I-Aimovig i-anti-monoglonal antibody evimbela i-migraines
Kunezinhlobo ezimbili zokwelashwa kwe-migraine: ukukhipha noma ukuvimbela. Imithi yokwelapha isetshenziswa ngesikhathi sokuhlasela kwe-migraine, ngenhloso yokuyiyeka. I-Triptans nama-NSAID afana ne-acetaminophen ne-ibuprofen (Advil) yizokwelapha okukhipha.
Imithi yokuvimbela izama ukunciphisa ukuvama nokuqina kwemakhanda e-migraine. Le mithi ihlukaniswe ngokubanzi njengemithi yokuvimbela imithi ye-migraine (OMPM) futhi ihlanganisa izidakamizwa zokucindezeleka, i-anticonvulsants, ne-beta-blockers.
Ku-athikili ka-2017 ka-November 2017 eyanyatheliswa eNew England Journal of Medicine , i-Goadsby kanye nabalobi ababambisene nabo bahlola ikhono lika-Aimovig kuya (erenumab) ukuvimbela ukuhlasela kwe-migraine. Ngokungafani ne-OMPM yamanje, i-Aimovig ngumkhiqizo we-biologic-i-antibody monoclonal. Ngokucacile, i-Aimovig ivimbela imigraines ngokuvimbela i-receptor ehlobene ne-calcitonin ye-gene-related (i-CGRP), ehlangene nokuvuselela kwe-migraine.
Ubani Obekwa Emizamweni Ye-Aimovig?
Phakathi nezivivinyo zokwelapha zesigaba sesi-2 nesigaba sesi-3, i-Aimovig iye yahlolelwa ezigulini ezinezinkinga zomzimba ezinama-episodic and chronic migraines.
I-migraines yama-episodic ichazwa njengezincane ezingaphansi kwe-15 migraine noma izinsuku zezinsizi ngenyanga, noma nge-orra ngaphandle. I-migraine engapheli ichazwa njengezinsuku ezingaba ngu-15 ezinyangeni ngenyanga. Ezinsukwini eziyisishiyagalombili kulezi zinsuku eziyishumi nanhlanu ziyizinsuku ze-migraine noma nge-aura.
I-migraines yama-episodic ivame kakhulu-cishe amaphesenti angu-90 abantu abane-migraines abanayo.
Phakathi kuka-5% namaphesenti ayisishiyagalombili abantu abane-migraine bane-migraines engapheli.
Mayelana necala
Ku-athikili ka-November 2017 eyanyatheliswa eNew England Journal of Medicine , i-Goadsby kanye nababhali-co-author bahlola ikhono lika-Aimovig ukuvimbela ukuhlaselwa kwe-migraine.
Kulesi sifundo, kwakunabalingani abadala abangu-995 abahlukaniswe ngamaqembu amabili okuhlola kanye neqembu lokulawula.
Iqembu lokulawula lathola umjovo we-placebo, futhi amaqembu okuhlola athola ama-70 mg noma i-140 mg engenayo yesikhumba esingaphansi kwe-Aimovig, elawulwa njengamanani ayisithupha ahlukaniswe amasonto amane ngaphandle.
Ngokusho kwabalobi, zombili izilinganiso "zanciphisa imvamisa ye-migraine, imiphumela ye-migraines emisebenzini yansuku zonke, nokusetshenziswa kwemithi eqondile ye-migraine esikhathini esingangezinyanga ezingu-6."
Ngesikhathi sokuqala, inani lezinsuku ze-migraine zitholakale inyanga ngayinye ngabahlanganyeli ocwaningweni kwakuyizinsuku ezingu-8.3. Phakathi kwezinyanga ezine nesithupha ukwelashwa, inani lezinsuku ze-migraine linciphile ngo-3.2 no-3.7 kumaqembu angu-70-mg Aimovig nama-140-mg Aimovig, ngokulandelana.
Phakathi kokuqala kocwaningo kanye nezinyanga ezine kuya kweziyisithupha ukwelashwa, eqenjini lama-70-mg, iziguli ezingama-43.3% zathola ukunciphisa okungenani amaphesenti angu-50 ezinsukwini ze-migraine ezinyangeni zonke.
Phakathi kokuqala kocwaningo kanye nezinyanga ezine kuya kweziyisithupha ukwelashwa, eqenjini lama-140-mg, amaphesenti angu-50 eziguli ahlangabezana nokunciphisa okungenani amaphesenti angu-50 ezinsukwini ze-migraine ezinyangeni zonke.
