Mankhwala Ochiritsira Akhoza Kuchitira Zonse Mitsempha 6 mu Masabata 8
Mavyret (glecapravir, pibrentasvir) ndi mankhwala omwe amagwiritsidwa ntchito pochiza matenda a chiwindi a hepatitis C (HCV) . Mankhwalawa amagwiritsidwa ntchito pa ntchito ya Mavyret potseka mapuloteni awiri omwe kachilombo ka HIV kamene kamayenera kubwereza.
Mavyret adavomerezedwa pa August 3, 2017 ndi US Food and Drug Administration kuti agwiritsidwe ntchito akuluakulu 18 ndi kupitirira. Kafukufuku akusonyeza kuti mankhwalawa akhoza kupeza mankhwala ochiza matenda omwe ali pakati pa 92 peresenti ndi 100 peresenti kumadalira HCV subtype, chiwerengero chomwe sichigwirizana ndi mankhwala ena otetezeka omwe amagwiritsidwa ntchito panopa ku matenda a hepatitis C.
Zochita ndi Zochita
Mavyret amatha kuteteza mitundu yonse ya ma HCV asanu ndi limodzi ( genotypes ) ndipo akhoza kugwiritsidwa ntchito onse omwe sanapezepo mankhwala osokoneza bongo a HCV ndi omwe asanalandire mankhwala. Komanso, mankhwalawa angagwiritsidwe ntchito kwa anthu omwe ali ndi chiwindi (omwe chiwindi chimagwirabe ntchito).
Mavyret ali ndi phindu lalikulu pa mankhwala omwewo monga momwe angathere matenda opatsirana ndi chiwindi cha matenda a chiwindi mwa milungu ingapo. Mankhwala ena onse amafunika osachepera 12 masabata kwa odwala atsopano. Izi zimaphatikizapo kuphatikizapo mankhwala a HCV Epclusa omwe amavomerezedwa ku ma genotype onse asanu ndi limodzi.
Komabe, mosiyana ndi Epclusa, Mavyret sangathe kugwiritsidwa ntchito kwa anthu omwe ali ndi chibwibwi chosokonezeka.
Chinthu china chosiyanitsa ndi mtengo . Ngakhale mankhwala monga Epclusa amanyamula ndalama zokwana madola 75,000 pa maphunzilo 12 (kapena $ 890 piritsi), Mavyret amaperekedwa pa $ 26,400 pamasabata asanu ndi atatu (kapena $ 439 pa piritsi).
Kusiyana kwa mtengo kungakhale kokwanira kutsimikizira odwala omwe ali ndi thanzi labwino kuti athetse chithandizo kwa anthu 3.9 miliyoni a ku America omwe ali ndi kachilombo ka HCV, ambiri mwa iwo ayenera kuyembekezera mpaka pali vuto lalikulu la chiwindi chisanafike.
Kulemba Malangizo
Mlingo woyenera wa Mavyret ndi mapiritsi atatu omwe amatengedwa kamodzi tsiku ndi tsiku ndi chakudya.
Pulogalamu iliyonse ili ndi mamiligalamu 100 a glecaprevir ndi mamiligalamu 40 a pibrentasvir. Mapiritsi ndi a pinki, oboola mawonekedwe a mafilimu, ovekedwa ndi mafilimu, ndipo amachotsedwa ndi "NXT" kumbali imodzi.
Kutalika kwa mankhwala kumasiyanasiyana ndi kachibadwa ka HCV, chithandizo cha mankhwala, komanso chikhalidwe cha chiwindi cha wodwalayo, motere:
- Poyamba asanatengedwe popanda kutsekemera: masabata asanu ndi atatu
- Poyamba asanatengedwe ndi chifuwa cha cirrhosis: masabata 12
- Poyamba anachitidwa ndi majeremusi a HCV 1, 2, 4, 5, ndi 6 opanda chidziwitso: masabata asanu ndi atatu kapena 16 malinga ndi chithandizo chammbuyomu
- Poyamba anachitidwa ndi majeremusi a HCV 1, 2, 4, 5, ndi 6 ndi matenda a cirrhosis: masabata 12 mpaka 16 malingana ndi chithandizo chammbuyomu
- Poyamba anachitidwa ndi HCV genotype 3 ndi kapena popanda cirrhosis: masabata 16
Pafupifupi 75 peresenti ya anthu a ku America omwe ali ndi matenda a chiwindi a mtundu wa C, omwe ali ovuta kwambiri, komanso omwe amawavuta kwambiri. Mosiyana ndi zimenezi, pakati pa 20 ndi 25 aliwonse ali ndi majeremusi 2 ndi 3, pomwe ndi ochepa okha omwe ali ndi magawo 4, 5, kapena 6.
Zotsatira Zotsatira
DAA zatsopano zatsopano monga Mavyret ali ndi zotsatira zochepa kuposa mankhwala ochiritsira kale, ambiri mwa iwo anali ndi pegylated interferon ( peginterferon ) ndi ribavirin . Zotsatira zofala kwambiri zomwe zimagwirizanitsidwa ndi Mavyret (zomwe zikuchitika pa oposa asanu mwa odwala) zimaphatikizapo:
- Mutu
- Kutopa
- Nausea
- Kutsekula m'mimba
Kawirikawiri, zotsatira zake zimawoneka bwino ndipo zimawongolera pakapita nthawi. Ndipotu, kafukufuku wamakono asanakhalepo kuti anthu osachepera limodzi pa anthu onse omwe ali pa Mavyret sanathe kuchiritsidwa chifukwa cha zotsatira zosautsa.
