Kungenzeka yini ukuthi le ndlela ibe yisidakamizwa esilandelayo se-blockbuster yesifo sikashukela?
I-US Food and Drug Administration (FDA) ivume ukusetshenziswa kwe-agonist entsha ye-GLP-1, i-Ozempic ye-Novo Nordisk (i-semaglutide), njengesivumelwano sokudla nokuzivocavoca kokwelapha uhlobo lwesifo sikashukela kubantu abadala. Kulindeleke ukuthi kutholakale ezinyangeni ezintathu zokuqala zika-2018.
Lokhu kuyakhuthaza, ikakhulukazi kunikezwa ukuthi i-American Diabetes Association esanda kushicilela mayelana nezinzuzo zabathile abathile be-GLP-1 ku-2018 Amazinga Wokunakekela Isifo Sikashukela.
Bayiqaphele ikhono lomuthi lokunciphisa ingozi yezigameko ezinkulu zenhliziyo, okubandakanya ukuhlaselwa yinhliziyo, ukushaya isifo, nokufa kwenhliziyo, kubantu abadala abane-type 2 yesifo sikashukela futhi basungula isifo senhliziyo.
Usebenza kanjani i-Ozempic?
I-Semaglutide yi-agonist ye-7 ye-GLP-1 ezovunyelwa e-United States kanye neyesine ngesonto elilodwa elingenayo injection ukuze lithole imvume (i-Tanzeum izosuswa ngokushesha). Izivivinyo zemitholampilo zibonise ukuthi kuzosebenza kahle.
Esivivinyo esanda kubikwa "sekhanda kuya phezulu," i-Ozempic yabonisa ukunciphisa okukhulu kwe-A1c kuno-Trulicity (amaphesenti angu-1.8 kuya kwezingu-1.4 amaphesenti) futhi kakhulu kakhulu kuneYydureon ( AstraZeneca), elinye i-agonist kanye ne-GLP-1 ngesonto lonke. I-Semaglutide iphinde iboniswe ukuthi izokulahlekelwa isisindo esikhulu kunabalingani bayo (cishe amakhilogremu angu-10 kuya kwangu-14 ngokulingana no-5 kuya kwangu-7 amakhilogremu uma usebenzisa i-Victoza).
Ama-agonists e-GLP-1, njenge-semaglutide, asebenza ukunciphisa ushukela wegazi ngokubhekisa izingxenye ezithile zomzimba, kuhlanganise nobuchopho, imisipha, ama-pancreas, isibindi nesisu.
Mhlawumbe ingxenye ye-efficacy ikhona kuleso semaglutide ine-homology yamaphesenti angu-94 ku-GLP-1 yabantu. Abantu abaningi abane-type 2 yesifo sikashukela banamazinga aphansi we-GLP-1, okungabangela amazinga kashukela ephakeme egazini.
Uma injected, i-agonist ye-GLP-1 ithumela isignali ebuchosheni ukunciphisa ukungena kokudla namanzi; Ngokwenza kanjalo, abantu abane-type 2 yesifo sikashukela banamathuba amaningi okudla ama-khalori ambalwa, balahlekelwa isisindo, futhi banciphise ushukela wabo wegazi.
Ngenkathi ubuchopho buzwa ukuthi buhlale bugcwele, i-GLP-1 i-agonists iphinda isebenze esiswini ukunciphisa ukucinwa kwe-asidi nokunciphisa ukuphuma kwe-gastric, okunciphisa ukuthi ukudla kushiya kanjani isisu sakho ngokushesha, ukwandisa ukugcwala nokunciphisa ukuthi ushukela wegazi osheshayo okhuphuka kanjani kubangele ukuhlukumeza.
Ukwengeza, i-GLP-1 agonists isiza ukunciphisa ushukela wegazi emva kokudla ngokukhuthaza ama-pancreas ukuba enze i-insulin lapho ehlangana nokudla nokunciphisa ukuphuma kwe-glucose ye-hepatic (isibindi) (inqubo eyaziwa ngokuthi i-gluconeogenesis).
