Mishonga Yokutanga Inogona Kubata Zvose zveHCV Infection
Epclusa (sofosbuvir uye velpatasvir) inonzi fixed-dose combination drug used in the treatment of chronic hepatitis C (HCV) infection. Mishonga mbiri iyo ine Epclusa inobata nekuvhara zvose enzyme (RNA polymerase) uye protein (NS5A) inokosha pakudzokorora kwehutachiona.
Overview
Epclusa yakagamuchirwa munaJune, 2016 neU.S. Food and Drug Administration (FDA) iyo inoshandiswa kune vanhu vakuru vane makore gumi nemasere uye kupfuura uye ndiyo inotanga kushanda-inoshanda yakakwanisa kubata mapoka matanhatu makuru eHCV genotype .
Epclusa yakakodzera kune vose vaimbove vasati vashandurwa (kurapa-naïve) varwere, pamwe chete nevaya vasina rutivi kana kusina mhinduro kune HCV yakatanga kurapwa (kurapa-vanoziva).
Epclusa inogona kushandiswa kune vanhu vakaongororwa vane cirrhosis , kunyange zvazvo zvinokurudzirwa kuti ribavirin inobatanidzwa pamwe chete mumamiriro ekurondedzerwa kweprhosis (kureva, uko chiropa chisisisiri kushanda). Epclusa inonzi inorapwa zvirwere zvinosvika 100 muzana mune mamwe mapoka, nepo kubudirira kwayo kune vanhu vane chirwere cheprhosis chakakodzwa kunodarika 94%.
Epclusa yakabudiswa pamwero wekutengesa mutengo we $ 74,760, kana $ 890 pamapiritsi kwemavhiki gumi nemaviri ekurapa.
Hepatitis C Kuwanda
Vanenge 75 kubva muzana veAmerica vane HCV vane geneotype 1, asi 20 kusvika ku25 muzana vane genotypes 2 kana 3. Kunyange zvazvo nhamba shomanana yevanhu muUnited States inotapukirwa nejenotype 4, 5, kana 6, inoramba iine matambudziko akawanda mu Middle East, kumaodzanyemba kweAfrica, uye Asia.
MuEgypt, nyika ine HCV yakawanda yevanhu, inenge imwe chete pavanhu vanomwe (14.5 muzana) inotendwa inotapukirwa.
Pakati pevanhu vanogara neHIV, chiyero cheHCV co-utachiona chinomhanya zvakakwirira se30 muAmerica neEurope. Munyika yose, mutoro mukuru weHIV / HCV co-utachiona hwevanhu vanosvika mamiriyoni 4 kusvika ku5, kana pakati pe10 ne15 muzana.
Pakati pevanhu, HCV kurapwa inofungidzirwa kuti inokosha nepamusoro yezinga rekushaiwa kwechiropa. Kubudirira kweEpclusa mukurapa maHCV makuru ejotypepes inoita kuti uve mushonga unonyanya kukosha kubva munyika yose, uye zvishoma chete zvinopesana nemishonga. (Ona "Zviratidzo uye Mafungiro" pasi apa.)
Dosage
Dhani imwe ipiritsi (400mg sofosbuvir / 100mg velpatasvir) inotorwa zuva nezuva kana kuti isina zvokudya. Epclusa mahwendefa akafanana nemadhimoni akaumbwa, uye firimu-yakavezwa, ne "GSI" yakaiswa kune rumwe rutivi uye "7916" pane imwe.
Kunyora Zvikurudzira
Epclusa inorayirwa pamusoro pevhisi 12-vhiki yevanhu vane chirwere chisingaperi chine HCV, kana vasina kana kubhadhara chirwere chepirhosis (umo chiropa ichiri kushanda). Mune vanhu vane chirwere cheprhosis chakakomborerwa, Epclusa inorayirwa kwemaawa gumi nemaviri ekubatana pamwe chete nemishonga ribavirin .
Nharaunda Dzakabatana
Maitiro akawandisa anowanzobatanidzwa nekushandiswa kweEpclusa (inowanikwa nevanenge 5 muzana yevarwere) ndeiyi:
- Headache
- Kuneta
- Nausea
- Kushaya simba uye kurasikirwa kwesimba
- Kunyunyuta
- Kusvibiswa
Mukutsvakurudza kwekliniki, migumisiro yemagumisiro yaiwanzoonekwa sechechi yakaderera neashoma kupfuura 1 muzana yevatori vechikamu kurambidza kurapwa semugumisiro wezviitiko zvinodhaka zvinodhaka.
