Novantrone (mitoxantrone) ndi Tysabri (natalizumab) zonsezi zimagwiritsidwa ntchito mofananamo pochiza matenda ambiri - kwa anthu omwe ali ndi vuto lobwezeretsa-multiple retler (RRMS) kapena kupitiliza-kubwezeretsa multiple sclerosis (PRMS). Novantrone imasonyezedwa kuti ikhale yopitilira mofulumira kwambiri (SPMS), ndipo Tysabri ikhoza kuthandizira pa nthawi ya SPMS kumene zilonda zowonongeka zikuwonetseratu ku MRIs.
Palibe chimodzi cha MS.
Izi zikutanthauza kuti anthu ambiri omwe ali ndi mitundu iyi ya MS ali ndi mwayi wosankha: Tysabri kapena Novantrone. Ngakhale zikanakhala zabwino ngati wina ali ndi phindu lalikulu pamzake pazinthu zonse, izi siziri choncho. Monga momwe zilili ndi MS, chigamulo cha Tysabri vs. Novantrone chimachokera pa zinthu zambiri zovuta. Chisankhocho chiyenera kukhazikitsidwa pa zokonda ndi moyo wawo, dokotala amalangizidwe ndi kupeza, ndi zinthu zina monga mtengo, kuopa zowonongeka komanso zofunikira.
M'nkhaniyi, ndayesetsa kuyerekeza Tysabri ku Novantrone mbali ndi mbali pazochitika zambiri za mankhwala omwe ndikudziwa kuti anthu akuwakonda kwambiri. Ndiroleni ndikuwonetseni kuti mankhwalawa ali ndi njira zosiyana zedi , kotero sikuti ngati mankhwala amodzi amachititsa ntchito yake "bwino" - amachita zinthu zosiyana, koma ali ndi cholinga chomwecho chochepetsera kupititsa patsogolo kulemala ndikuletsa kuti MS abwererenso.
Tysabri ndi anti-monoclonal antibody yomwe imaletsa ma T-maselo ena kuti asawoloke malire a ubongo, pamene Novantrone ndi chemotherapy yomwe imapangitsa kuti thupi lizigwira ntchito.
Nazi zinthu zina zomwe muyenera kuziganizira pakupanga kusankha kwanu:
Kupeza kwa Dokotala wanu ndi Zochitika Zanu
Madokotala okha omwe amalembedwa ndi ndondomeko ya kuyang'anira TOUCH akhoza kupereka Tysabri.
Anthu ambiri omwe adokotala awo sali ndi mwayi wopeza Tysabri amatha kusintha kwa katswiri wa sayansi ya ubongo yemwe ali ndi mwayi. Dokotala wina akhoza kupereka Novantrone, komabe, ndibwino kuti aperekedwe ndi dokotala wodziwa bwino pakuyang'anira ndi kusamalira odwala omwe amalandira mankhwala a chemotherapy a chikhalidwe ichi.
Zotsatira Zachisanu ndi Chitetezo
Ngakhale kuti mbiri ya ngozi ya Tysabri ndi Novantrone ndi yosiyana kwambiri, onsewa amachititsa kuti anthu ambiri asamachite mantha kapena ayi. Tysabri ali ndi mbiri ya PML ndi Novantrone ndi chemotherapy. Pano pali tsamba lachisanu ndi chiwiri - Novantrone nthawi zambiri zimakupangitsani kumva ngati mwachisawawa mutatha kulowetsedwa kwa masiku angapo, ndi zinthu monga kusanza / kunyoza, chiopsezo chowonjezereka cha matenda a chikhodzodzo ndi kupuma, ndipo, mwina mungataya zina tsitsi lanu. Pa Tysabri, mwina simungamve ngati kwambiri m'masiku omwe akutsatiridwa, chifukwa zotsatira zake zowonongeka, kutopa, kupweteka mutu komanso kupweteka. Cholinga cha anthu ambiri chitha kugwiritsidwa ntchito pakati pa (1.2 ndi 10,000) ngozi ya PML ndi Tysabri pangozi ya khansa ya m'magazi (7.4 pa 1,000) kapena kuwonongeka kwa mtima ndi Novantrone.
