Cholinga cha mankhwala othandiza kupewa matendawa ndi kuchepetsa nthenda komanso kupweteka kwa mutu wa mutu wa migraine.
Komabe mankhwala omwe amagwiritsidwa ntchito masiku ano, monga Topamax (topiramate), Inderal (propranolol), ndi Elavil (amitriptyline), nthawi zambiri sagwira ntchito monga momwe anthu angafunire. Kuonjezera apo, mankhwalawa ali ndi zotsatira zomwe nthawi zambiri zimawombera.
Nkhani yabwino ndi yakuti ochita kafukufuku tsopano akuyesetsa kwambiri kupanga mankhwala osokoneza bongo. Mapuloteni amodzi omwe akuwunikira ndi mankhwalawa ndi peptide ya calcitonin yokhudzana ndi majeremusi (CGRP), yomwe imapezeka kuti imakwezedwa kwambiri pa nthawi ya migraine.
Kwenikweni, mankhwala awiri, fremanezumab ndi erenumab, asonyeza lonjezo mu mayesero atatu - nthawi yeniyeni yokondweretsa ogwira ntchito ndi madokotala ndi okondedwa awo.
Tiyeni tiwone bwinobwino za mankhwala omwe akuwongolera CGRP.
Erenumab Yopewera Migraine Yoposera
Erenumab ndi anti-monoclonal antibody, ndipo imamangiriza ku CGRP receptor (malo oteteza mapuloteni).
Ngakhale kuti njira zowonongeka za erenumab sizikumveka bwinobwino, akatswiri amadziwa kuti CGRP imamasulidwa kuchokera ku magulu a trigeminal nerve fibers panthawi ya migraine. Atatulutsidwa, CGRP sichimangotenga mauthenga opweteka, koma imathandizanso kuchepetsa mitsempha ya magazi kunja ndi mkati mwa chigaza.
Ndipotu, pogwiritsa ntchito erenumab kuletsa malo otchuka a CGRP, ofufuza amanena kuti kugwidwa kwa migraine kungawonongeke-ndipo tsopano pali deta yabwino yosamalira chiphunzitsochi.
Mu gawo lachitatu la mayeso ku New England Journal of Medicine , opitirira 900 omwe ali ndi episodic migraine (omwe amadziwika kuti ndi osachepera 15 migraine pa mwezi), adasankhidwa kuti adzalandire limodzi mwa mankhwala atatu awa mwezi uliwonse kwa miyezi isanu ndi umodzi:
- 70-mg subcutaneous (pansi pa khungu kulowa mu mafuta anu) jekeseni wa erenumab
- Katemera wa 140-mg subcutaneous wa erenumab
- Jekeseni wa placebo subcutaneous
Ophunzirawo kapena ofufuzawo sanadziwe amene akulandira mankhwalawa pogwiritsa ntchito jekeseni wa placebo.
Zotsatira
Zotsatira za phunziroli zinawulula kuti masiku a migraine pamwezi amachepetsedwa ndi masiku 3.2 mu gulu la mankhwala a 70 mg ndi masiku 3.7 mu gulu la mankhwala a 140-mg, poyerekeza ndi masiku 1.8 mu gulu la placebo.
Atatha kufufuza, ofufuzawo adatsimikiza kuti zotsatirazi zinali zofunikira. Izi zikutanthauza kuti kuchepa kwakukulu mu gulu lachipatala kunali chenicheni (chifukwa cha zotsatira za mankhwala) osati zolakwika zophunzira mosasintha.
Zotsatira zinawonetsanso kuti pafupifupi theka la ophunzira omwe amalandira chiwerengerochi amakhala ndi 50 peresenti kapena kuchepa kwakukulu kwa masiku awo a migraine pamwezi poyerekeza ndi gawo limodzi mwa magawo anayi a gulu la placebo-kachiwiri, zotsatirazi zinali zofunikira.
Magulu ochiritsirawo anali ndi kuchepa kwakukulu kwa chiwerengero cha masiku omwe ankafunikira kugwiritsa ntchito mankhwala ovuta a migraine , poyerekeza ndi gulu la placebo.