Mune varwere vane chirwere chinonzi decompensed cirrhosis, chirwere chekushaya ropa uye chirwere chinowanzotaurwa. Kuongorora kwechipatara kwakaratidza kuti migumisiro yakasangana neEpclusa uye ribavirin inoshandiswa, iyo yakajairika, yaiwanzoreruka kuenzanisa, uye ne 5 muzana chete yevatori vechikamu vanoramba kurapwa semugumisiro wezviitiko zvinodhaka zvinodhaka.
Kubatana Kwemishonga
Izvi zvinotevera zvinofanirawo kudziviswa kana uchishandisa Epclusa:
- Mishonga inopesana nekenza: Hycampin
- Anticonvulsants: Tegretol, Dilantin, Trileptal, phenobarbital
- Anti-tuberculosis mishonga: Mycobutin, Rifater, Rifamate, Rimactane, Rifadin, Priftin
- Mishonga yeHIV : Sustiva (efavirenz), yakasimbiswa Aptivus (tipranavir / ritonavir)
- Mishonga inowedzera: St. John's Wort
Contraindications nekufungisisa
Mishonga inorwisa-arrhythmia Codarone (amiodarone), yakashandiswa kurapa kusagadzikana kwepfungwa, haisati yakurudzirwa kuti ishandiswe neEpclusa kunze kwekunge inonzi iine mishonga inokosha. Kushandiswa pamwe chete kwemishonga iyi kunogona kukonzera kukanganisa kwakanyanya kwemoyo (bradycardia), iyo yamufaro isati yakanyatsonzwisiswa. Kana kubatanidzwa, kutarisa mwoyo kunonyatsorudzirwa.
Proton pump inhibitors haigoni kukurudzirwa kuti ishandiswe neEpclusa kunze kwekunge inonzi iine mishonga inokosha. Kana zvakadaro, Epclusa inofanira kutorwa nechingwa maawa mana isati yasvika purotoni pump inhibitor dose.
Muvanhu vane utachiwana hweHIV vanoshandisa mishonga yeTenofovir (inowanikwa muTruvada , Atripla, Complera, uye Stribild), kunyanya kutarisirwa kunofanira kutorwa pazvinyorwa zveEpclusa. Kana yakashandiswa pamwe chete, Epclusa inogona kusimbisa zvinodhaka zvehuputi zvine chokuita neTenofovir. Nguva dzose kuongorora mafambiro emhepo kunokurudzirwa.
Antacids (ingava aluminium- kana kuti magnesium-based) inofanira kutorwa pamwe chete maawa 4 isati yasvika kana kuti mushure mekuberekwa kweEpclusa, asi H2 receptor inhibitors (aka H2 blockers) inofanira kutorwa pamwe chete neEpclusa kana maawa gumi nemaviri.
Dhiyosi yemishonga yemaginha Lipitor (avorvastatin) uye Crestor (rovustatin) inogona kuderedzwa kana ichinyorwa pamwe chete neEpclusa sekubatana kwemishonga iyi inogona kuwedzera zvose zvakakanganiswa uye nemigumisiro yemishonga yekuderedza cholesterol.
Kunyange zvazvo pasina kupesana kwekushandiswa kweEpclusa pakuberekwa, rudiki rwekliniki dhein data inowanikwa. Zvisinei, zvidzidzo zvemhuka mukushandiswa kwezvose sofosbuvir uye velpatasvir hazvina kuratidza kuti hazvina maturo pakukura kwe fetus. Kubvunzurudzwa kwevadzidzi kunokurudzirwa panguva yekuzvitakura kuongorora kukurumidza kweEpclusa therapy, kunyanya kana kutanga pakarepo kana kumirira kusvikira mushure mokuberekwa.
Zvinokurudzirwa kuti vakadzi vose vane makore anobereka vana vanofanira kuongororwa mwedzi wega wega nekuda kwepamuviri panguva yekurapa. Inokurudzirwa kuti vose vaviri nemurume wavo varoorana vagoverwa maitiro maviri asingaiti mahomoni ekudzivirira kubata pamuviri uye kuti anoshandiswa panguva yekurapa uye kwemwedzi mitanhatu inotevera.
Sources:
Gilead Science. "ZVINHU ZVINOKUDZIDZISA KUZIVA - EPCLUSA ." Foster City, California
Mohamoud, D .; Mumtaz, G .; Riome, S .; et al. "Epidemiology yehutachiona hweH hepatitis C muEgypt: kurongeka kwakarongeka uye kudhindwa kwemashoko." BMC Inotapukisa Zvirwere. 2013; 13 (288): DOI 10.1186 / 1461-2334-13-288.