Dzimwe nyanzvi dzezvechirwere dzinoenda kuchikara kune mutsva wekirasi yemishonga yehushutera.
PaAmerican College of Cardiology's (ACC's) Gore reScientific Session rakagadzirirwa munharaunda yedhorobha muguta reSan Diego pakati pemakore aMarch 2015, mhepo yairemerwa nehurukuro yePCSK9 inhibitors. Kunyanya, vazhinji vane cardiologist vaivapo vakanga vava kunyatsotsinhanisa nezvemigumisiro yemitambo yakareba gore reAmgen's Repatha (evolocumab) . Mumakiriniki ekuedzwa, PCSK9 inhibitors se evolocumab uye Regeneron / Sanofi's Pricious (alirocumab) yakaratidzwa kuderedza LDL-C ("yakaipa" cholesterol) zvishoma nezvakafanana nematemu uye zvichida zvimwe .
( Statins madhiragi akadai saZocor naCrestor.
Pakupedzisira, kungoderedza LDL cholesterol mazinga kungozvidzikisa hazvingaiti kuti zvibatsire zvachose kunze kwekudzikisawo njodzi yezviitiko zvepfungwa dzemangwana sekurohwa uye kushaya mwoyo. Uye kuitira kuti tione kana nguva yakareba yekudzivirira inobatsira iripo, tinoda nguva yakareba yekudzidza ... kwemakore kwenguva yakareba kudarika kukurudzira, asi, migumisiro yegore rimwe chete yatinoparidza panguva ino.
Chii Chinonzi PCSK9 inhibitors?
Proprotein convertase subtilisin / Kexin rudzi rwe 9 kana PCSK9 inonzi gene inobatanidzwa mune cholesterol uye mafuta asidi metabolism. Vanhu vane zvisikwa zvipenyu zvePCSK9 zvisingawanikwi vakaonekwa seine mazinga eLDL-C ("yakaipa" cholesterol) yakaenzana neavo vane maitiro emwero. Uyezve, kuchinjwa kwegene kwave kwakabatanidzwa kuzvivimbiso zvakanyanya zvemhuri hypercholesterolemia , chirwere chinokuvadza chinokonzera zvakakwirira zvikuru zve lipids kana cholesterol uye chirwere chemwoyo.
Mukuona kwekucherechedza kwakadaro, makambani emishonga Amgen uye Regeneron / Sanofi vakasika mishonga inonzi monoclonal iyo inotarisa PCSK9 protein (yakanyorwa nePCSK9 gene): Kudzokorora uye kwakakosha maererano.
Migumisiro Mushure megore Rimwe (ish) yeTradio Na PCSK9 Inhibitors
Musi waMarch 17, 2015, The New England Journal of Medicine yakabudisa mapepa maviri ekutsvaga mavhiki makumi mashanu nemakumi mashanu kubva kuEvolocumab's OSLER-1 uye OSLER-2 miedzo uye nemavhiki 78 kubva kuReneral / Sanofi's ODYSSEY miedzo yezvipatara.
Mimwe migumisiro inokosha kubva kumisungo ye OSLER inosanganisira zvinotevera:
- Mumasvondo makumi mana ehutachiona, evolocumab yakasimbisa kuderedzwa kwemazinga eLDL-C ne 61 muzana muvatori vechikamu vane maitiro akasiyana-siyana ehutano hwemwoyo.
- Kupedza vhiki makumi mashanu nemasvondo ekurapa, muyero wemwoyo yematambudziko (kukanganisa kwemwoyo, kurwisa, TIA nezvimwe zvakadaro) paive nezvikamu zviviri nemazana maviri kubva muzana kune avo vanotora kwete kutora evolocumab asi pamutambo wekuchengetedza maitiro (kutora statins) zvichienderana ne 0.95% kune avo vanotora evolocumab uye pane-standard-care-back therapy (kutora statins).
- Zviitiko zvinorwadza zvehutano neurocognitive pamwe nezvisingaiti zvinosvibisa zvinosanganisira arthralgia, musoro wepfungwa, kurwadziwa kwemakumbo, uye kuneta zvakataurwa kakawanda kune vatori vechikamu vachitora evolocumab.
Zvimwe zviitiko zvinokosha kubva kuODYSSEY miedzo zvinosanganisira zvinotevera:
- Kupedza vhiki makumi manomwe nemasere ekurapa, alirocumab yakaderedzwa LDL-C mazinga neanenge makumi matanhatu kubva muzana muzana kune avo vatori vechikamu (avo vane mhuri ye hypercholesterolemia kana dzakawanda dzepfungwa zvinokonzerwa nehutachiona, chirwere cheshuga nezvakadaro).