Kusinthasintha
Tysabri imayang'aniridwa mu intravenously (ndi IV mu malo osungirako mankhwala kapena mu ofesi ya dokotala) kamodzi pa mwezi.
Novantrone imachitidwa intravenously miyezi itatu iliyonse.
Kugwiritsa Ntchito Nthawi Yakale
Tysabri (pakadali pano) ingagwiritsidwe ntchito kosatha, ngakhale chitetezo cha mankhwala pambuyo pa zaka 2 za ntchito sichidziwika. Komabe, Novantrone, ingagwiritsidwe ntchito kwa zaka ziwiri kapena zitatu (10 kapena 11 mlingo wokwanira) m'moyo wa wodwalayo.
Mphamvu
Kugwiritsa ntchito mankhwalawa kumawoneka ngati kofanana, koma kovuta kuyerekeza mwachindunji, chifukwa cha kusiyana kwa kupanga mapangidwe. Mu kafukufuku wa zaka ziwiri, poyerekeza ndi malo otchedwa placebo, Novantrone awonetsedwa kuchepetsa chiwerengero cha kubwereranso , kuchepa nthawi pakati pa kubwereranso, kuwonetsa kuchepetsa kuchepa kwa 61 peresenti ya kuwonongeka kwa ophunzira omwe angathe kuyenda ndi kulemala kwakukulu kwambiri.
Tysabri yasonyeza kuchepetsa 68 peresenti ya kubwereranso kwa zaka ziwiri, komanso kuchepetsa kukula kwaumalema ndi kuchepetsa chiwerengero cha kubwereza kwatsopano.
Mimba (Yamakono ndi Yamtsogolo) ndi Kuyamwitsa
Akazi omwe ali ndi mimba kapena akuyesera kutenga pakati sayenera kutenga Tysabri kapena Novantrone, komanso sayenera kugwiritsidwa ntchito ndi amayi omwe akuyamwitsa. Tysabri amawoneka kuti ali mu "gawo lakutenga C," kutanthauza kuti linavulaza fetus m'ziphunziro za nyama koma zotsatira za anthu sizidziwika. Tysabri ayenera kuimitsidwa kwa nthawi ndithu asanayambe kutenga pakati (kawirikawiri miyezi itatu kapena itatu, kambiranani ndi dokotala wanu). Novantrone amaonedwa kuti ali mu "D Category D," kutanthauza kuti akhoza kuvulaza mwana pamene ali ndi pakati. Akazi a msinkhu wobereka amafuna kuyesa mimba asanalandire mlingo uliwonse wa Novantrone.
ZOCHITIKA KWAMBIRI: Azimayi ena (5-30%) amathera nthawi yonse ya Novantrone kuti asayambe nthawi zonse ndipo ali osauka (sangathe kutenga mimba). Ndikofunikira kwambiri kulingalira izi ngati mutha kusankha kapena kugwiritsa ntchito Novantrone ndikukambirana ndi mwamuna wanu kapena mnzanuyo. Kafukufuku waposachedwapa amasonyeza kuti mwayi woperewera kwa amayi ukhoza kuchepetsedwa ndi kugwiritsa ntchito mankhwala opatsirana (estroprogestinic mankhwala) pa mankhwala ndi Novantrone ndipo izi ziyenera kukambidwa ndi dokotala wanu.
Solu-Medrol
Solu-Medrol, corticosteroid yamkati yomwe imagwiritsidwa ntchito kufikitsa nthawi ndi kuchepa kwa kubwereranso, sikulandiridwa kwa anthu omwe akugwiritsa ntchito Tysabri kwa mwezi umodzi kapena chitsiriziro chitatha, chifukwa cha kuchulukitsidwa kwa thupi, ngakhale pali ena madokotala omwe angapereke mankhwalawa ngati ndikubwezeretsanso ndipo ndamva za mlingo wokwanira (125 mpaka 500 mg) womwe umaperekedwa panthawi imodzimodzimodzi ndi kulowetsedwa kwa Tysabri kuti athandizidwe ndi zotsatira zochepa zolakwika ku Tysabri. Komabe, Solu-Medrol nthawi zambiri amaperekedwa nthawi imodzimodzimodzi ndi kulowetsedwa kwa Novantrone ndipo angathe kupatsidwa mwaulere ngati kubwezeretsedwa kwa Novantrone infusions.
