MunaJuly, 2015, FDA yakabvumira mushonga mutsva weIncresto (Novartis) yekurapa mwoyo kusakundikana. Iwe unogona kuverenga pamusoro peIntero pano.
Kushingaira kwechirwere ichi chitsva ichikwirira pakati pevadzidzisi vekushaya moyo, uye nokuda kwechikonzero chakanaka. Mune chirongwa chikuru chemakiriniki (PARADIGM-HF), Entresto yakawandisa zvakanyanya enalapril, iyo iye zvino ndiyo inonyanya kushandiswa kwerapi kune varwere vane mwoyo kusakundikana.
Entresto ndiye wekutanga weAARN kirasi yemishonga. Iyi mishonga inobatanidza ARB inhibitor (munyaya ino, valsartan), ine neprilysin inhibitor (sacubitril). Neprilysin inhibition ndiyo mutsva weAARNI zvinodhaka.
Apo iyo enzyme neprilysin inorambidzwa mumoyo kusagadzikana varwere, ropa rezinga re natriuretic peptides rinowedzera. Nemhaka yekuti natriuretic peptides inogona kubatsira mumoyo kusakundikana, vatsvakurudzi vakaratidza kuti mishonga yakadai seIncresto inogona kuvandudza mugumisiro wevarwere vane chirwere ichi. Migumisiro yePARADIGM-HF yokuratidza inoratidza kuti vatsvakurudzi vakanga vakarurama.
Pane Kune Mucheto Kunoita Neprilysin Inhibition Here?
Kunyange zvazvo Entresto ichionekwa seyese inoshanda uye yakachengeteka muPARADIGM-HF muedzo, kune zvimwe zvinhu zvishoma zvatisingazivi pamusoro penguva refu neprilysin inhibition.
Neprilysin ine zviito zvizhinji mukuwedzera kune kuderedza mazinga evanhu vepanridetic peptides, uye zvimwe zvezviito izvi zvinoita sezviri kubatsira.
Saka kuvhara neprilysin hakusi chinhu chakanaka chose chekuita.
Kunyanya, neprilysin inoderedza kuunganidza kweprotini isina kunaka mumuviri, kusanganisira mapuroteni anokonzerwa nechirwere cheAlzheimer uye amyloidosis , uye kunyange kenza yeprostate . Ichokwadi, vatsvakurudzi vari kutsvaga kushingaira zvinodhaka zvinogona kuwedzera basa re neprilysin, mune tarisiro kuti inogona kubatsira kubata kana kudzivirira mamiriro akadai.
Saka, pasinei nokuti zvishoma zvakanyanya zvinokonzerwa nemigumisiro zvakashamiswa neIncresto muPARADIGM-HF muedzo, pane imwe nguva inogona kunge ine mikana yemigumisiro yakareba kwenguva refu nemushonga unodzivisa neprilysin.
Mune zvimwe zvandaitsvakurudza paIncresto ndaikwanisa kuwana kunyange kutaura (zvichida nevanotsvakurudza kana Novartis) yemigumisiro yakaipa yekusingaperi neprilysin inhibition. Saka ndakabvunza Novartis kuti ndibvunze kana kambani ine uchapupu, imwe nzira kana imwe, iyo kushandisa Entresto inogona kuisa njodzi yezvirwere zvakadai seAlzheimer's, amyloidosis, kana kenza yeprostate.
Novartis Replies:
Pashure pemazuva mashomanana panguva iyo kambani yakabvunza nyanzvi dzayo, ndakagamuchira mhinduro iyi kubva kuNovartis. Heino zvakakwana:
"Neprilysin inobatanidzwa mune zvakasiyana-siyana mukati momuviri, kusanganisira kuputsa marudzi akasiyana-siyana emapeptide anogadziriswa, ayo - nekutarisa neprilysin - Entresto inobatsira kuwedzera, zvichiita kuti zvive nemigumisiro inokonzerwa nekushaya mwoyo kwevarwere.Neprilysin imwe yezvinyorwa zvakawanda zvine chokuita nekuputsa pasi amyloid beta proteins.Nhamba kubva purogiramu yePARADIGM-HF yekuvandudza, ine vanopfuura 10 000 varwere vakadzidza, hairatidze chero matambudziko anokonzerwa neamyloidosis, kenza yeAlzheimer kana prostate neIntresto. Zvakakosha kuziva kuti varwere vane mwoyo yekukundikana vane 50 % kufa kwevanhu mumakore mashanu pasinei nekurapwa nemishonga yakakosha yezvino, chirwere chekufa chinopfuura kupfuura kanzira dzakawanda.Intero inoderedza kufa, inodzivirira kugarisa uye inoita kuti vanhu vane HF-REF vanzwe zviri nani. "
Ndakakundwa nezvinhu zvishoma pamusoro pemhinduro iyi. Chokutanga, kambani yakanga isati yakagadzirira nemhinduro pakarepo (zvandinonzwa) ndeye mubvunzo wakajeka uye wakakosha.
Uyezve, kambani haisi kuramba ngozi yokuti neprilysin inhibition inogona kukuvadza mamwe marudzi ezvirwere zvakakomba. Ichokwadi kuti zvidzidzo zvavo hazviratidzi uchapupu hwekukuvadza kwakadaro kunonyaradza, asi tinofanira kuona kuti zvidzidzo neIncresto zvose zvave zvishoma kwenguva shoma, uye kuti hazvisi pachena kuti varwere vakabata neIncresto vainyatsongororwa kuti amyloidosis, kenza yeAlzheimer kana prostate .
Pakupedzisira, kambani inoratidza kuti kuora mwoyo kwemamiriro ezvinhu akaipa zvakadai kuti kunyange kana mishonga yavo ichikonzera kana kuti ichiwedzera zvirwere izvi, njodzi inofanira kuitora.
Izvi, zviri pachena, inhau yekutonga kwemunhu. Pasinei nokuti murwere anotarisa mungozi sechinhu chinokosha kunobva pane zvaanoona nezvezvipingamupinyi nezvikomborero. Ichi chiyero chakaoma kuita, hongu, kana kwete dzose njodzi dzinodanwa kunze.
The Bottom Line
Entresto inoratidzika kuva mishonga inokumanikidza yevarwere vane mwoyo kusakundikana, uye pasina mubvunzo ichashandiswa zvikuru. Izvi hazvina mubvunzo zvichabatsira varwere vakawanda vane mwoyo yekukundikana kurarama kwenguva yakareba, uye vane zviratidzo zvishomanana.
Asi zvakananga nokuti Entresto ine maitiro ezvinodhaka zve blockbuster, uye saka nhamba huru dzevarwere dzichaiswa pachena neprilysin inhibition kwekutanga, zvichave zvakakosha zvikuru kune Novartis (uye FDA) kuti vaite zvidzidzo zvemashure ekutsvaga, kuitira kuti chero "zvisingatarisirwi" migumisiro yechiratidzo inogona kuonekwa uye inozivikanwa nekukurumidza sezvinobvira.
Sources:
McMurray JJV, Packer M, Desai AS, uye al. Angiotensin-neprilysin inhibition uye inalapril mumoyo kusakundikana. N Engl J Med 2014; DOI: 10.156 / NEJMoa1409077.
Jessup M. Neprilysin inhibition-chirongwa chemazwi chekushaya mwoyo. N Engl J Med 2014; DOI: 10.1056 / NEJMe1409898.