Imithi yokuqala ekwazi ukuphatha zonke izinhlobo ze-HCV Infection
I-Epclusa (i-sofosbuvir ne-velpatasvir) iyinhlanganisela ye-dose engaguquki esetshenziswa ekwelapheni ukutheleleka okungapheli kwesifo se-hepatitis C (HCV) . Imithi emibili ehlanganisa umsebenzi we-Epclusa ngokuvimbela kokubili i-enzyme (i-RNA polymerase) kanye neprotheyini (NS5A) ebalulekile ekuphindaphindiwe kwegciwane.
Sibutsetelo
I-Epclusa yamukelwa ngoJuni, ngo-2016 yi-US Food and Drug Administration (FDA) yokusetshenziswa kubantu abadala abaneminyaka engu-18 ubudala nangaphezulu futhi yilabo abasebenza ngokuqondile okusebenzayo abakwazi ukuphatha zonke izinhlobo ze-HCV eziyisithupha ezinkulu .
I-Epclusa ifaneleka kokubili iziguli ezingelashwa (iziguli-naïve) ngaphambili, kanye nalabo abangenayo impendulo engenalutho noma engekho ngaphambi kwe-HCV yokwelapha (ukwelashwa-okuhlangenwe nakho).
I-Epclusa ingasetshenziselwa abantu abahlolwe ukuthi bane- cirrhosis , nakuba kunconywa ukuthi i- ribavirin ilawulwa ngokuqondile ezimweni ze- cirrhosis ezikhokhelwe (ie, lapho isibindi singasasebenzi khona). I-Epclusa ibikwa ukuthi kunezinyathelo zokwelashwa eziseduze namaphesenti angu-100 kwamanye amaqembu, kuyilapho ukusebenza kwayo kubantu abane-cirrhosis evulekile kuthiwa kuphakama ngamaphesenti angu-94.
I-Epclusa yakhululwa ngentengo ejwayelekile ye $ 74,760, noma i-$ 890 iphilisi ngalinye ngeklasi lezinyanga ezingu-12 zokwelashwa.
Ukwanda kwesifo soHemititis C
Cishe ngamaphesenti angama-75 abantu baseMelika abane-HCV bane-genotype 1, kuyilapho amaphesenti angu-20 kuya ku-25 anama-genotype 2 noma 3. Ngenkathi inani elincane labantu base-US litheleleke nge-genotype 4, 5, noma 6, lihlala liyizinkinga ezinkulu EMpumalanga Ephakathi, eningizimu ye-Afrika nase-Asia.
EGibhithe, izwe elinabantu abakhulu kakhulu be-HCV, cishe umuntu oyedwa kwabayisikhombisa (amaphesenti angu-14,5) akholelwa ukuthi unegciwane.
Phakathi kwabantu abaphila negciwane lesandulela ngculazi, isilinganiso se-HCV co-infection siphezulu ngamaphesenti angu-30 e-US naseYurophu. Emazweni wonke, umthwalo jikelele we-HIV / HCV ukutheleleka kokungenawo wonke umuntu ungabantu abayizigidi ezingu-4-5, noma phakathi kwamaphesenti angu-10 no-15.
Phakathi kwalaba bantu, imithi yokwelapha ye-HCV ibhekwa kubalulekile ngamanani aphezulu okukhubazeka kwesibindi esivele sisebenza. Ukuphumelela kuka-Epclusa ekuphatheni wonke ama-genotypes ama-HCV amakhulu kwenza kube umuthi obaluleke kakhulu ovela embonweni womhlaba wonke, ngokuphikisana okuncane nje kokwelashwa. (Bheka "Ukukhonjelwa Nokucabangela" ngezansi.)
Isilinganiso
Isilinganiso sinye tablet (400mg sofosbuvir / 100mg velpatasvir) ethathwa nsuku zonke noma ngaphandle kokudla. Amaphilisi e-Epclusa ahlotshaniswa ne-diamond, futhi ifilimu iboshwe, nge "GSI" ehlangothini olulodwa futhi "7916" ngakolunye uhlangothi.
Ukubeka izincomo
I-Epclusa inqunywe ngaphezu kwe-12-week course eya kubantu abane-HCV yokutheleleka okungapheli, noma ngaphandle kwe-cirrhosis ehlawulisiwe (lapho isibindi sisasebenza khona). Kubantu abanesifo se-cirrhosis esiphendukekile, i-Epclusa inqunywe izifundo zezinyanga ezingu-16 ngokuhambisana ne- ribavirin yezidakamizwa.
Imiphumela Ejwayelekile Ejwayelekile
Imiphumela emibi kakhulu ehlobene nokusetshenziswa kwe-Epclusa (okwenzeka okungenani amaphesenti angu-5 weziguli) yi:
- Izinwele
- Ukukhathala
- I-nausea
- Ukungabi namandla nokulahlekelwa amandla
- Ukungalali
- Ukuthukuthela
Emcwaningweni wokwelashwa, imiphumela emibi ngokuvamile ibhekwa njengezinga eliphansi nephansi kwamaphesenti angu-1 abahlanganyeli abayeka ukwelashwa ngenxa yemicimbi yezidakamizwa ezimbi.
