PCSK9 inhibitors amasonyeza malonjezano, koma tikufuna zambiri zambiri
Gulu latsopano la mankhwala otsutsana ndi mafuta a kolesteroni-PCSK9 inhibitors-limapanga mphulupulu zambiri m'magulu a zamoyo, ndipo mauthenga osiyanasiyana amati mankhwala atsopanowa angakhale njira yabwino kwa odwala omwe amavutika kutenga zilembo . Maselo awiri oyambirira a PCSK9-Repatha (evolucumab) ndi Apamwamba (alirocumab) -wavomerezedwa kuti agwiritsidwe ntchito mu 2015.
Mankhwala osokoneza bongo a PCSK9 akhozadi kuwonetsa kupambana kwakukulu kwa kutsekemera kwa mafuta m'thupi.
Komabe, chitetezo chawo cha nthawi yaitali sichinakhazikitsidwe. Icho, ndi mtengo wawo wokwera kwambiri, madokotala ambiri samadziwa lero malo awo abwino mu mankhwala azachipatala.
Kodi PCSK9 Inhibitors Zimagwira Ntchito Motani?
Mankhwalawa amaletsa cholesterol choyang'anira chotchedwa "proprotein convertase subtilisin / kexin 9" (PCSK9) m'chiwindi. Pamwamba pa maselo a chiwindi muli ma receptors a LDL, omwe amamanga mitundu yozungulira ya LDL (yomwe ili ndi LDL cholesterol ) ndi kuwachotsa ku magazi. Mitundu yonse ya LDL ndi amalandila a LDL amachotsedwa m'maselo a chiwindi, kumene mbali za LDL zimasweka. Ovomerezeka a LDL amatha kubwerera pamwamba pa maselo a chiwindi, kumene angathe "kumangirira" mbali zina za LDL.
PCSK9 ndi mapuloteni oletsa omwe amamanganso kwa LDL receptors. Ma receptors a LDL omangidwa ndi PCSK9 sagwiritsanso ntchito kachilomboko, koma m'malo mwake amasweka mkati mwa selo.
Choncho, PCSK9 imachepetsa mphamvu ya chiwindi kuchotsa LDL cholesterol m'magazi. Poletsa PCSK9, mankhwala atsopanowa amachititsa kuti chiwindi chichotsere cholesterol cha LDL, ndi kuchepetsa miyendo ya magazi a LDL.
Pamene PCSK9 inhibitor ikuwonjezeredwa kuchipatala chokwanira, LDL cholesterol imawongolera pansi pa 50 mg / dL, ndipo nthawi zambiri zimakhala 25 mg / dL kapena zochepa.
The PCSK9 Inhibitors
Pamene puloteni ya PCSK9 yowonongeka inayamba kupezeka kumayambiriro kwa zaka za 2000, asayansi anadzazindikira kuti kuletsa mapuloteniwa kuyenera kuchepetsa kuchepa kwa khungu la mafuta m'thupi. Makampani osokoneza bongo anayamba kuthamangira mpikisano kuti apange PCSK9 inhibitors.
Chodabwitsa, mankhwala awiriwa atha kale ndikuyesedwa m'mayesero a zachipatala: evolucumab (Repatha, opangidwa ndi Amgen) ndi alirocumab (Zofunika, zopangidwa ndi Sanofi ndi Regeneron). Mankhwalawa ndi ma antibodies monoclonal , okonzedwa kukhala ndi zotsatira zokha pa PCSK9, ndi (zovuta, zosachepera) kulikonse. Onsewa amathandizidwa ndi jekeseni ya subcutaneous (monga mankhwala a insulin), ndipo amaperekedwa kamodzi kapena kawiri pamwezi.
Kuyezetsa Mankhwala ndi PCSK9 Zizindikiro
Mayesero oyambirira a chipatala anachitidwa ndi evolucumab (mayesero a OSLER) ndi alirocumab (mayesero ODYSSEY), omwe adapangidwa pofuna kuyesa kuti chitetezo ndi kulekerera kwa mankhwalawa atsopano.
M'mayesero awa, odwala oposa 4500 amene mavitamini a cholesterol atsimikiziridwa kuti ndi ovuta kuchiza adalandira imodzi kapena ina mwa mankhwalawa. Odwala anali osasintha kuti alandire kachilombo ka PCSK9 komanso mankhwala osokoneza bongo, kapena mankhwala osokoneza bongo . Onani kuti palibe odwala omwe amachiritsidwa okha ndi PCSK9 inhibitor.
Ophunzira onse adalandira ma statins.
Zotsatira mwa mayesero onsewa zinali zofanana ndi-LDL cholesterol inachepetsedwa mwa odwala omwe amalandira PCSK9 inhibitor pafupifupi 60 peresenti, poyerekeza ndi magulu olamulira omwe amachitira ndi statin okha. Mayesero oyambirirawa sanakonzedwe mwachindunji kuti ayese kusintha kwa zotsatira za mtima, koma zotsatira zomwe anthu adapeza kuti zatha kulandira PCSK9 inhibitor zikuyang'ana.