- Dambudziko rakaipa rinokonzerwa nekurapa ne alirocumab rinosanganisira kupindira-nzvimbo maitiro, myalgia, neurocognitive uye ophthalmologic zviitiko.
- Vose varwere vari muchidzidzo ichi vakanga vatova mitemo-ingava yepamusoro-dose kana kuti inowirirwa mubare. Muvatachiwana vanogamuchira alirocumab, mutengo wemagariro emwoyo wakanga uri 1,7 muzana kusvika 3.3 muzana kune avo vanotora placebo.
Iko PCSK9 Inhibitors muNew Statins?
Cardiologists ikozvino vanobvunza nezvehukama hweku cholesterol sekuguma-zvose-be-zvose biomarker. Sezvatakadzidza kubva pakutsvakurudza kwakapfuura, mamwe madhiragi anongoderedza LDL-C, kuwedzera HDL nezvimwewo zvingasava nerudzi rwechokwadi-sekudzivirira kurwisa kana kushaya mwoyo. Nzira iyo cholesterol uye lipids inobatana mumuviri wedu yakaoma kunzwisisa kupfuura isu iye zvino tinonzwisisa.
Kubva kure, nzira yakanakisisa yatinayo yekurapa chirwere chemwoyo ndiyo mitemo, yakasiyana nedhiragi yezvinodhaka iyo inodzivirira mangwana yezviitiko zvepfungwa. Iyi mishonga inogona kushanda nekungodzikisa mazinga eLDL asiwo nekugadzirisa mapepa anovhara mitsetse yedu.
Kuti PCSK9 inhibitors ionekwe sedzakakosha sematemu, tinoda makore akawanda emigumisiro, ndicho chikonzero Amgen ari kuisa pamwe chete FOURIER kudzidza. ICHINYANZIDZO chekudzidza chichange chiri kuongorora kwemakore mashanu ekutungamira kwe evolocumab mune avo vanotora mitemo uye pangozi yepamusoro yezviitiko zvepfungwa zvakadai sekurohwa nekushaya mwoyo. (Kana iwe uchida, AMGEN ikozvino inokumbira vatori vechikamu kuti vadzidze.) Zvine mhinduro kubva kuFOURIER yekudzidza, vatsvakurudzi vanotarisira kuwedzera kuderera kwezvakaipa zvinokonzerwa nemwoyo yematambudziko zvakaratidzwa mugore rimwe kusvika kumakore akawanda . Uyezve, zvigumisiro kubva pane zvidzidzo zvinogona kutibatsira kuti tinyatsonzwisisa kuti varwere vanowanikwa zvakadini kubva kuPCSK9 inhibitors.
Mumakore mashomanana, kana tikaona kupiwa kwenguva refu yemwoyo, zvino tinogona kutarisa kubudirira kwemasimoni kune Amgen, evolocumab's maker. Kubudirira kwakadaro kunoenderana nokuti pamusana pokusaziva chokwadi kuti vanhu vanorwara vanogona kubatsirwe zvakadini kubva kuEvolocumab, pane chimwe chinhu chinotambudza pamusoro pePSK9 inhibitor: Tsvakurudzo inoratidza kuti kune vamwe vanhu, evolocumab uye alirocumab inogona kusvibisa nehutachiona hwehutachiona. Kunyanya kunyanya, dambudziko reODYSSEY rakaratidza kuti alirocumab inogona kukanganisa kukanganisa, kukonzera amnesia kana kukonzera kuvhiringidzika.
Sources
Chinyorwa chinonzi "PCSK9 kuvhara muvarwere vane hypercholesterolemia" naNR Desai uye MS Sabatine kubva kuna Elsevier muna 2015. Kuwana kubva kuCliniical Key musi wa3/15/2015.
Chinyorwa chakanzi "Efficacy uye kuchengetedzwa kweAlirocumab muRucucing lipids uye Mwoyo Yezvakaitika" naJG Robinson uye vanyori vanyori kubva kuNeJM 3/17/2015. Yakasvika pa3/15/2015.
Chinyorwa chakanzi "Efficacy uye kuchengetedzwa kweEvolocumab mukuderedza Lipids uye Mamiriro Emoyo" neMS Sabatine uye vanyori vanyori kubva kuNeJM 3/17/2015. Yakasvika pa3/15/2015.
Chinyorwa chakanzi "Kuderedza LDL Cholesterol Yakanaka, asi Sei uye Nani?" by NJ Stone naDML James kubva kuNeJM 3/17/2015.