Ezigulini ezine-cirrhosis eziphelile, i-anemia ne-diarrhea nazo zivame ukubikwa. Ucwaningo lwezokwelapha lwaluphakamisa ukuthi imiphumela emibi ehambisana ne-Epclusa kanye nokusetshenziswa kwe-ribavirin, ngenkathi evamile, yayivamile ukulinganisela, kanti kuphela amaphesenti angu-5 abahlanganyeli abayeka ukwelashwa ngenxa yemicimbi yezidakamizwa ezimbi.
Ukusebenzisana kwezidakamizwa
Okulandelayo kufanele futhi kugwenywe uma usebenzisa i-Epclusa:
- Imithi yokulwa nomdlavuza: Hycampin
- Anticonvulsants: Tegretol, Dilantin, Trileptal, phenobarbital
- Imithi yokulwa nesifo sofuba: i-Mycobutin, i-Rifater, i- Rifamate, i-Rimactane, i- Rifadin, i-Priftin
- Imithi ye-HIV : Sustiva (efavirenz), yandisa i-Aptivus (tipranavir / ritonavir)
- Izithako ze-Herbal: iSt John's Wort
Ukungafani nokucabangela
Isidakamizwa sokulwa nomuthi we-Codarone (amiodarone), esetshenziselwa ukuphatha ukushaya kwenhliziyo okungavamile, akunconywa ukuthi kusetshenziswe nge-Epclusa ngaphandle uma kuthathwa njengokudinga ngokwemithi. Ukusetshenziswa okuhlangene kwalezi zidakamizwa kungaholela ekunciphiseni okukhulu kwenhliziyo (bradycardia), umphumela wayo awusakuzwakala ngokugcwele. Uma kulawulwa ngokubambisana, ukuqapha kwenhliziyo kunconywa kakhulu.
Ama-proton pump inhibitors awanconywa ukuba asetshenziswe ne-Epclusa ngaphandle uma kubhekwa ukuthi kunesidingo sempilo. Uma kunjalo, i-Epclusa kufanele ithathwe ngokudla amahora angu-4 ngaphambi kwenzalo yeproton pump inhibitor.
Kubantu abathintekayo abane-HIV abasebenzisa i-tenofovir yezidakamizwa (etholakala eTruvada, Atripla, Complera, naseStribild), kufanele kunakekelwe okwengeziwe uma kuhlongozwa i-Epclusa. Uma isetshenziselwa ndawonye, i-Epclusa ingathuthukisa izinyosi ezihlobene nezinso ezihlobene nokusetshenziswa kwe-tenofovir. Ukuqapha kwenyusa njalo kunconywa.
Ama-antacids (noma i-aluminium- noma i-magnesium-based) kufanele athathwe ngokuhlukile ngamahora amane ngaphambi noma ngemva kwe-Epclusa dose, kanti ama- H2 receptor inhibitors (aka H2 blockers) kufanele athathwe kanyekanye no-Epclusa noma amahora angu-12 ahlukene.
Izilinganiso zezidakamizwa ze-statin I-Lipitor (avorvastatin) ne-Crestor (rovustatin) ingadinga ukunciphisa uma ihlelwe eceleni kwe-Epclusa njengoba ukubambisana kwezidakamizwa kungandisa kokubili ukuhlushwa nemiphumela emibi yemithi yokwehla kwe-cholesterol.
Nakuba kungekho ukuphikisana kokusetshenziswa kwe-Epclusa ekukhulelwe, idatha encane yomtholampilo iyatholakala. Kodwa izifundo zezilwane ekusetshenzisweni kokubili kwe-sofosbuvir ne-velpatasvir azibonisi umthelela ekuthuthukiseni ingane. Ukubonisana okwebuchwepheshe kunconywa ngesikhathi sokukhulelwa ukuhlola ukuphuthuma kwe-Epclusa therapy, ikakhulukazi ukuthi uqale ngokushesha noma ulinde kuze kube ngemva kokubeletha.
Kunconywa ukuthi bonke abesifazane abaneminyaka yobudala ababelethwe yingane kumele bahlolwe njalo ngenyanga ngokukhulelwa ngesikhathi sokulashwa. Kunconywa ukuthi bobabili owesifazane nomlingani wakhe wesilisa banikezwe okungenani izindlela ezimbili ezingekho ze-hormonal zokuvimbela ukukhulelwa kanye nokuthi zisetshenziswe ngesikhathi sokwelapha kanye nezinyanga eziyisithupha emva kwalokho.
Imithombo:
I-Science Science. " IZINDLELA EZIPHAKATHI ZOKWENZA INFORMATION - EPCLUSA ." Foster City, California
U-Mohamoud, uD .; I-Mumtaz, G .; Riome, S .; et al. "I-epidemiology yegciwane lesifo se-hepatitis C eGibhithe: ukubuyekezwa okuhleliwe kanye nokwaziswa kwedatha." I-BMC Izifo Ezithathelwanayo. 2013; 13 (288): DOI 10.1186 / 1461-2334-13-288.