Mankhwala Oyamba Amatha Kutenga Mitundu Yonse ya HCV Infection
Epclusa (sofosbuvir ndi velpatasvir) ndi mankhwala osakaniza omwe amagwiritsidwa ntchito pochiza matenda a chiwindi a hepatitis C (HCV) . Mankhwala awiri omwe amaphatikizapo Epclusa amaletsa mapuloteni onse (RNA polymerase) ndi mapuloteni (NS5A) ofunika kwambiri kuti kachilombo ka HIV kamveke.
Mwachidule
Epclusa inavomerezedwa mu June, 2016 ndi US Food and Drug Administration (FDA) kuti agwiritsidwe ntchito kwa anthu akuluakulu azaka 18 ndi kupitirira ndipo ali woyamba kugwira ntchito yokhoza kuthetsa mabala onse akuluakulu asanu ndi limodzi a HCV .
Epclusa ndi yoyenera kwa odwala omwe sanayambe kuwachiritsidwa (odwala-naïve) odwala, kuphatikizapo omwe ali ndi mbali kapena osayankhidwa ku chithandizo choyambirira cha HCV (odwala-odziwa).
Epclusa ikhoza kugwiritsidwa ntchito kwa anthu omwe amapezeka ndi matenda a chiwindi , ngakhale kuti ndibwino kuti ribavirin izigwiritsidwa ntchito pokhapokha ngati matenda a chiwindi asagwire ntchito. Epclusa akuti ali ndi mankhwala opatsirana pafupifupi 100 peresenti m'magulu ena, pamene mphamvu zake kwa anthu omwe ali ndi chifuwa chachikulu cha cirrhosis amanenedwa kuti ndi okwana 94 peresenti.
Epclusa anatulutsidwa pa $ 74,760, kapena $ 890 piritsi pamaphunziro khumi ndi awiri.
Kuchuluka kwa chiwindi cha chiwindi
Pafupifupi 75 peresenti ya anthu a ku America omwe ali ndi HCV ali ndi genotype 1, pamene 20 mpaka 25 peresenti ali ndi majeremusi 2 kapena 3. Ngakhale kuti anthu ochepa chabe ku US ali ndi matenda a 4, 5 kapena 6, amakhalabe ndi mavuto ambiri Middle East, kum'mwera kwa Africa, ndi Asia.
Ku Egypt, dziko lokhala ndi HCV lalikulu, pafupifupi mmodzi mwa anthu asanu ndi awiri (14.5 peresenti) amakhulupirira kuti ali ndi kachilomboka.
Pakati pa anthu omwe ali ndi kachilombo ka HIV, mlingo wa kachilombo koyambitsa matenda a HCV umapitirira 30 peresenti ku US ndi Europe. Padziko lonse, vuto lonse la kachilombo ka HIV / HCV ndi anthu okwana 4-5 miliyoni, kapena pakati pa 10 ndi 15 peresenti.
Pakati pa anthuwa, njira zachipatala za HCV zimawoneka kuti n'zofunikira ndi chiŵerengero chachikulu cha vuto la chiwindi. Kupambana kwa Epclusa pochiza mabala onse akuluakulu a HCV kumapanga mankhwala ofunika kwambiri kuchokera ku dziko lonse lapansi, ndi zochepa chabe zotsutsana ndi mankhwala. (Onani "Malingaliro ndi Malingaliro" pansipa.)
Mlingo
Mlingo ndi piritsi imodzi (400mg sofosbuvir / 100mg velpatasvir) yotengedwa tsiku ndi tsiku kapena popanda chakudya. Mapiritsi a Epclusa ali ofanana ndi a diamondi, ndi mafilimu ovekedwa, ndi "GSI" mbali imodzi ndi "7916" pambali inayo.
Kulemba Malangizo
Epclusa amalembedwa pa maphunziro a milungu isanu ndi iwiri kwa anthu omwe ali ndi matenda a HCV osatha, omwe alibe chiwindi (omwe chiwindi chimagwirabe ntchito). Kwa anthu omwe ali ndi matenda a chiwindi, Epclusa akulamulidwa pa maphunziro a masabata 16 kuphatikiza ndi mankhwala a ribavirin .
Zotsatira Zogwirizana
Zotsatira zambiri zomwe zimagwirizanitsidwa ndi ntchito ya Epclusa (yomwe imachitika pafupifupi oposa asanu pa odwala) ndi awa:
- Mutu
- Kutopa
- Nausea
- Kufooka ndi kutaya mphamvu
- Kusagona
- Kukhumudwa
Mu kufufuza kwachipatala, zotsatira zowonongeka zinkaonedwa kuti ndizochepa ndipo osachepera 1 peresenti ya ophunzira akusiya mankhwala chifukwa cha zochitika zosautsa mankhwala.