Phakathi kokuqala kocwaningo kanye nezinyanga ezine kuya kweziyisithupha ukwelashwa, kulabo abathola indawo yokuhlala, amaphesenti angama-26.6 athola okungenani amaphesenti angu-50 ekunciphiseni kwezinsuku ze-migraine ezinyangeni zonke.
Inombolo yezinsuku lapho iziguli okufanele zisebenzise imishanguzo ethile yokwelapha imishanguzo enzima yancipha ngo-1.1 izinsuku ezinqenjini ezingama-70-mg kanye nezinsuku ezingu-1.6 eqenjini lama-140-mg uma liqhathaniswa nezinsuku ezingu-0.2 eqenjini le-placebo.
Ukwehluleka kwemisebenzi yansuku zonke kwenza i-migraines ihlukumeze. Ukusebenzisa i-questionnaire, abacwaningi bahlola ukuthuthukiswa kokusebenza kwemisebenzi yansuku zonke. Bathole ukuthuthukiswa okuphawulekayo kulabo abathola i-Aimovig.
Imiphumela emibi nokulinganiselwa
Nakuba imiphumela emibi ka-Aimovig yabika iningi labahlanganyeli, lezi zenzakalo ezimbi zazingehluke kakhulu kulabo abathola indawo yokuhlala.
Ngokuphawulekayo, abantu abaningi abathola i-70 mg ye-Aimovig babika ubuhlungu endaweni yokujola ngaphandle kwalabo abasebandleni lokulawula.
Izibonelo zezenzakalo ezivame kakhulu ezibandakanyekile zibandakanya ukubandayo, ukuphefumula okuphezulu kokuphefumula, nesifo se-sinusitis.
Omunye umkhawulo wokucwaninga wukuthi abacwaningi abafaki iziguli ezingazange zithole inzuzo yokwelapha eziklasini ezimbili noma ngaphezulu ze-OMPM.
Kodwa-ke, abacwaningi bafaka iziguli eziye zayeka i-OMPM ngenxa yokungasebenzi ngokwanele, ukungabi nampendulo eqinile, noma imiphumela emibi engalungile. Eqinisweni, iziguli ezingu-38.7 ezisesampuli zazingakaze zithole izinzuzo ezivela kuma-OMPM.
Ngaphezu kwalokho, ngokusho kweGoadsby nabambhali abambisene nabo:
Ukusebenza ngendlela efanayo kuboniswe ngendlela efanayo nesilingo sesi-2 se-erenumab esibandakanya iziguli ezine-migraine engapheli, lapho amaphesenti angu-68 eziguli ayekade eyeka imithi yokuvimbela imithi ngenxa yokungabi namandla noma imiphumela engavumelekile.
Uma kuhlangene nemiphumela evela kwezinye izivivinyo zesigaba sesi-2 nesigaba sesi-3 ezihlola ukusetshenziswa kwe-Aimovig kulabo abane-migraine engapheli ne-episodic, kubonakala sengathi i-Aimovig ingasiza ekuvimbeleni i-epradic migraines.
Ucwaningo olwengeziwe luzodingeka lwenziwe ukuze kutholakale ukuphepha kwesikhathi eside se-Aimovig, nokuthi imiphumela yalo ihlala isikhathi eside kangakanani.
Indlela i-Aimovig iqoqa ngayo kuze kube yi-OMPM
Umehluko omkhulu phakathi kwe-Aimovig ne-OMPM ukuthi i-Aimovig ihlose ngokuqondile izinqubo ezithile ze-pathophysiological ezidlala indima ekudleni.
Akukona ucwaningo olwenziwe olwenziwe ukuqhathanisa imiphumela ye-Aimovig neminye imithi evikela ukuphathwa kwekhanda. Ngaphezu kwalokho, akukho ucwaningo oluningi oluhlola ukusebenza kwama-OMPM ngokwawo.
Ngokusho kwe-American Academy of Neurology:
Ubufakazi abukatholakali ngokwenza ukufaniswa okubanzi phakathi kwama agent amaningi ngaphakathi kwekilasi elilodwa; Ubufakazi obunjalo buyohlinzeka ngokuqonda okunzulu okuphelele kokusebenza okunempilo kanye nokwaziswa okubekezeleleka kuwo wonke ububanzi bezinsiza zokwelapha. Kudingeka izifundo ezihlolisisa ngokuqondile lapho ukwelashwa okuvimbelayo kuqinisekisiwe futhi ukuthi imithi kufanele ifakwe kanjani.
