Ingabe i-Empagliflozin ukuphumelela kwesifo sikashukela ngesifo sezinso sasilindelwe
Uma kuziwa ekuphepheni isifo sikashukela soshukela kanye nokunciphisa ingozi yokuhluleka kwezinso (okudinga i- dialysis noma ukufakelwa kwezinso ), akuzona zonke izinsuku esizizwayo ngemithi eqondisa imigomo efana ne "Holy Grail,", "i-game changer", "enkulu ukuqhuma " , njll. Yebo, singase sibe ngenye yalezi zikhathi ezingavamile emithi lapho umuthi ubonise imiphumela ethembisa ngokwanele ukuzololonga lawo malebuli.
Kukhona imithi yokulawula isifo sikashukela, okuthiwa i- empagliflozin (eyaziwa ngegama layo, Jardiance). Noma kunjalo, ukuze uqonde indima ye-empagliflozin ekuvimbeleni ukwehluleka kwezinso, kubalulekile ukwazi kancane ngemuva.
Okwenza Isifo Sikashukela Silimaza Izinso
Isifo sikashukela sinamandla phansi kwesinye sezizathu zesifo sezinso nokuhluleka kwezinso emazweni amaningi athuthukile. Ukusabalala kwalo kuqhubeka nokukhula ngenkathi impikiswano yayo iqhubeka nokuba yinkinga yempilo yomphakathi. Kuyinto isifo esithulile, kulula kakhulu ukunganaki kuze isiguli siqala ukuthuthukisa izinkinga.
Izinso akuzona kuphela izitho eziphazamiseke yilokhu kuphazamiseka. Njengoba isifo sikashukela silimaza imithwalo yegazi, ngokwempela, zonke izigungu ziyinto efanelekayo. Ngokuya ngobukhulu bemithwalo yegazi ehilelekile, isifo se-vessel sesitsha sikashukela sasihlukanisiwe sibe yi- microvascular (isib.
isifo sengqondo sesifo sikashukela emehlweni, isifo sezinso noma ukungathandabuzeki kwesifo sikashukela, njll), kanye nezinkinga ezinkulu (isib. isifo senhliziyo esiholela engozini yokuhlaselwa kwenhliziyo, izifo zesifo sofuba emithanjeni yegazi ebuchosheni zandisa ingozi yokushaya isisu, njll).
Njengoba kunikezwe ngenhla, kuyaqondakala ukuthi noma nini ukuphumelela kwenziwa enkundleni yokuphathwa kwesifo sikashukela, izwe liyaqaphela.
Odokotela neziguli balindele izindaba ezinhle ngokuphefumula. Ingabe lesi sidakamizwa esisha sizokwehlisa ingozi yokufa kwesifo sikashukela? Kuthiwani ngokuhlaselwa kwenhliziyo noma ukushaywa yizinhlungu? Mhlawumbe ukunciphisa ingozi yokuhluleka kwesifo sikashukela?
Noma, njengoba kunjalo njalo , ingabe konke kungaba isiphetho esicasulayo lapho ukulawulwa kwesifo sikashukela kungathuthuki emiphumeleni engcono yomtholampilo yeziguli? Eqinisweni, kube khona izifundo ezibika ingozi ephezulu yokufa / isifo ngemithi ethile yesifo sikashukela. Kungenxa yalokhu kubonakala sengathi dichotomy ukuthi i-FDA manje idinga bonke abakhiqizi abasebenzisa izidakamizwa ezishaya isifo sikashukela ukufakazela ukuthi imishanguzo yabo emisha ngeke ibe yingozi engozini yezinhliziyo kanye nezifo ze-vascular.
Imithi Emisha Ingayithuthukisa Isifo Sikashukela Namagciwane Ahlobene Nezinso?