Potsirizira pake, ophunzirawo adapanga gawo lotchedwa Migraine Physical Function Diary Diary, yomwe mapepala apamwamba amasonyeza kulemera kwa migraine kuntchito.
Zovuta zowonongeka thupi ndi zochitika za tsiku ndi tsiku zimapindulitsa kwambiri kwa magulu opatsirana poyerekeza ndi gulu la placebo.
Zotsatira Zoipa
Mitengo ya zovuta zina zinali zofanana pakati pa ophunzira omwe analandira erenumab ndi omwe adalandira placebo. Onse, osachepera 3 peresenti ya ophunzira onse adachoka pamayesero chifukwa cha zotsatirapo zoipa.
Kutsiliza
Zotsatira izi zimasonyeza kuti erenumab ndi yothandiza (m'ma mlingo onse) pofuna kupewa chisautso chachilendo pakati pa anthu ena. Erenumab ikuwoneka kuti ili ndi mbiri yabwino ya chitetezo. Izi ndizokulandira uthenga monga mankhwala omwe amapezeka pakali pano omwe amatha kupewa mankhwalawa nthawi zambiri amatha chifukwa cha zovuta.
Fremanezumab Yopewera Migraine Yachilendo
Fremanezumab ndi anti-human anti-monoclonal antibody yomwe imalumikiza ndi kulepheretsa mapuloteni enieni CGRP, mosiyana ndi zomwe zimalandira (monga erenumab).
Mu gawo lachitatu la mayeso ku New England Journal of Medicine , pa anthu chikwi chimodzi omwe ali ndi matenda a migraine osatha (omwe amadziwika kuti ndi osapitilira 15 pa mwezi kwa miyezi itatu), adasankhidwa kuti adzalandire limodzi mwa ma regoma atatu otsatirawa pa sabata 12 nthawi:
- Kachilombo kakang'ono kamodzi kake ka fremanezumab pazotsatira, kenaka ndi jekeseni lotchedwa placebo subcutaneous pa sabata 4 ndi sabata 8 (yotchedwa jekeseni ya chitatu)
- Majekesiti atatu a subcutaneous a fremanezumab omwe amapezeka pamsasa, umodzi pa sabata 4, ndipo umodzi pamlungu 8 (wotchedwa jekeseni wamwezi)
- Jekeseni wa placebo subcutaneous pachiyambi, sabata 4, ndi sabata 8
Monga chidziwitso cha erenumab, ophunzira ndi ofufuzawo sadziwa kuti akulandira mankhwala ndi ndani amene amalandira malowa.
Pamene otsogolera anali kukonzekera maulendo asanu (pa kufufuza, mndandanda, sabata inayi, sabata lachisanu ndi chitatu, ndi sabata 12), deta yawo yonse inalembedwa tsiku ndi tsiku pogwiritsa ntchito chipangizo cha mutu wa mutu. Chitsanzo cha deta yachidziwitso chimaphatikizapo ngati mutu wachitika, nthawi yake, ndi kupweteka kwake.
Zotsatira
Zotsatira za phunziroli zinawulula kuti anthu omwe amalandira jekeseni imodzi ya fremanezumab kapena majekeseni atatu a mwezi wa fremanezumab amachepetsa kuchepa kwa masiku a migraine pamwezi, poyerekeza ndi gulu la placebo.
Makamaka, anthu omwe alandira malowa amakhala ndi masiku khumi ndi awiri (10,4) a migraine motsutsana ndi omwe amalandira fremanezumab quarterly (8.5 masiku) ndi mwezi (masiku 8.0).
Kuonjezerapo, pangakhalenso kuchepetsa kwakukulu kwa chiwerengero cha masiku omwe ophunzira akufunikira kugwiritsa ntchito mankhwala ovuta a migraine mu gulu la mankhwala motsutsana ndi gulu la placebo.
Potsirizira pake, pangakhale kuchepa kwakukulu kwaumphawi wokhudzana ndi kupweteka kwa mutu (monga kuyesedwa ndi mlingo wotchedwa Headache Impact Test) kwa gulu la mankhwala motsutsana ndi gulu la placebo.