Kuyanjana kwa Mankhwala
Kugwiritsiridwa ntchito kwa mankhwala a rifampin, omwe amagwiritsidwa ntchito pochizira chifuwa chachikulu, amatsutsana kuti agwiritsidwe ntchito ndi Mavyret ndipo ayenera kuchotsedwa asanayambe mankhwala. Izi zimaphatikizapo mankhwala omwe amatchedwa Mycobutin, Rifater, Rifamate, Rimactane, Rifadin, ndi Priftin.
Mankhwala ena amadziwika kuti agwirizane ndi Mavyret ndipo akhoza kuwonjezera kapena kuchepetsa chiwerengero cha Mavyret mu mwazi.
Zotsatirazi sizilangizidwa kuti zigwiritsidwe ntchito ndi Mavyret:
- Carbamepazine, ankakonda kupweteka ndi matenda osokoneza bipolar
- Ethinyl estradiol (estrogen) -kumakhala ndi mankhwala oletsa kubereka
- Sustiva (efavirenz) amagwiritsidwa ntchito pa kachilombo ka HIV
- Atorvastatin, lovastatin, ndi simvastatin zomwe zimagwiritsidwa ntchito pochizira cholesterol
- Wotchedwa St. John's Wort
Matenda a Chiwindi
Mavyret amatsutsana kuti agwiritsidwe ntchito kwa anthu omwe ali ndi chiwindi chachikulu cha chiwindi (monga momwe amayesedwa ndi chiwerengero cha Child-Pugh C) ndipo sakuvomerezedwa kwa aliyense amene ali ndi vuto lochepa (Child-Pugh B).
Kuyezetsa ntchito kwa chiwindi kumalimbikitsidwa asanayambe mankhwala kuti muthetse mavuto. Mapepala a Child-Pugh ndi othandiza pozindikira kuopsa kwa matenda a chiwindi chifukwa cha kuyesedwa kwa magazi ndi kubwereza zizindikiro za makhalidwe.
Kuchepetsa kutentha kwa chiwindi
Mavyret ayenera kugwiritsidwa ntchito mosamala kwa anthu omwe ali ndi chiwindi cha hepatitis B ndi chiwindi cha hepatitis C. Vuto la hepatitis B (HBV) lakhala likudziwika kuti limatha kugwira ntchito mwamsanga kapena pakangotha chithandizo. Kubwezeretsedwa kungaperekedwe ndi zizindikiro za jaundice ndi kutupa kwa chiwindi. Ngati chithandizo sichiimitsidwa nthawi yomweyo, kubwezeretsedwa kungachititse kuti chiwindi chilephera komanso ngakhale imfa.
Ngakhale kuti matenda a HBV sagwirizana ndi ntchito ya Mavyret, amafunika kuyang'anitsitsa kwambiri mavitamini a chiwindi kuti adziwe zizindikiro zoyambirira zowonjezera.
Mimba
Ngakhale kuti Mavyret sagwirizana pa nthawi yomwe ali ndi mimba, pali deta yochepa ya anthu yomwe ilipo kuti idziwe zomwe zilipo. Ndikunena kuti, kafukufuku wa zinyama asonyeza kuti kugwiritsa ntchito glecaprevir ndi pibrentasvir pa nthawi ya mimba sikumayenderana ndi zovuta za fetus, kuphatikizapo kuwonetsetsa pamene akuyamwitsa.
Kuyankhulana kwapadera kukulimbikitsidwa osati kungoyang'ana phindu ndi ngozi za chithandizo koma kuthandiza kudziwa ngati mankhwalawa ndi ofunika mwamsanga kapena chinachake chimene chingachedweke pambuyo pa kubereka.
Pofuna kuteteza mimba pakulandila, maanja akulangizidwa kuti agwiritse ntchito njira ziwiri zosagwiritsira ntchito mankhwala osapatsirana pakapita miyezi isanu ndi umodzi chitatha. Popeza kuti maantirogen-based controls are not recommended, lankhulani ndi dokotala kuti muwone ngati chithandizo chovomerezeka cha progestin chokha chingakhale choyenera.
> Zotsatira:
> Abbie, Inc. "Mfundo Zowonjezera Kufotokozera Mauthenga: Mapiritsi a Mavyret (glecaprevir ndi pibrentasvir) , pogwiritsa ntchito pamlomo Woyamba US kuvomerezedwa: 2017." Chicago, Illinois; yasinthidwa mwezi wa 2017.
> Foster, G ;; Gane, E .; Asatryan, A. et al. "KUCHITA-3: chitetezo ndi kuthandizira kwa glecaprevir / pibrentasvir poyerekeza ndi sofosbuvir plus daclatasvir omwe ali ndi kachilombo koyambitsa matenda a HCV omwe ali ndi matenda atatu omwe alibe matenda." J Hepatol. 2017; 66 (Suppl 1): S33.
> Utsogoleri wa US Food and Drug Administration. "FDA imavomereza Mavyret kwa Hepatitis C." Silver Spring, Maryland; adatulutsidwa pa August 3, 2017.