Le minyaka eyishumi edlule ibone ezinye izigaba ezintsha zemithi evunyelwe ukulawula isifo sikashukela. Izibonelo ezimbalwa yizi:
- I-GLP-1 Ama-agonists akhulisa i-insulin ekhishwa yi-pancreas
- I-DPP-4 Inhibitors isondeza isenzo se-GLP-1 ngakho-ke ngokungaqondile iholela esenzweni esifanayo njengenhla
- I-SGLT-2 Inhibitors ivimbela i-glucose (ushukela) ukubuyisela kabusha izinso. Lezi zidakamizwa zigxile kwingxoxo yami kulesi sihloko
Indlela i-Dd SGLT-2 Inhibitors ethinta ngayo izinso?
I-SGLT imelela i-sodium-glucose cotransporter.
Ukuze uyibeke ngemibandela elula, iprotheni ehilelekile ekuthuthiseni izinhlobo ezimbili zezinto ngaphakathi kwezinso, kusukela emcimbini ube yigazi. Enye yalezi yi-sodium, enye enye i-glucose ebizwa ngokuthi "izingulube" ekuthuthweni kwe-sodium. Inombolo "2" ibhekisela kuhlobo oluthile lwamaprotheni olutholakala ohlelweni lwezintambo zezinso, ingxenye ebizwa ngokuthi "i-tubulus proximal." Kukhona futhi i-SGLT-1 kodwa okuphethwe kuphela yingxenyana encane yalokhu kuthutha).
Imvelaphi yezinto eziphilayo zamangqamuzana kuyasiza ukuqonda ukuthi kungani i-endocrinology ne-nephrology yonke iyahamba ngalezi zidakamizwa ezintsha, i-SGLT-2 inhibitors.
Manje njengoba siyazi ukuthi yiyiphi indima ye-SGLT-2, kungase kube lula ukuqonda ukuthi kwenzekani uma "ukuvimbela" isenzo sephrotheni . Izinso ngeke zisakwazi ukugcoba i-glucose eyayivele ihlungiwe emcinini (yilokho okwenza njalo), futhi ngokuyisisekelo i- sugar / glucose ingena endlini yangasese . Okusho ukuthi i-glucose encane igcinwe egazini lakho, mhlawumbe nokulawula okungcono kwesifo sikashukela.
Isidakamizwa esixoxwe kulesi sihloko into okuthiwa i-empagliflozin (i-Jardiance), i-SGLT-2 inhibitor evunywe yi-FDA yokwelapha uhlobo lwesifo sikashukela. Nakuba ezinye izidakamizwa ezintsha zesifo sikashukela zihambisane nokukhangisa okunamandla okudumisa izinzuzo zabo, izilingo eziningi ziye zahluleka ukubonisa ingozi encishisiwe yemiphumela emtholampilo kanzima (njengokuthuthukiswa kokuhlasela kwenhliziyo noma ingozi yokushaya isifo) ngale mithi emisha, uma kuqhathaniswa nezidakamizwa zendabuko ukulawula isifo sikashukela. Ukuze ushintsho noma kunjalo, lapho imithi emisha impela ibonisa isithembiso esinamandla sokunciphisa ukuhlaselwa kwenhliziyo, ukushaywa noma ukuhluleka kwezinso, kuzomele kube yilapho okuyiyona ndawo yokubheka.
Ukwelashwa Kwendabuko Yezifo Zesifo Sesifo Sikashukela
Ngeshwa, eminyakeni engamashumi amabili edlule, asizange senze izinyathelo ezinkulu ekuphuculeni ukwelashwa kweziguli ezinezifo zesifo sikashukela. Izindlela zokwelashwa zamanje zisekelwe ekusebenzeni okujwayelekile njengokulawula ukucindezelwa kwegazi, noma ukunciphisa amaprotheni ukulahlekelwa emcini (besebenzisa imithi ebizwa ngokuthi i-ACE-inhibitors noma i-angiotensin receptor blockers). Singase sithandane nalezi zinhlelo ngamanye imigomo, njengokukhulisa amazinga alkali egazini, ukulawula okuhle kwesifo sikashukela, nokunciphisa amazinga e-uric acid. Kodwa-ke, ezimweni eziningi lezi zindlela zokungenelela zingase zingenele ukwenza umehluko obalulekile kumathuba omuntu olwa nesifo sokuhluleka kwezinso.
Kungenzeka yini ukuthi ama-Empagliflozin abe yisisulu sokumangaza ngesifo sikashukela se-Nephropathy?