Kwa odwala omwe ali ndi chifuwa chachikulu, matenda a kuchepa kwa magazi ndi kutsekula m'mimba amanenanso kawirikawiri. Kafukufuku wa chipatala anawonetsa kuti zotsatira zoyanjanitsidwa ndi Epclusa ndi ribavirin, ngakhale zodziwika, zinali zofewa pang'ono, ndipo ndi 5 peresenti ya anthu omwe amasiya mankhwala chifukwa cha zochitika zoopsa za mankhwala.
Kuyanjana kwa Mankhwala
Zotsatirazi ziyeneranso kupeŵa pamene mukugwiritsa ntchito Epclusa:
- Mankhwala oletsa khansa: Hycampin
- Anticonvulsants: Tegretol, Dilantin, Trileptal, phenobarbital
- Mankhwala oletsa chifuwa chachikulu: Mycobutin, Rifater, Rifamate, Rimactane, Rifadin, Priftin
- Mankhwala a kachilombo ka HIV : Sustiva (efavirenz), akuwonjezera Aptivus (tipranavir / ritonavir)
- Zowonjezera zitsamba: St. John's Wort
Kusamvana ndi kulingalira
Codarone (amiodarone) ya anti-arrhythmia, yomwe imagwiritsidwa ntchito pochita chizoloŵezi cha mtima, sivomerezedwa kuti igwiritsidwe ntchito ndi Epclusa pokhapokha ngati kuyenera kukhala ndi mankhwala. Kugwiritsa ntchito mankhwalawa kungawonongeke mtima kwambiri (bradycardia), zotsatira zake sizikumvetsetsedwe bwino. Ngati ogwirizanitsa ntchito, kuyang'ana kwa mtima kumalimbikitsidwa kwambiri.
Proton pump inhibitors sizitchulidwa kuti zisagwiritsidwe ntchito ndi Epclusa pokhapokha ngati kuti ndizofunikira mankhwala. Zikatero, Epclusa ayenera kutengedwa ndi chakudya chamadala 4 pasanayambe mlingo wa proton pump inhibitor.
Anthu omwe ali ndi kachilombo ka HIV omwe amagwiritsa ntchito mankhwalawa a tenofovir (omwe amapezeka ku Truvada , Atripla , Complera, ndi Stribild), ayenera kusamalidwa kwambiri polemba Epclusa. Pogwiritsidwa ntchito pamodzi, Epclusa amatha kuyambitsa zowononga zokhudzana ndi impso zogwiritsidwa ntchito ndi tenofovir. Kuwongolera nthawi zonse kumatchulidwa.
Antacids (mwina aluminium- kapena magnesium-based) ayenera kutengedwa mosiyana maola 4 asanayambe kapena pambuyo pa mlingo wa Epclusa, pomwe H2 receptor inhibitors (aka H2 blockers) iyenera kutengedwa chimodzimodzi ndi Epclusa kapena maola 12.
Mlingo wa mankhwala a statin Lipor (avorvastatin) ndi Crestor (rovustatin) angafunikire kuchepetsedwa ngati ataperekedwa pamodzi ndi Epclusa ngati mankhwalawa amatha kuwonjezerapo mavuto ndi zotsatira za mankhwala otsika kwa mafuta m'thupi.
Ngakhale kulibe kutsutsana kwa kugwiritsa ntchito Epclusa pathupi, deta yaing'ono yachipatala imapezeka. Komabe maphunziro a nyama ku ntchito ya sofosbuvir ndi velpatasvir sanasonyeze zotsatirapo pa kukula kwa fetus. Kuyankhulana kwapadera kumalimbikitsidwa panthawi yoyembekezera kuti muwone msanga za Epclusa mankhwala, makamaka ngati muyambe mwamsanga kapena kuyembekezera mutatha kubereka.
Ndikoyenera kuti amayi onse omwe ali ndi zaka zakubadwa ayenera kuyang'aniridwa mwezi uliwonse kuti akhale ndi pakati pa nthawi ya mankhwala. Zimalimbikitsanso kuti amayi ndi abambo awo aperekedwe njira zosachepera ziwiri zosamalirako komanso kuti azigwiritsidwa ntchito panthawi ya mankhwala komanso kwa miyezi isanu ndi umodzi.
Zotsatira:
Sukulu ya Gileadi. "ZOCHITIKA ZOCHITA ZOKUTHANDIZA - EPCLUSA ." Foster City, California
Mohamoud, D .; Mumtaz, G .; Riome, S .; et al. "Mliri wa matenda a hepatitis C ku Egypt: ndondomeko yowonongeka ndi deta." Matenda a BMC Opatsirana. 2013; 13 (288): DOI 10.1186 / 1461-2334-13-288.