Kuwunika
Musanayambe Novantrone, mutenga mayesero awa: kuyesa magazi (CBC, chiwindi cha chiwindi, kutenga pakati kwa amayi), electrocardiogram (EKG), ndi echocardiogram ngati kuyesedwa koyambirira kwa gawo lamanjenje la ejenti (LVEF) liyenera kuchitidwa pamaso pa mlingo uliwonse ya Novantrone. Chithandizo cha Novantrone chiyenera kutha ngati LVEF isintha kwambiri kapena ili pansi pa 50%. Mayesero onse adzabwerezedwa musanatenge chithandizo chilichonse. Tysabri ingaperekedwe kokha ku malo osungirako mankhwala omwe amalembedwa kudzera pulogalamu ya "TOUCH". "KUKHALA" kumayimira "Tysabri Outreach: Kudzipereka Kwodzipereka ku Umoyo" ndipo ndi pulogalamu yomwe inayikidwa pofuna kuyesa milandu iliyonse ya PML kumayambiriro, komanso kuwateteza. Mudzayang'aniridwa ndi dokotala kapena namwino ndikupeza MRI musanayambe Tysabri, kenaka anayesera miyezi itatu kapena 6 iliyonse kuti asinthe mazira. Mudzafunsidwa kuti mukambirane zambiri zokhudzana ndi chitetezo cha odwala ndi kudzaza kafukufuku wochepa musanayambe kulowetsedwa.
Contraindications
Novantrone sayenera kugwiritsidwa ntchito ndi anthu omwe ali ndi matenda a mtima kapena kumwa mankhwala ena omwe angawononge mtima, matenda a chiwindi, zofiira ndi zoyera magazi, mavuto a magazi, khansara kapena mbiri ya mankhwala ochizira khansa. Tysabri sayenera kutengedwa ndi anthu omwe amatenga ma immunosuppressants kapena immunomodulators kapena anthu omwe ali ndi ma chitetezo a chitetezo. Ngakhalenso mankhwala osayenera sayenera kutengedwa ndi anthu omwe ali ndi matendawa.
Mtengo
Tysabri ndi imodzi mwa mankhwala otsika kwambiri a MS omwe alipo, pa $ 28,400 pachaka kwa Tysabri palokha. Novantrone imadula pafupifupi madola 3,000 pachaka kwa mankhwala, kuti azikhala otsika mtengo kwambiri. Zonsezi zimabwera ndi ndalama zina zowonjezera.
Pansi
Chigamulo chogwiritsa ntchito Tysabri kapena Novantrone ndichinthu chokha, chomwe chingakhale chophweka kapena chovuta, malingana ndi zomwe mumaganizira kapena zomwe zikukukhudzani (mwachitsanzo, munthu yemwe ayenera kulipira mthumba angapeze Novantrone zambiri Chokondweretsa, pamene mtsikana yemwe akufuna ana m'tsogolomu akhoza kudalira kwambiri Tysabri). Ngati dokotala ali ndi maganizo amphamvu mwa njira imodzi, onetsetsani kuti mumufunse kuti afotokoze zifukwa. Nthawi zonse muzimasuka kuti mutenge maganizo ena ngati simukukhulupirira. Zitha kukhala kuti dokotala sakhoza kupeza Tysabri - ngati mukufuna, pezani dokotala wina amene amamufunsa ndikufunsa maganizo ake. Mwinanso, mwina dokotala wanu sasangalala pogwiritsira ntchito mankhwala a chemotherapy, koma pali madokotala ena omwe agwiritsira ntchito Novantrone m'mazana ambiri odwala omwe ali ndi zotsatira zabwino. Pitirizani kufunafuna mayankho mpaka mutakhutitsidwa.
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