Kukhona izizathu zokukholelwa ukuthi i-empagliflozin ingase iphule ukuphazamiseka kwe-"inertia inertia" yeminyaka engamashumi amabili edlule. I-Empagliflozin yaqala ukugubha isifo sikashukela ngasekupheleni kuka-2015 lapho imiphumela ye-EMPA-REG yecala ebonisa ukuthi yaba nethonya elikhulu ekunciphiseni ukufa komzimba, ukuhlasela kwenhliziyo okungenasifo, kanye nokushaya. Imiphumela yashicilelwa kamuva eNew England Journal of Medicine.
Ucwaningo ngokwalo luyivivinyo elikhulu elibandakanya iziguli ezingaphezu kuka-7000 zesifo sikashukela emazweni angu-42 ezindaweni eziningi. Kubalulekile ukuqaphela ukuthi abangaphezu kwamaphesenti angama-80 abahlanganyeli base bevele belashwa ngendlela ejwayelekile yesifo sikashukela sezinso (ngenhla amaphesenti angama-80 ase-ACE inhibitors noma ama-block block angiotensin). Cishe zonke iziguli zazingengozi enkulu yezifo zenhliziyo. Ubukhulu besilingo kwaba esinye sezici ezangeze ukwethembeka eziphethweni zayo.
Njengoba kunikezwe le miiphumela ekhuthazayo, ukuhlaziywa okuqhubekayo kwemiphumela ye-empagliflozin ngesilinganiso sokuthuthukiswa nokwehla kwesifo sezinso kwenziwa. Lokhu kwaholela esihlokweni sesibili esashicilelwe ngoJuni 2016, esagxile kulokho umuthi owenzayo ezintsheni. Ngokuqondile, ukuhlaziywa kubheka isilinganiso sokusebenza kwesifo sezinso ezikhulayo (ngeziguli ezingezansi hhayi kumuthi). Lokhu kwenziwa ngokulinganisa ukwehla kwezinga le- creatinine noma ukulahleka kwamaprotheni emcintini. Imiphumela yokugcina ibonisa ukuthi iziguli zesifo sikashukela zesifo sikashukela esengozini enkulu yezifo zenhliziyo, futhi ngubani othatha i-empagliflozin (engeziwe "ekunakekelweni okujwayelekile") angase abone ukuwohloka okukhulu kwezinso kunabo abangenayo. Iziguli ezithatha le med nazo zaziphethe ukuphathwa kweshukela okungcono kakhulu kwegazi, kanye nokucindezela kwegazi okuphansi, ububanzi besisindo, isisindo, namazinga e-uric acid.
Imiphumela emibi kanye nemibuzo engaphenduliwe
Noma nini lapho umuthi ubizwa ngokuthi "ushintsho lomdlalo", ngokuvamile umqondo omuhle ukubuyela emuva futhi ubheke ngomthamo onempilo wokungabaza kwesayensi. Buza imibuzo mayelana nokusebenza kwayo, mhlawumbe? Nanka eminye imibuzo esadingeka iphendulwe ngokuthembekile ngalesi sikhathi:
- Ingabe kukhona okungafani ngempela nge-empagliflozin? Singazibona yini izinzuzo ezifanayo kwezinye izidakamizwa eziseklasini efanayo yemithi (SGLT-2 Inhibitors, isib. Canagliflozin, dapagliflozin)?
- Ingabe izinzuzo ezifakiwe zibangelwa umfutho wegazi ophansi noma isisindo, okwakuboniswa ezigulini ezithatha impi?
- Ingabe ukulawulwa ushukela okungcono wegazi kuchaza ukuphakama kwe-empagliflozin?
Lezi zindaba ezingenhla ziphakamisa isicaciso se-over-promise and hype. Kuthiwani uma singadubula ushukela wegazi elingcono / ukulawulwa kwengcindezi yegazi usebenzisa imithi ekhona kanye nokulungiswa kwendlela yokuphila (cabanga into efana ne-metformin + lisinopril + yokudla / ukuvivinya umzimba) ? Ngabe lokho kungasinika isibani esifanayo le buck, mhlawumbe ngezindleko eziphansi kakhulu? Le mibuzo kanye neminye imibuzo izoba yizifundo zocwaningo eminyakeni ezayo.
