Chinangwa chekudzivirira migraine therapy ndechokuderedza nhamba uye kuoma kwemusoro wemusoro.
Asi ikozvino inoshandiswa migraine-mishonga inodzivirira, seTramaama (topiramate), Inderal (propranolol), neElavil (amitriptyline), kazhinji haisi yakakosha sezvinoda vanhu. Mukuwedzera, iyi mishonga ine migumisiro yakawanda iyo inowanzoita kuti isarambe.
Nhau dzakanaka ndeyokuti vatsvakurudzi vari kunyanya kufunga nezvekuvandudza manodra migraine mishonga yekudzivirira. Chimwe chirongwa chepuroteni chavari kutarisa nemishonga iyi ndeye calcitonin inosangana nepeptide yegene (CGRP), iyo yakawanikwa ichikwidziridzwa vanhu panguva yekurwiswa kwemigraine.
Kunyanya kunyanya, mishonga mbiri, fremanezumab uye erenumab, vakaratidza chivimbiso muchikamu chechikamu chechitatu-nguva inonakidza yevashandi uye vanachiremba nevanodikanwa.
Ngatinyatsoongororai izvi zvinotanga kuitika CGRP-zvinotarisirwa zvinodhaka.
Erenumab yekudzivirira Episodic Migraine
Erenumab inonzi humocidal monoclonal antibody, uye inosungirirwa kuCGRP receptor (nzvimbo yeprotein yekudzivirira).
Kunyange zvazvo erenumab yakanyatsogadzirisa maitiro isinganzwisiswi zvakakwana, nyanzvi dzinoziva kuti CGRP inosunungurwa kubva kune hutatu hutachiona hwemagetsi panguva yekurwisana kwemigraine. Kana imwe nguva yakasunungurwa, CGRP haisi kungobatanidzwa mukutumirwa kwezvirwere zvinorwadza, asi inoshandawo kudimburira midziyo yeropa kunze uye mukati mehenya.
Nezvo, kuburikidza nekudzivirira kubvisa chirongwa cheCGRP chekuchengetedza, vatsvakurudzi vanofungidzira kuti kusangana kwemasimba kunogona kukanganisa-uye ikozvino kune dambudziko rakanaka rekutsigira iyi dzidziso.
Muchikamu chechitatu muedzo muNew England Journal of Medicine , vanopfuura 900 vatori vechikamu vane episodic migraine (vanotsanangurwa sevari pasi pe15 migraines pamwedzi), vakashandurwa kuti vawane rimwe remhando nhatu idzi dzinotevera mwedzi umwe kwemwedzi mitanhatu:
- A 70-mg subcutaneous (pasi peganda kusvika mumafuta ako nenyaya) jekisi ye erenumab
- A 140-mg injection inogadzirwa erenumab
- A placebo subcutaneous injection
Vatori vechikamu kana avo vatsva vaiziva kuti vaigamuchira erenumab maererano nejecha re placebo, ndicho chikonzero ichi chidzidzo chakanyorwa sechidzidzo chekupeta-mapofu.
Mhinduro
Migumisiro yechirongwa ichi yakaratidza kuti nhamba yemazuva emigraine pamwedzi yakaderedzwa ne 3.2 mazuva muboka rera-70-mg uye mazuva 3.7 mu 140-mg boka rekurapa, zvichienzaniswa nemazuva 1.8 muboka re placebo.
Mushure mekuongororwa kwenhamba, vatsvakurudzi vakafunga kuti chigumisiro ichi chakakosha. Izvi zvinoreva kuti kuderedzwa kwepamusoro kweboka rekurapa kwaive kwechokwadi (zvichienderana nemigumisiro yemishonga) uye kwete kuverenga kusinganzwisisiki.
Zviitiko zvakare zvakaratidza kuti inenge hafu yevatori vechikamu vanowana erenumab vakawana 50 kubva muzana kana kukura kudarika muhuwandu hwavo hwemazuva emigraine pamwedzi kana ichienzanisa nechetatu chevaya vari muboka re-placebo-zvakare, chigumisiro chacho chaive chakakosha.
Mapoka ekurapa aivawo nekuderedza kukuru kwemazuva emazuva aidiwa kushandisa mishonga yakaoma migraine , zvichienzaniswa neboka re placebo.
