lower leg length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Head Circumference to Height Ratio
時間枠：Baseline (Day 1) and Weeks 26 and 52
The head circumference to height ratio was calculated by head circumference divided by standing height, or head circumference divided by total length. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 2: Change From Baseline to Week 52 in Brainstem, Skull, and Spine Morphometric and Volumetric Parameters
時間枠：Baseline (Day 1) and Week 52
The magnetic resonance imaging was planned to be collected to measure foramen magnum and other brainstem, skull, and spine morphometric parameters in Stage 2 participants. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Week 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Social Score, Emotional Score, and School Functioning Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
The pediatric quality of life (PedsQL) Generic Core Scales assesses pediatric health related quality of life (HRQOL) across functioning domains. Items use a 5-point scale (0=Never to 4=Almost Always). Responses are reverse scored and linearly transformed to a 0-100 scale (0→100, 1→75, 2→50, 3→25, 4→0), where higher scores indicate better quality of life (fewer problems). Domain scores for Social, Emotional, and School Functioning are calculated from the transformed item scores. If more than 50% of items in a domain are missing, the domain score is not computed. If at least 50% are completed, the domain score equals the mean of the non missing transformed item scores. All domain scores range from 0 (almost always) to 100 (never), with higher scores indicate better HRQOL. Baseline was defined as the last available value prior to the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Psychosocial Health Summary Score, Physical Health Summary Score, and Total Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
The PedsQL core scale was a brief, standardized, generic instrument that was used to measure HRQOL in various pediatric conditions. Psychosocial health summary scores were the meaning of item scores in emotional, social, and school functioning scales; and Physical health summary scores were the meaning of item scores in physical scale. Total score was the mean of all the item scores in all scales. Psychosocial and physical health summary scores and total scores each ranged from 0 (almost always) to 100 (never). Higher scores indicate better HRQOL. For participants aged 5 to 7, only parents completed the questionnaire. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Mobility Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
The screening tool for everyday mobility and symptoms (STEMS) was completed by clinicians for participants 5 years of age and older. The STEMS captures mobility, use of mobility aides, and impact of pain and/or fatigue at the end of the day across 3 environments: home, school/work and community. Mobility aides were recorded using numeric 5-point rating scale, score ranged from 1 to 5, where 1= independent on all surfaces including stairs, 2= use of sticks, 3= use of crutches, 4= use of wheeled walking device, and 5= use of wheelchair or mobility scooter. Lower score indicated the better outcome. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Participants Reported Symptoms
時間枠：Baseline (Day 1) and Weeks 26 and 52
The STEMS was completed by clinicians for participants 5 years of age and older. The STEMS captures mobility, use of mobility aides, and impact of pain and/or fatigue at the end of the day across 3 environments: home, school/work and community. Participant reported symptoms were recorded using letters where A= no pain or fatigue, B1= pain only, B2= fatigue and C= pain and fatigue. This was completed for each of the 3 environments resulting in 3 scores, whereby the numeric rating reflects the use of mobility aides and the letter reflects the symptoms. The baseline value was defined as the last available value before the first dose of study drug. Only participants with a Baseline response of "A" were included in the "A to A," "A to B1," and "A to missing" categories at each time point. Similarly, only participants with a Baseline response of "B1" were included in the "B1 to A" and "B1 to missing" categories at each time point.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in General Fatigue, Sleep/Rest Fatigue and Cognitive Fatigue Scores and Total Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
The PedsQL Multidimensional Fatigue Scale measures fatigue across 3 subscales:General Fatigue, Sleep/Rest Fatigue and Cognitive Fatigue. Items are rated on a 5 point scale (0=Never to 4=Almost Always). Responses are reverse scored and linearly transformed to a 0-100 scale (0→100, 1→75, 2→50, 3→25, 4→0), with higher scores indicate less fatigue and better functioning. Subscale scores are calculated as mean of transformed item scores within each subscale. A Total Score was calculated as mean of all transformed items across subscales. If more than 50% of items are missing within a subscale or across total scale, corresponding score is not computed. If at least 50% are completed, scores are calculated as mean of non missing transformed items. All scores range from 0 (no pain) to 100 (severe pain), with higher scores indicate less fatigue. Baseline was defined as last available value prior to first dose of study drug. For participants aged 5-7 years, only parent proxy report was completed.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Current Pain and Worst Pain Rating (PPQ) Score
時間枠：Baseline (Day 1) and Weeks 26 and 52
The PedsQL PPQ assesses current pain and worst pain intensity in the last week using a visual analog scale as well as pain location using a body map. Current and worst pain were scored separately, and scoring was based on the line length to the nearest 0.5 centimeter (5 millimeter). The score ranged from 0 (no pain) to 100 (severe pain), where higher scores indicated greater levels of pain intensity. The PedsQL PPQ was only administered in participants ages 5 years of age and older using both self-report (ages 8 and older) and parent proxy report (ages 5 and older) forms in all countries. For participants aged 5 to 7, only parents completed the questionnaire. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 2: Change From Baseline to Week 52 in Achievement of Gross Motor, Fine Motor, Communication, and Feeding Milestones
時間枠：Baseline (Day 1) and Week 52
For Stage 2 participants, achievement of developmental milestones was planned to be assessed using the ACH developmental recording form. This form allows developmental milestones to be recorded and was not a formalized screening tool or assessment. The form measures the domains of gross motor function, fine motor function, communication and feeding via participant reports to the Investigator. The form depicts the cumulative percentage distributions for children with ACH for each item as well as norms for reference based on the Denver II test, where available. Data collected via this form was planned to be evaluated descriptively to explore the age at which participants in this study achieve developmental milestones. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Week 52
Stage 1: Plasma Concentration of SAR442501
時間枠：Pre-dose and 6, 24 and 72 hours post dose on Day 1; Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Blood samples are collected to determine plasma concentration of SAR442501.
Pre-dose and 6, 24 and 72 hours post dose on Day 1; Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Stage 1: Maximum Observed Plasma Concentration (Cmax) of SAR442501
時間枠：Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Blood samples are collected to determine Cmax of SAR442501. The Cmax of SAR442501 was calculated using non-compartmental method.
Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Stage 1: Time to Reach the Maximum Concentration (Tmax) of SAR442501
時間枠：Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Blood samples are collected to determine tmax of SAR442501. The tmax of SAR442501 was calculated using non-compartmental method.
Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Stage 1: Area Under the Concentration Versus Time Curve From Time 0 to 72 Hours After Study Drug Administration (AUC0-tau) of SAR442501
時間枠：Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Blood samples are collected to determine AUC0-tau of SAR442501. The AUC0-tau of SAR442501 was calculated using non-compartmental method.
Pre-dose and 3, 6, 12, 24 and 72 hours post dose on Day 57
Stage 1: Minimum Plasma Concentration (Ctrough) of SAR442501
時間枠：Pre-dose on Days 8, 29, 57, 92, 183, 274, 365 and 449
Blood samples are collected to determine Ctrough of SAR442501. The Ctrough of SAR442501 was calculated using non-compartmental method.
Pre-dose on Days 8, 29, 57, 92, 183, 274, 365 and 449
Stage 1: Change From Baseline to Week 26 in Collagen X Biomarker (CXM) Level
時間枠：Baseline (Day 1) and Week 26
Serum samples were collected to assess the change in CXM level with study drug. The CXM was also named PRO-C10 because the biomarker assay used was aimed to target the recognition of the C terminus of the NC1 domain of type X collagen. The baseline value was defined as the last available value before the first dose of study drug. Change from baseline in CXM level has been reported.
Baseline (Day 1) and Week 26
Stage 1: Change From Baseline to Weeks 26 and 52 in Osteocalcin Level
時間枠：Baseline (Day 1) and Weeks 26 and 52
Serum samples were collected to assess the change in osteocalcin level with study drug. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Bone-Specific Alkaline Phosphatase Level
時間枠：Baseline (Day 1) and Weeks 26 and 52
Serum samples were collected to assess the change in bone-specific alkaline phosphatase level with study drug. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Procollagen Type 1 N-Terminal Propeptide (P1NP) Level
時間枠：Baseline (Day 1) and Weeks 26 and 52
Serum samples were collected to assess the change in P1NP level with study drug. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Change From Baseline to Weeks 26 and 52 in Collagen-Type 1 C-Telopeptide (CTX) Level
時間枠：Baseline (Day 1) and Weeks 26 and 52
Serum samples were collected to assess the change in CTX level with study drug. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52
Stage 1: Number of Participants With Anti-drug Antibodies (ADA) to SAR442501
時間枠：From the first dose of study drug administration (Day 1) up to early termination of the study, approximately 58 weeks (Stage 1: SAR442501 Dose A) and 46 weeks (Stage 1: SAR442501 Dose B)
Serum samples were collected to assess the antibodies to SAR442501. Samples were screened and then confirmed for antibodies binding to SAR442501 and the titer of confirmed positive samples were reported. Positive ADA refers to pre-existing ADA at the pre-dose assessment on Day 1.
From the first dose of study drug administration (Day 1) up to early termination of the study, approximately 58 weeks (Stage 1: SAR442501 Dose A) and 46 weeks (Stage 1: SAR442501 Dose B)
Stage 2: Number of Participants With Change From Baseline to Weeks 26 and 52 in Neurological Examination Findings
時間枠：Baseline (Day 1) and Weeks 26 and 52
A complete neurological examination included assessment of mental status, motor function and balance, sensory exam, newborn and infant reflexes, muscle stretch reflexes in the older children and evaluation of the cranial nerves. The baseline value was defined as the last available value before the first dose of study drug.
Baseline (Day 1) and Weeks 26 and 52