Okuqhamuka uma udla imishanguzo
Njengazo zonke izidakamizwa, kunengozi yemiphumela emibi. Umphumela ovame kakhulu we-side effect wabika kwaba yisisindo sokunambitheka kancane, esasihloselwe ukunciphisa ngokuhamba kwesikhathi. Okunye ukusabela okubi okuvamile, okubikwe okungenani amaphesenti amahlanu weziguli eziphathwa nge-Ozempic, zazihlanza, isifo sohudo, ubuhlungu besisu, nokuqothulwa.
Kukhona izixazululo kulezi zemihelo ongabonisana nodokotela wakho ukuze uqiniseke ukuthi imithi ayiphazamisi usuku lwakho nosuku. Khumbula, kusho ukusiza, ungabangeli izinkinga ezengeziwe.
Ukungafani
I-Ozempic inezinzuzo eziningi, kodwa akuwona wonke umuntu. Akufanele isetshenziswe ngabantu abanomlando womuntu siqu noma womndeni we-medullary carcinoma yegciwane noma iziguli ezine-endocrine neoplasia syndrome uhlobo 2.
Lokhu kungenxa yokuthi kumagundane namagundane, i-semaglutide ibangele ukwanda komthamo wokuthembela kwezilingo kanye nokwelashwa kwesikhathi sokwelashwa kwezigameko ze-C-cell tumor (adenomas and carcinomas). Ngakho-ke, akukwazi ukuthi i-Ozempic ibangela izicubu ze-C-cell ze-thyroid, kuhlanganise ne-medullary thyroid carcinoma (MTC), kubantu.
Ukwengeza, abantu abanomlando we- retinopathy yesifo sikashukela (isifo se-iso) badangala ukusebenzisa le mithi njengoba kungase kube nzima kakhulu izimpawu futhi kubangele izinkinga. Kwabikwa ukuthi ingozi yokuthola i-retinopathy yesifo sikashukela kanye nezinkinga ziphakeme kulabo abasebenzisa i-Ozempic futhi nabo basebenzise i-retinopathy yesifo sikashukela kanye nalabo abangenalo.
Ingozi ephezulu ye-retinopathy ingaxhunyaniswa nokunciphisa okusheshayo ku-A1c lapho uqala imithi. Ama-insulin amaningi afaka isixwayiso esifanayo.
Ekugcineni, kulabo bantu abanomlando we-pancreatitis, le mithi ayinconywa. Ucwaningo luye lwabonisa ukuthi labo bantu abathatha i-Ozempic babike ukunyakaza okunamandla nokuhlala njalo. Kunconywa ukuthi abantu abathatha isinqumo sokuthatha le mithi bayaphathwa ngokucophelela ngezibonakaliso nezimpawu zokuphefumula, okufaka phakathi ubuhlungu obukhulu besisu esiswini, ngezinye izikhathi buyekezela emuva noma ngaphandle kokuhlanza. Uma kwenzeka ukuthi i-pancreatitis imiswe imithi futhi uma itholakale, akufanele iqaliswe kabusha.
Uma ungena kwelinye lala maqembu, ungazizwa udangele ngokuthola ukwelashwa. Kunezinye izinketho udokotela wakho angancoma ukuthi zikulungele kangcono.
Ukuphatha nokuPhepha
I-Ozempic ifika ekhompyutheni ekhethiwe, elahlwa yi-FlexTouch futhi ijojowe ngaphansi kwamathishu amafutha kanye ngesonto. Isilinganiso sokuqala singu-0.25 mg sokuqala futhi emva kwamasonto amane umthamo ukwandiswa ube ngu-0.5 mg kanye ngesonto. Uma ngemuva okungenani amasonto amane ukwelashwa kwegazi kwegazi kudingekile, udokotela wakho angakwandisa umthamo ku-1 mg kanye ngesonto ngalinye.
