I-Aimovig i-antioclonal antibody ekhusela i-migraines
Kukho iintlobo ezimbini zonyango lwe-migraine: ukukhupha okanye ukukhusela. Ukunyangwa kwamathambo kusetyenziswa ngexesha lokuhlaselwa kwe-migraine, ngenjongo yokumisa. I-Triptans kunye nee-NSAID ezifana ne-acetaminophen kunye ne-ibuprofen (Advil) zonyango.
Amanyango okukhusela azama ukunciphisa ubukhulu kunye nobukhulu beentloko ze-migraine. Ezi zonyango zikwahlula ngokubanzi njengemithi yokukhusela imithi (i-OMPMs) kunye nokubandakanya izidakamizwa, i-anticonvulsants kunye ne-beta-blockers.
Kwinqaku likaNovemba ka-2017 elipapashwe kwi- New England Journal of Medicine , i-Goadsby kunye nababhali-mbonisi bavavanya ikhono lika-Aimovig (erenumab) ukukhusela ukuhlaselwa kwe-migraine. Ngokungafani nee-OMPM zangoku, i-Aimovig ngumkhiqizo we-biologic-i-antioclonal antibody. Ngokukodwa, i-Aimovig ivimbela i-migraines ngokuthintela i-receptor ye-calcitonin ye-gene-peptide (receptor), edibaniswa nokusebenza kwemigraine.
Ngubani oye wafakwa kwiimvavanyo zeAimovig?
Ngexesha leSigaba sesi-2 kunye novavanyo lweSigaba 3, i-Aimovig iye yavavanywa kwizigulane ezinama-epradic and eproniced migraines.
Imigraines yama-Episodic ichazwa njengama-15 engama-migraine okanye iintsuku zentloko ngenyanga, nokuba kunye okanye ngaphandle kwe-aura. Imigraines engapheli ichazwa ubuncinane iintsuku ezili-15 zentloko ngenyanga. Ubuncinane ezisibhozo kwezi ntsuku ezilishumi elinesihlanu iintsuku ze-migraine okanye ngaphandle kwe-aura.
Izigulana ze-episodic ziqhelekileyo-malunga neepesenti ezingama-90 zabantu abane-migraine abanalo.
Phakathi kwama-5 ekhulwini kunye ne-8 ekhulwini labantu abane-migraine bane-migraines engapheliyo.
Malunga novavanyo
Ngomxholo kaNovemba ka-2017 opapashwe kwi- New England Journal of Medicine , i-Goadsby kunye nababhali-mbhalane bavavanya ikhono lika-Aimovig ukukhusela ukuhlaselwa kwe-migraine.
Kule sifundo, kwakukho abathathi-nxaxheba abangama-995 abahlukeneyo baba ngamaqela amabini okuhlola kunye neqela lokulawula.
Iqela elilawulayo lafumana ijoyi ye-placebo, kwaye amaqela okuhlola athola i-70 mg okanye i-140 mg yangeniso engaphantsi kwe-Aimovig, elawulwa njengamayeza amathandathu athathwe kwiiveki ezine ngaphandle.
Ngokubhaliweyo bombhali, zombini ama-dosage "anciphise imvamisa ye-migraine, imiphumo ye-migraines kwimisebenzi yemihla ngemihla, kunye nokusetyenziswa kwemithi ethile ye-migraine kwiinyanga ezili-6."
Kwinqanaba lokuqala, inani leentsuku ze-migraine ezifunyenwe ngenyanga nganye ngabafundi abathathiweyo kwisifundo bekuyiintsuku eziyi-8.3. Phakathi kweenyanga ezine neyesithandathu zonyango, inani leemigraine liyehla ngo-3.2 no-3.7 kuma-70-mg Aimovig kunye nama-140-mg Aimovig ngamaqela, ngokulandelanayo.
Phakathi kokuqala kokufunda kunye neenyanga ezine ukuya kweyesithandathu unyango, kwiqela lama-70-mg, iipesenti ezingama-43.3 zezigulane zineziphumo zokunciphisa ama-50 ekhulwini kwiintsuku ze-migraine nganye ngenyanga.
Phakathi kokuqala kokufunda kunye neenyanga ezine ukuya kweyesithandathu unyango, kwinqanaba lama-140-mg, iipesenti ezingama-50 zezigulane zafumana ubuncinane ukunciphisa ipesenti ezingama-50 kwinani leentsuku ze-migraine nganye ngenyanga.
