Mpaka posachedwa, madokotala ambiri adanena kuti chakudya cha CHOLECHITI-CHD. Choyamba, cholesterol chokwera m'magazi kapena hypercholesterolemia zimayambitsa matenda a mtima (CHD). Chachiwiri, zakudya zomwe zimakhala ndi mafuta a nyama komanso cholesterol zimapangitsa kuti mafuta azipezeka m'magazi. Chachitatu, kuchepetsa makilogalamu m'magazi kumachepetsa chiopsezo cha matenda a mtima.
Pamtengo wapatali, cholesterol-zakudya-CHD zozizwitsa zimaoneka ngati zomveka. Pambuyo pake, "ndife zomwe timadya," ndipo ngati timadya zakudya zokhala ndi mafuta a kolesterolini ndi zokhuta (zinyama), ndiye kuti magazi athu amatha kupitirira. Kuwonjezera apo, chifukwa zipika-zomwe zimagwiritsira ntchito mitsempha ndi kuyambitsa CHD ndi kupwetekedwa-zimakhala mbali imodzi yokhala ndi cholesterol, kuchuluka kwa kolesterolo m'magazi achiwiri ndi zakudya kudzawonjezera chiopsezo cha CHD ndi kupweteka. Ndipo, ngati mutachepetsa makasitomala m'magazi anu pogwiritsa ntchito mankhwala, ndiye kuti mumachepetsa chiopsezo cha CHD ndi kupweteka, pomwepo? Chabwino, potsata malingaliro onse awa, nkokayikitsa.
Posachedwapa, pakhala kusintha kwa nyanja m'malamulo omwe amayang'anira kayendetsedwe ka CHD. Sitikudziwa ngati chakudya chokhala ndi mafuta a kolesterolini ndi mafuta odzaza ndi owongolera kuwonjezeka kwa kolesterolo m'magazi. Komanso, sitikudziwa ngati kuchepetsa magazi m'thupi mwa omwe ali pachiopsezo cha matenda a mtima kumathandiza kupewa matenda, angina osasunthika, matenda a mtima ndi zina.
Zonse zomwe tikudziwa ndizo kusintha kwa moyo (mwachitsanzo, kulemera kwa thupi, kuchita masewera olimbitsa thupi ndi kusuta fodya) komanso statins, kapena mankhwala monga Zocor ndi Crestor, zomwe zimapangitsa kuti zikhale zolimba komanso zimachepetsa kuchepetsa lipoprotein cholesterol (LDL-C) kapena "cholesterol" choipa, mwinamwake kuthandizira kupewa imfa ndi zochitika zina za mtima,
Evolocumab ndi wa kalasi yatsopano ya mankhwala. M'mayesero a kachipatala tawonetsedwa kuti tithe kuchepa msanga maseŵera a LDL-C m'malo osiyanasiyana omwe amapezekapo-makamaka mwa iwo omwe ali ndi matenda a chibadwa omwe amatchedwa a hypercholesterolemia omwe amachititsa kuti maselo a cyclopea (kwenikweni, apamwamba kwambiri) a cholesterol mu magazi. Tsopano kaya evolocumab idzapindulitse anthu ambiri omwe ali pangozi ya imfa komanso zochitika zovuta zomwe zimayambitsa matenda a mtima zimakhalabe zikuwoneka, ndipo zimadalira zotsatira za maphunziro a nthawi yayitali kapena omwe angakwaniritse omwe akuwonetsa ophunzira pazaka za evolocumab (Repatha ) mankhwala. M'mawu ena, nthawi yokha idzauza ngati evolocumab ikugwira ntchito.
Kodi Evolocumab N'chiyani?
Evolocumab ndi munthu wodwala monoclonal antibody amene amamanga ndipo motero amaletsa mapuloteni PCSK9. Mapuloteniwa amalepheretsa munthu kulandira LDL-C chifukwa cha kuwonongeka kwa chiwindi komanso kusokoneza mphamvu ya wolandirayo kubwezeretsa. (N'zochititsa chidwi kuti kafukufuku amasonyeza kuti zilembo zingathe kulembetsa PCSK9, komabe, zikagwiritsidwa ntchito pamodzi, statins ndi evolocumab sizigwirizana kwenikweni kapena zimatha.)
Pakalipano, Amgen, wopanga evolocumab, akuyesa mayesero angapo akuluakulu odwala m'madera osiyanasiyana padziko lonse lapansi.
Zotsatira za mayeserowa ndizowonjezera pokhudzana ndi mphamvu ya evolocumab yochepetsera mayendedwe a LDL-C. Mwachitsanzo, mu mayesero amodzi a Gawo 3, ophunzira omwe ali ndi vuto lachilombo la hypercholesterolemia (omwe amagwiritsa ntchito mankhwala osokoneza bongo) omwe anali ndi mankhwala otchedwa statin treatment (ena anali ndi mankhwala enaake a cholesterol otchedwa Zetia) anawonjezeka ndi 31% peresenti ya ma LDL-C pa 12 masabata poyerekeza ndi anthu omwe sanalandire mankhwala. (Ophunzirawo anachepetsedwa ndi 23 peresenti ya apolipoprotein B.) Chofunika kwambiri, evolocumab anagwira ntchito mofulumira kuposa mankhwala ena awiri atsopano akubwera pansi paipiipi: lomitapide ndi mipomersen.
