Kukanganisa kunogona kuitika kweInyvio kunosangana navanachiremba.
Primum non nocere . An aphorism iyo inogadzirisa mweya unogara kwenguva refu wemishonga: "Kutanga, usaita zvinokuvadza." Tiri kurarama munyika umo vanachiremba vanotarisirwa kuti vaite chimwe chinhu, vanoita chero chinhu chokurapa zvirwere. Asi dzimwe nguva migumisiro yechiito inowedzera kubatsirwa kwekusaita. Semuenzaniso, vanachiremba havaiti kuvhiyirwa kune vashandi vasarudzo; vanachiremba havasi kupa chemo yakakura-chese kune vanhu vanoparadzwa nemusana unouraya mutezo; uye vanachiremba vanoedza kudzivisa kurapa varwere vane mishonga nehupenyu hunotyisa zvinokonzera.
Entyvio mishonga inoshandiswa pakubatsira vanhu vane chirwere chinoputira (IBD), chirwere chinoparadza chinokanganisa hupenyu hwevaya vanobatwa. Muiti wayo (Takeda Pharmaceuticals), FDA uye gastroenterologists kwose kwose kunetseka, zvisinei, kuti vanhu vanotora Entyvio vangazvizarurira pachavo kune hutachiona nekufambira mberi kweiyo multifocal leukoencephalopathy (PML).
PML chirwere chisina kujairika chepakati yenheyo inowanzotarisana neavo vane zvirwere zvekudzivirira zvakanyanya (funga vanhu vane AIDS). Kusvika ikozvino, Entyvio haisati yaita kuti PML kune chero vanhu vanoitora, asi ikakemikari yayo yekemikari, mumwe mubatanidzwa wezvinyorwa zvinogamuchirwa anonzi natalizumab, inokonzera PML munenge 1 munhu pa1000 achiwana kurapwa. Muchidimbu, zvinogona kuitika zvinokonzerwa neCyyvio zvinogona kupfuura zvakanyanya zvekurapa kwechipatara kune vanhu vane IBD uye vane simba rekudzivirira zvirwere.
Chii chinonzi IBD?
Mvura yako inzvimbo yakasviba.
Yakazara nebhakitiriya inotibatsira kudya zvokudya zvedu. Yeuka kuti mabhakitiriya ari mishonga, uye, chero kupi zvako kunze kwegomba, mabhakitiriya akadaro angaita kuti mega-immune reaction. (Kutaura nezvehutano hwaBill Murray kubva kuBhostbusters , "zvibayiro zvevanhu, imbwa, uye makati vanorarama pamwe chete, huzhinji hwemhepo!") Nokudaro, masero ezvirwere mumuviri wedu anogara achichengetedzwa, uye "kuvhiringidza muviri" ndizvo zvinonzi quo.
Nenzira inofadza, kuburikidza nehutano hwakaoma, muviri wedu unoderedza zvakakwana-kushandiswa kwegumbo-inosanganiswa nemaronda e-lymphoid. Ichokwadi kuti izvi zvose zvinokurudzira zvinongobvumirana chete, uye isu tose tinoziva, kumwe kubvumirana kunofungidzira kunopera (pun inenge yakatarwa); zvisinei, kuziva zvatinoziva nezveBD, izvi zvose zvinonzwisisika.
Sezvinoratidzwa kubva muzita razvo, kupisa kwehutachiona chirwere ndechimwe chiitiko chinoratidza chiratidzo chekuvhiringidza. Iine kugoverwa kwebimodal nemakore ekutanga ekutanga pakati pe15 ne30 ne60 ne80 nehuwandu hwekuwanda muAshkenazi vaJudha. Zviratidzo zvechirwere zveBD zvakashata: kurwadziwa mumimba, chirwere, kubuda ropa, anemia, uye kuora kurasikirwa. Inogonawo kuratidza munzvimbo dzeatomic kunze kwegomba uye dzinokonzera arthritis, matambudziko eziso (uveitis uye iritis), kupisa (erythema nodosum) nezvimwe.