Pakupedzisira, vatori vechikamu mubhuku racho vakapedza chikamu chinonzi Migraine Physical Function Impact Diary, icho chikoro chepamusoro chinoratidza kuwedzera kwemigraine mutoro mukushanda.
Zvizhinji muhutano hwepanyama uye zuva rega rega-mabasa anovandudzika zvikuru kumapoka ekurapa kana achienzaniswa neboka re placebo.
Migumisiro yakaipa
Izvo zviitiko zvezviitiko zvakashata zvakanga zvakafanana pakati pevatori vechikamu vakagamuchira erenumab nevatori vechikamu vakagamuchira placebo. Kakawanda, pasi pe3 muzana yevose vakabatanidzwa vakasiya kubva mukutongwa nekuda kwemigumisiro yakaipa.
Mhedziso
Izvi zvinoratidza kuti erenumab inoshanda (mumatambudziko maviri) ekudzivirira episodic migraine kune vamwe vanhu. Erenumab inoratidzikawo kuva nehutano hwakanaka hwehutano. Izvi zvinogamuchirwa nhau sekunezvino migraine-mishonga yekudzivirira inowanzomiswa nekuda kwekusagadzikana kwemigumisiro.
Fremanezumab yekudzivirira Chronic Migraine
Fremanezumab inonzi humanized monoclonal antibody inosungira uye inovhara puroteni chaiye CGRP, kusiyana neyakagamuchira iyo (seyrenumab).
Muchikamu chechitatu muedzo muNew England Journal of Medicine , pamusoro pevanhu vane chiuru chevanhu vane migraine isingagumi (inotsanangurwa sevanopfuura 15 migraine pamwedzi kwemwedzi mitatu), vakashandurwa kuti vawane rimwe remitemo mitatu inotevera kwevhiki 12 nguva:
- A single subcutaneous injection ye fremanezumab pachiyero chekutanga, inoteverwa nejectbo subcutaneous injection pavhiki 4 nevhiki 8 (inonzi chirwere chechina)
- Zvirwere zvitatu zviduku zvinokonzerwa ne fremanezumab uye imwe pazvinyorwa, imwe pavhiki 4, uye imwe pavhiki 8 (inonzi kujowa kwemwedzi)
- A placebo subcutaneous injection pakutanga, vhiki 4, uye vhiki 8
Kufanana nekutongwa kwekudzivirira, vatori vechikamu uye vaongorori vose vakanga vasingaoni kuti ndiani aigamuchira mushonga pamwe naiye akanga achiwana placebo.
Kunyange zvazvo vatori vechikamu vakarongerwa kushanya kwechishanu (pakutsvaga, kwekutanga, vhiki yechina, vhiki yechisere, uye vhiki yegumi nembiri), zvose zvinyorwa zvepfungwa zvakanyorwa zuva rega rega kuburikidza nemusoro wemagetsi-diary device. Muenzaniso wezvinyorwa zvepfungwa zvakabatanidza kana hutsika hukavapo, nguva yayo, uye marwadzo ayo akaoma.
Mhinduro
Migumisiro yechirongwa ichi yakaratidza kuti avo vatori vechikamu vanogamuchira chirwere chimwe chete che fremanezumab kana kuti mishonga mitatu yemwedzi ye fremanezumab yakaita kuderedzwa kukuru muvhareji yemazuva emigraine pamwedzi, zvichienzaniswa neboka re placebo.
Kunyanya zvakananga, vatori vechikamu vaiwana placebo vaive nehuwandu hwemazuva gumi nemazana gumi nemaviri ekutambisa kune avo vanogamuchira fremanezumab quarterly (8.5 mazuva) uye pamwedzi (8.0 mazuva).
Mukuwedzera, pakange panewo kuderedza kukuru mukati mevhareji yemazuva vatori vechikamu vaida kushandisa mishonga yakaoma migraine muboka rekurapa rinopesana neboka re placebo.
Pakupedzisira, pakanga pane kuderedza kukuru kwekuremara kwakabatana nemusoro (sekuenzaniswa nechiyero chinonzi Headache Impact Test) cheboka rekurapa rinopesana neboka re placebo.