Pofuna kuthamanga, chifukwa cha zotsatira zake zoipa, evolocumab imalekerera kusiyana ndi lomitapide ndi mipomersen.
Muyeso lina la Gawo 3, anthu omwe sanali ovomerezeka ndi zilembo ziwiri ndipo anachitidwa ndi evolocumab ndi Zetia yokha, anapeza kuti kuchepa kwa LDL-C kumakhala 53 mpaka 56 peresenti poyerekeza ndi kuchepa kwa 37 mpaka 39 peresenti. Komanso, evolocumab inachititsa zinthu zovuta kwambiri kuposa Zetia.
Pomalizira, mu maphunziro a Phase 2, mwa ophunzira omwe ali ndi hypercholesterolemia ndipo kale ali ndi mphamvu yapamwamba kwambiri ya mankhwala, evolocumab yachepetsa ma LDL-C ndi 66 mpaka 75% peresenti pamwezi.
Kodi Lingathandizedi Odwala?
Panthawiyi, aphungu adakalipobe ngati evolocumab ikhoza kupereka chithandizo chilichonse cha thanzi kwa anthu omwe ali pangozi ya kudwala ndi matenda a mtima. Kungowonjezera mitsempha ya cholesterol mwina kumatanthauza pang'ono mwa anthu ambiri, mfundo inayendetsedwa kunyumba ndi ndondomeko zatsopano za ACC / AHA zomwe zatha kuthetsa magulu ambiri a serum cholesterol. Kuwonjezera apo, malangizowa amasonyeza kuti maantimini, mankhwala okhawo omwe amasonyezadi phindu lililonse pofuna kuchepetsa kufala kwa mtima ndi kufa, ayenera kuuzidwa kwa anthu omwe ali ndi matenda a mtima (kupweteka kapena kupweteka kwa mtima), anthu okhala ndi ma LDL-C kuposa 190 ( cholesterol choipa kwambiri, anthu a zaka zapakati pa 40 ndi 75 omwe ali ndi matenda a shuga a mtundu wa 2, ndi anthu a zaka zapakati pa 40 ndi 75 omwe ali ndi chiopsezo cha matenda a mtima pa 7.5 peresenti m'zaka 10 zotsatira.
Ngati panthawi ya ma ARV nthawi yayitali, evolocumab ikuwoneka bwino pakuchepetsa zotsatira za matenda a mtima monga kupweteka ndi matenda a mtima, ndiye tikuyang'ana mankhwala omwe angakhale osiyana ndi ma statins. Timayang'anizana ndi chakudya cha kolesterolini-CHD hypothesis yomwe yatsimikiziridwa motsimikizirika kuyambira zaka za sayansi. Potsirizira pake, kuthekera kwa evolocumab kuchepetsa kwambiri ma LDL-C m'mitundu yosiyanasiyana ya anthu okhudzidwa kumadzetsa kukumbukira mankhwala a blockbuster Zetia, omwe atsimikiziridwa kuti sagwira ntchito (kapena ngakhale kuvulaza pang'ono) poletsa kulemba zida zowonjezera mwa ophunzira. Mwa kuyankhula kwina, Zetia inali yolephera kwambiri ndipo mwina ikhoza kukhala evolocumab
> Zosowa
> "Anti-PCSK9 Chotsitsa Chotsitsa Cholesterol M'madokotala Odwala Statin Kulekerera" ndi Erik Stroes ndi anzake omwe adafalitsidwa pa 11/23/2014 (e-pub patsogolo kusindikiza) mu Journal of the American College of Cardiology.
> Bersot TP. Chaputala 31. Mankhwala Osokoneza Bongo kwa Hypercholesterolemia ndi Dyslipidemia. Mu: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Basic Pharmacological Therapeutics, 12e . New York, NY: Hill ya McGraw; 2011.
> "Zotsatira za evolocumab kapena ezetimibe zowonjezeredwa kapena zowonjezereka zowonongeka kwa LDL-C kutsitsa kwa odwala omwe ali ndi hypercholesterolemia: mayesero a LAPLACE-2 omwe amachitidwa mwakayakaya" ndi JG Robinson ndi anzake omwe amafalitsidwa ku JAMA pa 5/14/2014.
> "Kuletsedwa kwa PCSK9 ndi evolocumab mu chikhalidwe cha azimayi (TESLA Part B): mayesero omwe amatsogoleredwa ndi apakati pawiri, aŵiri-bline, ndi a placebo" ndi FJ Raal ndi anzake omwe amafalitsidwa mu The Lancet pa 10/2/2014.