Okokugcina, gcina engqondweni yemiphumela emibi ye-empagliflozin ebikwe kulolu cwaningo, ezinye zazo zaziyi:
- Izifo zobulili
- Urosepsis
- Ngesikhathi isivivinyo se-empagliflozin singakabiki lokhu, i-FDA isanda kukhishwa isixwayiso mayelana nobungozi bokulimala kwezinso kusukela ekusebenziseni "abazala" bayo (canagliflozin, dapagliflozin)
Umlayezo Wasekhaya Wokuthatha Umguli
- Imiphumela yalezi zivivinyo ezimbili, (emiphumeleni ye-empagliflozin engozini yenhliziyo, isifo se-vascular, nesifo sezinso) eshicilelwe phakathi kwesikhashana sezinyanga ezimbalwa ngokungangabazeki iyamangalisa kepha kuzodinga ukuqinisekiswa esikhathini esizayo.
- Ucwaningo lubonisa ukuthi i-empagliflozin inganciphisa ubungozi bokuhlaselwa kwenhliziyo, ukushaywa, nokufa uma kunezelwa ekuphatheni okujwayelekile kwesifo sikashukela kuziguli ezine-type 2 zesifo sikashukela ezisengozini enkulu yezifo zenhliziyo.
- I-Empagliflozin ingase ihlehlise ukuwohloka okungenakugwemeka kokusebenza kwezinso okubonakala kubangelwa yisifo sikashukela esengozini enkulu. Asisazi ngokugcwele ukuthi lokhu kungenxa yomphumela wokuvivinya izinso ngaphezu kwe-glycemic (ishukela egazini).
- Uma imiphumela ibonakaliswa ekuhlolweni okuqhubekayo, okokuqala, mhlawumbe singase sikwazi ukuhambisa ukungenelela okwedlule okwamanje okusetshenziselwa ukwelapha isifo sezinso zesifo sikashukela (njengokucindezelwa kwegazi nokulawulwa ushukela). Lokhu kungabanikeza iziguli okuthile okunganciphisa ngokoqobo ithuba lokuphelisa i-dialysis.
Sethemba ukuthi lezi zintuthuko / ukuphumelela okusha akuyona nje inkinga "yenhlanhla", njengoba kuye kwaba njalo neminye imithi yesifo sesifo sikashukela esikhathini esidlule (i-Bardoxolone yiyona iphuzu). Njengoba lezi zivivinyo ezimbili zishicilelwe, ngibonile inombolo edidayo yezihloko ezingenakulinganisela emaphepheni we-layout emngceleni we-hyperbole. Isicaphuno esivela kumhleli okwakushicilelwa eNew England Journal of Medicine (kanye kanye nomagazini lapho izifundo zaqala khona) zihlukumeza okushiwo yilokho esikwaziyo kuze kube manje:
... "sishiywe ukungezwani okubonakala kukhuthazayo, kodwa akuzona" ukugijima ekhaya "ngokuphathelene nokuphathwa kwesifo sikashukela. Eminyakeni ezayo, ukuhlolwa okusebenzayo okulawulwayo nokuqhathanisa okuhambisana ngokufanayo nama agent amasha nama-agent adala kungasiza ukuhlonza uhlelo oluphuthumayo yokwelashwa kwezigidi zabantu abaphila impilo yabo ethintekayo yi-type 2 sikashukela ".
> Imithombo:
> Empagliflozin kanye nokuqhubekela phambili kwezifo zezinso ngohlobo lwesibili lwesifo sikashukela .Unjiniyela C, et al; I-EMPA-REG UKUSETSHENZA Abaphenyi. N Engl J Med. 2016 Jun 14
> Empagliflozin, Imiphumela Yezinhliziyo, nokufa ngohlobo lwe-2 lwesifo sikashukela. U-Zinman B, et al; I-EMPA-REG INDLELA Abaphenyi.N Engl J Med.2015 Nov 26