Cha kumapeto kwa chaka cha 2016, GLAGOV inawonetsa kuti, mu 968 anthu omwe ali ndi matenda odwala matenda a umphawi (CAD) omwe amatha kupatsidwa mankhwala ndi evolocumab kuphatikizapo statin kapena statin okha, iwo omwe amalandira evolocumab amadziwa (peresenti) kuchepetsa 1% zapadera zawo za Mulungu-zotsatira zabwino kwambiri.
Chiyeso chachikulu choyambirira chomwe chinapangidwira kuyesa zotsatira zachipatala pa PCSK9 inhibitor, yesero la FOURIER, linafalitsidwa kumayambiriro kwa chaka cha 2017. Kuphunzira kwakukuluku kunalembetsa anthu oposa 27,000 ndi CAD, ndipo adawapanganso kuti alandire evolocumab kuphatikizapo statin ndi statin yekha. Pambuyo pa nthawi yotsatila ya miyezi 22, zotsatira zachipatala mu kagulu ka evolocumab zakhala bwino kwambiri kuchokera ku chiwerengero cha ziwerengero, ngakhale pang'ono pokha. Mwachindunji, chiopsezo cha matenda a mtima chinachepetsedwa ndi 1.5 peresenti, chiopsezo chosowa chithandizo chamankhwala chosawonongeka ndi 1.5 peresenti, ndipo chiopsezo cha kupweteka ndi 0,4 peresenti. Chiwerengero cha imfa sichinachedwe kwambiri. Ngakhale kuti zikutheka kuti kukula kwa phindu lachipatala kudzakhala bwino ndi nthawi zowonjezereka zotsatila, kulembera mosapita m'mbali kuti ndizochitika zaka zingapo.
Zotsatira zoyipa ndi PCSK9 Zizindikiro
M'maphunziro a pulogalamu ya PCSK9 inhibitors, odwala ambiri anali ndi zotsatira zina-makamaka khungu pa malo ojambulidwa, koma zotsatira zolakwika zinaphatikizanso kupweteka kwa minofu (zofanana ndi zowawa za misinkhu ) ndi mavuto amodzi (makamaka amnesia ndi kulephera kukumbukira). Mu maphunziro oyambirira mbali iyi yomaliza yawonetseredwa mwa pafupifupi 1 peresenti ya odwala randomized to PCSK9 inhibitor.
Zotsatira za mavuto amalingaliro , ngakhale ali otsika, zakhala zikukweza mbendera zina zoyang'anira. Mu kafukufuku wochepa wa mayesero a FOURIER, panalibe kusiyana kwakukulu pakati pa chidziwitso pakati pa anthu omwe amalandira evolocumab kuphatikizapo chilembo, poyerekeza ndi anthu omwe alandira chilemba chokha. Komabe, funsoli lidalibe ngati kuyendetsa galimoto ya mafuta m'thupi kumakhala kochepa kwambiri kwa nthawi yaitali kungapangitse chiopsezo cha kuchepa kwa chidziwitso, zilizonse zomwe amagwiritsa ntchito kuti achite. Apanso, nthawi yotsatira ikufunika kuti mupeze yankho labwino pafunso lofunika ili.
PCSK9 Inhibitors mu Maganizo
The PCSK9 inhibitors zingakhale zofunikira kwambiri pakuchiza kolesterol, komanso kuchepetsa kuopsa kwa mtima. Komabe, ngakhale changu chonse chikuwonetsedwa ndi akatswiri a cardiologists, tiyenera kusunga zinthu moyenera tsopano.
Choyamba , pamene zotsatira za mtima ndi mankhwala atsopano zikuwoneka bwino kwambiri (mu kafukufuku wa nthawi yayitali), kukula kwa kusintha kwake mpaka pano sikulu kwambiri. Kuwongolera kwa nthawi yaitali kudzakhala kofunikira kuti tiwone momwe phindu la mankhwalawa limapindulira-ndipo, makamaka, ngati potsirizira pake adzapereka phindu la kufa kwa nthawi yaitali.
Chachiwiri , mofanana ndi "mankhwala osokoneza bongo" amakono (mankhwala osokoneza bongo omwe amapangidwa kuti apangidwe), PCSK9 inhibitors ndi okwera mtengo kwambiri. Kugwiritsa ntchito kwawo, makamaka zaka zoyambirira, kungakhale kochepa kwa anthu omwe ali pachiopsezo chachikulu, ndipo omwe sangathe kuchepetsedwa ndi statins-monga anthu omwe ali ndi matenda a hypercholesterolemia .
Chachitatu , ngakhale kuti mankhwalawa akukambidwa ngati m'malo mwa mankhwala a statin, tiyenera kuzindikira mosamala kuti mayesero a zachipatala mpaka lero agwiritsanso ntchito kuwonjezera pa ma statins, osati mmalo mwa statins. Kotero, ife tiribe deta yachipatala kuti tiwone ngati iwo angakhale othandizira kukhala ovomerezeka ndi statin.
Chachinayi , pamene mbiri ya chitetezo cha mankhwala a PCSK9 pakalipano akuwoneka akulonjeza, pitirizani mafunso omasuka; makamaka, ngati kuyendetsa galimoto ya cholesterol ku machitidwe otsika kwambiri kwa nthawi yaitali kungakhale yopanda phindu, makamaka pokhudzana ndi chidziwitso.
> Zotsatira:
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