IBD inouya muvhiri mbiri dzakaipa: ulcerative colitis uye chirwere cheCrohn . Kunyange zvazvo yakafanana nenzira dzakawanda, pane zvimwe zvakasiyana zvakasiyana pakati pemhando mbiri idzi dzeBD. Kuchengetedza kwehutachiona kunowanikwa kumakoroni uye kunokonzera zvikamu zvemuviri kana zvinokonzera; nepo chirwere cheCrohn chinogona kukanganisa chero chikamu chepeji yeGI (kubva mumuromo kusvika kune anus) uye inowedzera muhutano hwayo, ichida kutsika nzvimbo dzeGI tract.
Kazhinji kacho, chirwere cheCrohn chinoparadza imba yakatarisana nevhaocecal valve. Chirwere cheCrohn chinokonzera zvipembenene zvemuviri zvinokonzera kuwanda kwehutachiona hunokonzerwa nemitambo kana kunyange fistula (migwagwa isingagamuchiri pakati pemativi emukumbo).
Nekuremekedza IBD, vanachiremba vane chinangwa chekudzora kuwedzera kwakanyanya kana kusarura, kuchengetedza kuregererwa kubva kune zvakadaro-uye kunobata fistulas uye kuvhiringidzika (kunokonzerwa nemagetsi) uye kupa mamwe maitiro ekurapa zviratidzo. Vanhu vakawanda vane IBD vanopedzisira vachivhiyiwa pane imwe nguva muupenyu hwavo.
Nzira yepamusoro yekurapa kweBD inosanganisira immunosuppressant zvinodhaka zvakadai seglucocorticoids, sulfasalazine, uye 5-aminosalicylic acid.
Azathioprine uye cyclosporine zvimwe zvirwere zvinopesana nekuputira uye zvirwere zvisingagadziriswi zvinobatsira mukurapa IBD. Chazhinji munguva pfupi yapfuura, biologic agents zvakadai sematalizumab inotaurwa pamusoro apa uye vedolizumab (Entyvio) yakashandiswa kurapa IBD.
Entyvio uye Progressive Multifocal Leukoencephalopathy (PML)
Maererano neCDA:
Entyvio is an integrin receptor oppagonist. Integrin receptors ndiwo mapurotini anoratidzwa pamusoro peimwe masero. Integrin receptors inoshanda semabhiriji e-cell-cell interactions. Entyvio inodzivisa kusangana kweivo inonzi integrin receptor (inotsanangurwa pakuparadzira masero ekuvhiringidza) neproteiniti yakadaro (inoratidzwa pamasero ari mukati memadziro emiropa yegazi), nokudaro inodzivisa kubuda kweavo vanofamba masero ekuvhiringidza kune mutezo iyo yeropa uye munzvimbo yokuputika mumutsara wepamuviri.
Uyezve, maererano neCDA:
Zviitiko zvakaratidza kuti huwandu hwevatori vechikamu hwakabatwa neInyvio kuenzaniswa ne-placebo yakawana uye yakachengetedza kupindura kwechipatara, yakagadziriswa uye yakachengetedzwa kwekliniki yekuregererwa, yakagadziriswa yekliniki yekuregererwa kwekliniki, uye yakaonekwa munguva yekupedzisira, yakave yakajeka yekoni
Mune mamwe mazwi, Entyvio inoshanda kuburikidza nekudzivirira kuputika mumurakiti weGI uye yakaratidza kuti inobudirira kana ichirapa mararamiro nekuchengetedza steroid-kusununguka kusununguka. Nhoroondo, meta-analysis ye Entyvio nedzimwe nhengo dzebiologic dzakaratidza kuti Entyvio yakanga yakanyatsobudirira pakuchengeta kuregererwa kune vanhu vane ulcerative colitis semamwe marudzi ezvigadzirwa zvebiologic. Nhamba yekuti, entyvio inogadzirirwa vanhu vasingateereri kana kusakanganiswa nemimwe mishonga inoshandiswa mukurapa IBD (steroids kana biologic agents).