Inombolo yezilinganiso ezilinganiselwe kuphela ezihlolile ukusebenza kwe-OMPM. Ngokusho kwe-AAN, kunobunye ubufakazi obuqinile noma obulinganiselayo obusekela ukuphumelela kwezifo ezilandelayo zokuvimbela:
- I-Divalproex ye-sodium, i-valproate ye-sodium, ne-topiramate (izidakamizwa zokulwa nezifo)
- I-Metoprolol, i-propranolol, i-timolol, i-atenolol, ne-nadolol (beta-blockers)
- I-Amitriptyline ne-venlafaxine (izidakamizwa zokucindezeleka)
Ngaphezu kwalokho, i-gabapentin, i-lamotrigine, i-clomipramine, ne-fluoxetine, enqunyelwe ukuvimbela i-migraine, cishe ayiphumeli ekuvimbeleni i-migraines.
Ukuphawula, ukwelashwa ngezidakamizwa ezihlukunyezwayo kudinga ukulandelwa ngokucophelela kokuphefumula, ukuhluleka kwesibindi, kanye nemiphumela ye-teratogenic njengamaphutha okuzalwa. Ngaphezu kwalokho, i-divalproex sodium ingabangela ukuzuza kwesisindo. Kuze kube manje, kubonakala sengathi i-Aimovig ayikho imiphumela emibi kangaka.
Into eyodwa esiyazi ngayo ngama-OMPM ukuthi ukunamathela kuphansi. Ngamanye amazwi, abantu abaningi abathatha le mithi bayeke ukuthatha.
Esifundweni esilandelayo esashicilelwe eCephalagia ngo-2015, uHepp nozakwabo bahlola ukuphumelela kwezinhlobo ezingu-14 zama-OMPM okwelashwa kwe-migraines engapheli. Phakathi kweziguli ezingu-8688, izinga lokunamathela ezinyangeni eziyisithupha liphakathi kwamaphesenti angu-26 namaphesenti angu-29. Ezinyangeni ezingu-12, izinga lokunamathela liye lafika phakathi kwamaphesenti angu-17 namaphesenti angu-20.
Ngokusho kwabalobi:
Nakuba izizathu zokungaboni kahle zingathathwa emininingwaneni yemali, izifundo ezishicilelwe ngaphambilini zisikisela ukuthi ukunamathela okuphansi kungabhekwa eziningana zezici, kuhlanganise nemiphumela emibi kanye / noma ukungabi namandla kwe-OMPM. Ngaphezu kwalokho, imihlahlandlela yezokwelapha i-AAN iphinde ikhombise ukuthi ambalwa kuphela we-OMPM atholakalayo empeleni abe nobufakazi obuhle bokutholwa kwekhono labo ekuvimbeleni izinhlungu zekhanda.
Ngokuthakazelisayo, abacwaningi bathola ukuthi kuma-OMPM angu-14 ahlolwe, i-amitriptyline, i-nortriptyline, i-gabapentin, ne-divalproex yayinezinga eliphansi kakhulu lokunamathela uma kuqhathaniswa ne-topiramate.
I-neurostimulation
Nansi indaba ebalulekile nge-migraines: Asiqondi ngempela ukuthi basebenza kanjani. Ngaphandle kokuqonda okucacile izindlela zalesi sifo, kunzima ukudala ukwelashwa okuvela kumabonakude nokuvimbela okubhekiswe endleleni ethile.
Cabanga ngendima elandelayo evela kusihloko sokubukeza sika-2013 esibizwa ngokuthi "i-Migraine: isimo sobuchopho":
Amaphuzu we-migraine pathogenesis aye agxile esifundeni sokuqala sokuqala njengokusakaza ukucindezeleka ku-cortex noma 'i-generator migraine' ku-brainstem. Kodwa ukuqhubeka kwesikhashana kokuhlaselwa kwe-migraine kubonisa izinguquko ngesikhathi esisodwa ekusebenzeni kwezifunda eziningi zobuchopho, futhi akucaci ukuthi kunesifunda esisodwa esisodwa lapho i-migraine iqala khona kuzo zonke iziguli.