Zotsatira Zoipa
Zotsatira zovuta kwambiri pa phunziroli zinali zopweteka pa malo opangira jekeseni, zomwe zimachitika makamaka mwa ophunzira omwe alandira fremanezumab kusiyana ndi omwe amalandira malowa. Komabe, kupweteka kwa zomwe anachitazo sizinali zosiyana pakati pa magulu, zomwe zimachitika pafupifupi mofanana m'magulu onse atatu.
Kuonjezera apo, panali ziŵerengero zochepa za chiŵerengero cha enzyme ya chiwindi mwa asanu ndi atatu mwa ophunzira omwe amatenga fremanezumab. Mipingo, komabe, inabwerera ku zachilendo, kotero ophunzira sanasiye kuphunzira.
Ndipotu, kwa ofufuza a phunzirolo, onsewa adagwiritsa ntchito mankhwala monga antisteroidal anti-inflammatory (NSAIDs) kapena Tylenol (acetaminophen) kawirikawiri kapena mankhwala olepheretsa tsiku lililonse. Kudya kwa mankhwalawa kungathe kufotokozera mapulaneti ena a chiwindi omwe amatha kupitirira, makamaka popeza fremanezumab siimene zimayambitsa chiwindi.
Kutsiliza
Mu kuyesedwa kwa gawo 3, fremanezumab inapatsidwa mwina kamodzi kapena mwezi uliwonse inali yopindulitsa popewera matenda a migraine osatha. Sizinangowonjezera masiku a migraine pamwezi (pafupifupi ziwiri zosachepera), koma inachepetsera kulemala kwachilendo.
Mawu Ochokera
Mfundo yaikulu apa ndi yakuti mankhwalawa, omwe amawunikira makamaka migraines (chithandizo cham'mbuyo chithandizo chinapangidwa pofuna kuthana ndi mavuto ena, monga kugwidwa ndi kuvutika maganizo), kupereka chiyembekezo ndi njira ina kwa anthu. Iwo sali angwiro, komabe, kuthandizira malingaliro kuti njira yoyesera ndi yolakwika ikufunikiranso pokonza ndondomeko yanu yothetsera matenda.
Kuphatikiza pa kukhala ogwira ntchito popewera migraines mwa anthu ena, mankhwala awiriwa a CGRP anali ololedwa bwino-bonasi iwiri. Izi zinati, kufufuza kwina kuli kofunikira kuti tione momwe chitetezochi chikukhalira komanso chitetezo cha mankhwalawa.
Komanso, migraineurs m'maphunziro onse awiriwa anachotsedwa ngati sakanayankhira mankhwala awiri otha msinkhu wa migraine. Choncho, ndi kovuta kunena kuti erenumab, fremanezumab, kapena mankhwala ena okhudzidwa a CGRP muipiyo idzakhala njira zabwino kwa anthu omwe amatsutsa migraine .
Kuwonjezera apo, kufufuzaku kunayang'ana anthu akuluakulu okha, kotero mayesero omwe amaphunzira ana ndi achinyamata omwe ali ndi migraine amafunikanso.
> Zotsatira:
> Bigal ME, Walter S, Rapoport AM. Peptide yamtundu wa Calcitonin (CGRP) ndi kumvetsa kwamtundu wa migraine komanso chikhalidwe cha chitukuko. Mutu . 2013 Sep; 53 (8): 1230-44.
> Buse DC et al. Kuchuluka kwa matenda a migraine, kulemala, ndi zikhalidwe za anthu: zotsatira kuchokera ku American Migraine Prevalence and Prevention Study. Mutu. 2012 Nov-Dec; 52 (10): 1456-70.
> Goadsby PJ et al. Chiyeso cholamulidwa cha erenumab kwa episodic migraine. N Engl J Med 2017; 377: 2123-32.
> Schuster NM, Wokwatulidwa AM. Calcitonin yokhudzana ndi majini a peptide othandizidwa ndi majini a mankhwala a migraine ndi mutu wa masana: Kuwunika. Clin Neuropharmacol . 2017 / Aug; 40 (4): 169-74.
> Silberstein SD ndi al. Fremanezumab pofuna kupewa chithandizo cha matenda a migraine osatha. N Engl J Med 2017; 377: 2113-22.