Ungathatha le mithi nganoma isiphi isikhathi sosuku, noma ngaphandle kokudla. Udokotela wakho noma uthisha oqinisekisiwe wesifo sikashukela uzokufundisa ngendlela efanele yokujola umjovo kanye nokulinda.
Izindleko Nempilo Yomshuwalense Wezempilo
Esikhathini esiningi, imishanguzo emisha ivame ukuba yintengo encane kakhulu uma kuqhathaniswa nalabo abaye bahlala isikhathi eside. Kodwa-ke, uNovo Nordisk uye wabonisa ukuthi i-Ozempic izobe ibalwe "ngokuhambisana" namanye ama-agonists ase-GLP-1 kanye kanye nesonto ngalinye. Kulindeleke ukuthi labo abanomshwalense kumele bakhokhe inani elifanayo kwezinye izidakamizwa kuleli klasi.
Ngokuvamile, amakhadi wokulondoloza i-copay atholakalayo kulabo abangenawo umshwalense. Uma unemibuzo ethile mayelana nokukhokha ungakhuluma nommeleli wekhasimende leNovo Nordisk.
Ukuthuthukiswa Kwesikhathi Esizayo
Ama-agonists e-GLP-1 afakazele ukuthi ayinzuzo enkulu kakhulu ekudleni nokuzivocavoca kulabo bantu abane-type 2 yesifo sikashukela. Futhi ngenkathi bengakabonakali njengokwelashwa kokuqala kwezidakamizwa, basebenzise kaningi njenge-agent yensimbi yesibili. Ngenxa yokuthi zandisa amathuba okulahlekelwa isisindo futhi zingase zithole izinzuzo zempilo yenhliziyo, cishe zizoba yi-agent engeza okukhethwa kukho ku- Metformin .
Ngokuthakazelisayo, i-Novo Nordisk iphinde isebenze ekuthuthukisweni kokubili kwalesi sidakamizwa. Baqhuba izifundo ukuze bahlole ukuthi i-Ozempic inezinzuzo zenhlalakahle yempilo kanye nokusetshenziswa kwe-Ozempic ngokukhethekile njengendlela yokwelapha isisindo sokulahlekelwa ukukhuluphala.
Ukwengeza, inguqulo yepilisi ye-Ozempic iphinde isilingo; lokhu kungenzeka ukuthi kube yi-agonist yokuqala ye-GLP-1 engadingeki noma yimiphi imijovo nhlobo. Lokho kungaba yishintsho semidlalo esiphelele kubantu abanesifo sikashukela-ukuze bakwazi ukuthola izinzuzo ezifanayo ngaphandle kokujola kungaba okukhangayo kakhulu.
Izwi elivela
Kuze kube manje, ucwaningo lubonisa ukuthi i-Ozempic ingaletha ukulawulwa ushukela omkhulu wegazi nokulahlekelwa kwesisindo.
Yiqiniso, kunezinye izinkinga-ukujova imithi, imiphumela emibi ejwayelekile, ingozi eyengeziwe yokwehla kwe-retinopathy, kanye nezindleko ezingenzeka, ukubiza ezimbalwa. Kodwa-ke, kufanele ulinganise ubuhle nokuqhafaza nomhlinzeki wakho wokunakekelwa kwezempilo futhi unqume ukuthi ukulahleka kwesisindo okungenzeka, ukulawulwa kweshukela egazini, kanye nezinzuzo zezempilo zenhliziyo ezingaphezu kwezingozi.
Hlala ubukele ulwazi oluthe xaxa ngomphumela walo empilweni yezinhliziyo kanye nokuthuthukiswa kwezintsha ezintsha, njengokuvuma ifomu lepilisi.
> Imithombo:
> I-American Diabetes Association. Amazinga Wokunakekelwa Kwezokwelapha Esifo Sikashukela-2018. Ukunakekelwa yisifo sikashukela 2018 Jan; 41 (Ungezelelo 1): S86-S104.
> Novo Nordisk. Umjovo we-Ozempic-semaglutide .