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Sanofi

捜査官

  • スタディディレクター：Clinical Sciences & Operations、Sanofi

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

便利なリンク

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2023年10月10日

一次修了 (実際)

2025年2月12日

研究の完了 (実際)

2025年2月12日

試験登録日

最初に提出

2023年9月20日

QC基準を満たした最初の提出物

2023年9月28日

最初の投稿 (実際)

2023年10月4日

学習記録の更新

投稿された最後の更新 (実際)

2026年6月25日

QC基準を満たした最後の更新が送信されました

2026年6月1日

最終確認日

2026年5月1日

詳しくは

本研究に関する用語

追加の関連 MeSH 用語

その他の研究ID番号

  • DRI16646
  • U1111-1280-5374 (レジストリ識別子：ICTRP)
  • 2023-503677-37 (レジストリ識別子：CTIS)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

資格のある研究者は、患者レベルのデータと、臨床研究報告書、修正を含む研究計画書、白紙の症例報告書、統計解析計画、データセット仕様などの関連研究文書へのアクセスを要求できます。 患者レベルのデータは匿名化され、治験参加者のプライバシーを保護するために研究文書は編集されます。 サノフィのデータ共有基準、対象となる研究、アクセスを要求するプロセスの詳細については、https://vivli.org をご覧ください。

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

はい

米国FDA規制機器製品の研究

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

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