Kusvika ikozvino, zvakanyorwa zvakashata zvinokonzerwa neCyyvio zvaive zvisingakwanisi kune musoro, kurwadziwa pamwe chete, kushungurudza, uye fever. Zvimwe zvakakomberedzwa zvakakomba zvinosanganisira zvirwere uye hepatotoxicity (chiropa toxicity). Asi vanachiremba, feds, uye muiti wezvinodhaka vari kutarisira mhirizhonga yakaipa zvikuru iyo isati yadzorera musoro wayo wakaipa: progressive multifocal leukoencephalopathy (PML).
PML chirwere chepfungwa chinokonzerwa nehutachiona neJC virus Vazhinji vedu vane zvirwere zvehutachiona hwehutachiona uye hutachiona hwevanhu vane utano hwakanyanya kudarika. Asi kune vanhu vane zvirwere zvekudzivirirwa kwezvirwere zvinokonzerwa neHIV, kenza, sarcoidosis, nezvimwe zvirwere, PML inogona kubata.
Mune vanhu vane PML, jc virus inoderedza oligodendrocytes kana masero emasero zvikuru mumakumbo ehemispheres asiwo uropi hunoita kana cerebellum. Mune mamwe mazwi, chirwere ichi chinotora nyaya yedu yakachena ye myelin inoda nerve conduction. Zviratidzo zvinosanganisira kuora mwoyo, zvinetso zvekuona, kupera simba (hemiparesis), kutambudzika kutaura (aphasia) uye kuora mwoyo kwepfungwa.
Mumwedzi 3 kusvika ku6, PML inouraya anenge 50 muzana yeavo vanotapukirwa. Zviratidzo zvevaya vanosimbisa PML nekuda kwe natalizumab therapy kune multiple sclerosis zvishoma zviri nani; 20 muzana chete vanofa. Asi kunyange kune avo vanopedzisira vaine PML, hurema huri hukuru. Maererano neHarrison's Principles of Internal Medicine , sekunyorwa kwayo kwegore ra2012, vanhu 104 vakaporerwa ne natalizumab kwe multiple multiple sclerosis yakagadzirwa PML, uye munhu mumwe chete akatarisirwa Crohn's akawedzera chirwere chacho.
Pasi Pasi
Kana iwe kana munhu waunoda ane chirwere cheBD, kunyanya IBD iyo isingateereri steroid uye zvimwe zviratidzo zvekudzivirira muviri, Entyvio inoratidzika sekurapa kunovimbisa. Zvisinei, usati watanga kurapwa neInyvio, zvakakosha kuti iwe unoratidze chero hutachiona huripo kana hutachiona "husingaendi" uye hunogona kuratidza kuti simba rekudzivirirwa mumuviri rakaoma. Uyezve, kana iwe uchangobva kupemerwa, haufaniri kutora Entyvio kana. (Nyaya, haufaniri kutora Entyvio kana uine zvinetso zvechiropa, zvinokonzerwa nemagetsi, nezvimwewo.) Kana iwe ukava nematambudziko emagetsi (kana kuti chero matambudziko anokosha) paunenge uri muCyyvio, zvinotarisirwa kuti iwe utaure nokukurumidza utano hwako hwehutano mupi.
Pamusoro pekupedzisira, zvakakosha kuyeuka kuti tisati tichitevera PML kune vanhu vanotora Entyvio . Uyezve, muiti we FDA neCyyvio ari kunyatsocherechedza zviitiko zve PML kune chikamu chekupinda kwaInyvio uye iye zvino vari kuitisa zvidzidzo zvemashure ekutsvaga uye nekufambisa mberi uye kuendeswa mberi kwehuwandu hwezvakaipa.
Sources:
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Greenberg DA, Aminoff MJ, Simon RP. Chitsauko 5. Dementia & Amnestic Disorders. Muna: Greenberg DA, Aminoff MJ, Simon RP. eds. Clinical Neurology, 8e . New York, NY: McGraw-Hill; 2012.
"Vedolizumab (Entyvio) yeChirwere cheMukondombera" kubva kuThe Medical Letter on Drugs and Therapeutics yakabudiswa musi wa9/15/2014.
Wallace JL, Sharkey KA. Chitsauko 47. Pharmacotherapy yeArmatic Disease Disease. Muna: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e . New York, NY: McGraw-Hill; 2011.