Njengo-Aimovig, uCefaly uhlose ukuphazamisa ngokuqondile i-pathogenesis ye-migraine ngokukhomba izindlela. Ngokungafani ne-Aimovig, enikezwa njengomjovo, i-Cefaly iyisisetshenziswa se-neurostimulation esibekwe phezu kwebunzi. Ivuselela inhlanzi ye-trigeminal, okucatshangwa ukuthi idlala indima enkulu emagraines.
UCefaly usanda kuvunyelwa yi-FDA hhayi nje kuphela ukungenelela kokuvikela kodwa futhi nokuphathwa okunzima, futhi. Iza ezinhlobonhlobo ezintathu: Cefaly Acute, Cefaly Prevent, noCefaly Dual. (I-Cefaly Dual inamamodi kokubili ukwelashwa okunamandla nokuvimbela kwamagraines.)
Ngokusho kwabenzi balo, i-Cefaly Prevent ilawula amanje okusheshayo angasetshenziswa nsuku zonke ukuvimbela ukuhlasela kwe-migraine.
Ezilingo zokwelashwa, okwenzeka phakathi kuka-2009 no-2012, labo abathola ukwelashwa kwe-Cefaly ekuvimbeleni i-migraines babhekana nokunciphisa okukhulu kokubili kwezinsuku ze-migraine nezinhloko ngemuva kwezinyanga ezintathu zokusetshenziswa.
Ngokuqondile, iziguli ezitholwe ukwelashwa kwe-Cefaly zithole amaphesenti angu-29.7 ambalwa kwezinsuku zokufuduka kanye namaphesenti angama-32.3 ambalwa kwezinsuku ezikhanda ikhanda. Ngaphezu kwalokho, amaphesenti angu-38,2 weziguli ezithola uCefaly abhekana nokunciphisa okungenani amaphesenti angu-50 ezinyangeni zenyanga zenyanga.
Ngaphandle kokuthola izinsuku ezimbalwa ze-migraine nezinsizi, labo abasebenzisa i-Cefaly nabo babedinga imishanguzo emincane ye-anti-migraine ("imithi yokukhulula"). Okuphawulayo, kwakungazange kube nemiphumela emibi kakhulu kulabo abathola ukwelashwa kwe-Cefaly.
Phakathi nesifundo sokuthunyelwa kokukhangisa okwenziwa yiCefaly, amaphesenti angu-53 weziguli ezitholile idivayisi zazijabule ngakho. Amaphesenti angu-4 kuphela wabasebenzisi abike ukunganeliseki futhi abike imiphumela emibi emincane, njengokulala, ukukhanda ikhanda, noma ukubetha okubangelwa idivayisi. Njengazo zonke izilingo zokwelapha, kwakungekho nemiphumela emibi kakhulu emayelana nokwelashwa kwe-Cefaly.
Izwi elivela
Nakuba singaqondi ngokugcwele ukuthi i-migraines isebenza kanjani, ukungenelela okusha okufana nomkhiqizo we-biologic u-Aimovig, kanye nedivayisi ye-neurostimulation i-Cefaly, ihlose ukuphazamisa izindlela zalesi sifo. I-Aimovig ayisazovunyelwa yi-FDA, kepha u-Cefaly uyatholakala. Uma unesithakazelo kulezi noma ezinye izifo zokuvimbela, zixoxisane ne-neurologist yakho.
> Imithombo:
> Charles, A. Migraine: isimo sobuchopho. Umbono wamanje ku-Neurology. 2013; 26: 235-239.
> De Novo Ukufakwa Isicelo seCefaly Device . I-FDA.
> Goadsby PJ, et al. Uhlolo Olulawulwayo lwe-Erenumab ye-Epradic Migraine. I-New England Journal of Medicine. 2017; 377: 2123-2132.
> Hepp Z, et al. Ukuhambisana nemithi yokuvimbela imithi ye-migraine phakathi kweziguli ezine-migraine engapheli, i-Cephalagia. 2015; 35: 478-488.
> Riederer F, Penning S, Schoenen J. Transcutaneous Supraorbital Nerve Ukukhuthazwa (t-SNS) neCefaly Device for Migraine Prevention: Ukubuyekezwa Kwemininingwane Ekhona. Ubuhlungu nokuTherapy. 2015; 4: 135-137.