Migumisiro yakaipa
Chiitiko chinowanzovhiringidza pane chidzidzo chakanga chiri kurwadziwa panzvimbo yejojo, iyo yakaitika kakawanda kune vatori vechikamu vanogamuchira fremanezumab pane avo vanotora kugamuchira nzvimbo. Zvisinei, kuoma kwekuita kwacho kwakanga kusina kusiyana pakati pemapoka, zvichiitika pazvinenge zvakaenzana muzvikamu zvitatu zvitatu.
Uyezve, pakanga pane zvimwe zvinyoro zvishoma zvechiropa chinokonzerwa nehutachiwana humwe hwevatori vechikamu vakatora fremanezumab. Izvo zvikamu, zvisinei, zvakadzokera kune zvakajairika, saka avo vatori vechikamu havana kubviswa kubva pachidzidzo.
Ichokwadi, kune avo vaongorori vekudzidza, vose ava vaitora mishonga vakashandisa mishonga se-nonsteroidal anti-inflammatory (NSAIDs) kana Tylenol (acetaminophen) kazhinji kana kupesana nezuva nezuva. Kudya kwemishonga iyi kunogona kutsanangura izvi zvisingagumi zvekunyengedzera kwechiropa, kunyanya sezvo fremanezumab isingagadziriswi muropa.
Mhedziso
Muchikamu chechitatu chekuedza, fremanezumab yakapiwa kana kwegore kana mwedzi yakabatsirika mukudzivirira kusingaperi kwemigraine. Izvo hazvina kungotadzisa nhamba yemazuva emigraine pamwedzi (anenge anenge maviri pasi), asi yakaderedza kuremara kwakabatana kwemigraine.
Shoko Rinobva
Chinokosha apa ndechokuti mishonga iyi, iyo inonyatsotarisa migraines (kare mishonga yekudzivirira yakagadzirirwa kubata mamwe mamiriro ezvinhu, sekugumburwa uye kuora mwoyo), kupa tariro uye imwe sarudzo yevanhu. Havasi vakakwana, kunyange zvakadaro, vachitsigira pfungwase kuti nzira yekuedza uye kukanganisa inenge ichiri kudiwa paunenge uchitora chirongwa chako chekudzivirira migraine.
Mukuwedzera pakubudirira mukudzivirira migraines kune vamwe vanhu, idzi mbiri dzeCGRP-dzinotarisirwa dzakanyatsorambidzwa-kabhiri bonus. Izvozvo zvakati, zvidzidzo zvakawanda zvinodiwa kuti zviongorore kuchengetedza kwenguva refu nekubudirira kwemishonga iyi.
Uyezve, migraineurs mune zvese zvidzidzo izvi akaiswa kunze kana vasina kupindura maviri maviri asati apinda migraine mishonga yekudzivirira. Saka, zvakaoma kutaura kuti erenumab, fremanezumab, kana zvimwe zvinodhaka zvinokonzerwa neCGRP mune pipeline zvichava sarudzo dzakanaka dzevanhu vane mafungiro emagraine .
Uyezve, zvidzidzo zvakaongororwa chete nevanhu vakuru, saka miedzo inodzidza vana uye vechidiki vane migraine inodiwa zvakare.
> Sources:
> Bigal ME, Walter S, Rapoport AM. Calcitonin peptide yakabatana nejeni (CGRP) uye migraine kunzwisisa ikozvino uye nyika yekusimudzirwa. Headache . 2013 Sep; 53 (8): 1230-44.
> Buse DC et al. Kusagadziriswa kwemagraine kupararira, kuremara, uye hukama hwevanhu: zvibereko kubva kuAmerica Migraine Prevalence uye Kudzivirira Kudzidza. Headache. 2012 Nov-Dec; 52 (10): 1456-70.
> Goadsby PJ et al. Chiyero chinodzora che erenumab chechipiri chinonzi migraine. N Engl J Med 2017; 377: 2123-32.
> Schuster NM, Rapoport AM. Calcitonin peptide yakabatana nejeni-inotarisirwa kurapwa kwemigraine nemasumbu emusoro: Kuongorora. Clin Neuropharmacol . 2017 Jul / Aug; 40 (4): 169-74.
> Silberstein SD et al. Fremanezumab nokuda kwehutano hwekuchengetedza hwekusingaperi migraine. N Engl J Med 2017; 377: 2113-22.