Phakathi kokuqala kokufunda kunye neenyanga ezine ukuya kweyesithandathu unyango, kulabo bafumana indawo yokuhlala, iipesenti ezingama-26.6 zafumana ubuncinane ukuncipha kweepesenti ezingama-50 kwinani leemigraine ezinyangeni nganye ngenyanga.
Inani leentsuku apho izigulane ezazisebenzisa iimpawu ezithile zonyango zokunyanga ama-migraines aphantsi zaye zahla ngo-1.1 iintsuku kwiqela lama-70-mg kunye ne-1.6 iintsuku kwiqela lama-140-mg xa kuthelekiswa neentsuku ezingama-0.2 kwiqela le-placebo.
Ukungonakali kwemisebenzi yemihla ngemihla kwenza i-migraines iyancipha. Ukusebenzisa i-questionnaire, abaphandi bavavanya ukuphucula ekusebenzeni imisebenzi yansuku zonke. Bafumene uphuculo olukhulu kulabo bafumana iAimovig.
Imiphumo emibi kunye nokulinganiselwa
Nangona iziphumo ezimbi ze-Aimovig zabikwa uninzi lwabathathi-nxaxheba, ezi ziganeko ezimbi zazingenanto ezahlukileyo kwalabo bafumana indawo ye-placebo.
Ngokucacileyo, abantu abaninzi abafumana i-70 mg ye-Aimovig babika intlungu kwiziko lejoza ngaphandle kwalawo maqela elawulo.
Imizekelo yeziganeko eziqhelekileyo eziqhelekileyo zazibandakanya ukubandayo, ukuphefumula okuphezulu okuphefumula, kunye ne-sinusitis.
Omnye umda wokufundwa kukuba abaphandi abazange bazibandakanye izigulane ezingazange zifumane inzuzo yezobubele kwiiklasi ezimbini okanye ngaphezulu ze-OMPM.
Nangona kunjalo, abaphandi babandakanye izigulane eziye zayeka ii-OMPM ngenxa yokungasebenzi ngokwaneleyo, ukungabikho kwempendulo eqhubekayo, okanye iimpembelelo ezingathandekiyo. Enyanisweni, iiphesenti ezingama-38.7 zezigulane kweso sampulu azizange zifumane nzuzo kwi-OMPM.
Ukongezelela, ngokutsho kweGoadsby kunye nababhali-mbhali:
Ukusebenza kwabonakala ngendlela efanayo kwisigaba sesi-2 sovavanyo lwe-erenumab olubandakanya izigulane ezine-migraine ezingapheliyo, apho iipesenti ezingama-68 zezigulane sele ziyeke ukuyeka imithi yokukhusela i-migraine ngenxa yokungabi namandla okanye iziphumo ezingamkelekanga.
Xa zidibaniswe neziphumo ezivela kwezinye izilingo zeSigaba sesi-2 kunye neSigaba sesi-3 ezihlola ukusetyenziswa kwe-Aimovig kulabo abane-migraine engapheliyo kunye ne-episodic, kubonakala ngathi u-Aimovig unokunceda ukukhusela i-epradic migraines.
Uphando olongezelelweyo lufuneka luyenziwe ukucacisa ukhuseleko lwangexesha elide le-Aimovig, kunye nokuhlala ixesha elide.
Indlela i-Aimovig ityelela ngayo ukuya kwi-OMPM
Ukwahlukana okukhulu phakathi kweAimovig kunye nee-OMPM kukuba i-Aimovig ijolise ngokukodwa iinkqubo ezithile ze-pathophysiological ezenza indima kwimigraine.
Akukho uphando okwaneleyo owenziweyo ukuthelekisa imiphumo ye-Aimovig kunye namanye amayeza asetyenziswe ukukhusela i-migraine ikhanda. Ngaphezu koko, akukho uphando oluninzi oluhlola ukuphumelela kwe-OMPM ngokwazo.
Ngokwe-American Academy ye-Neurology:
Ubungqina abufumaneki ngokwenza ukuthelekiswa kokubanzi phakathi kwee-agent ezininzi ngaphakathi kweklasi enye; Ubungqina obunjalo buya kunika ulwazi olunzulu malunga nokusebenza kakuhle kunye nokunyamezela iiprofayili kwiinkalo ezibanzi zonxibelelwano. Izifundo zifunekayo ukuba zivandlakanise ngokuthe ngqo xa unyango olukhuselweyo lufanelekile kwaye ukuba imithi kufuneka ifakwe njani.
Inani elithile leephando liye lahlola ukuphumelela kwe-OMPM. Ngokutsho kwe-AAN, kukho ubungqina obuqinileyo okanye obunokulinganisela obuxhasa ukuphumelela kwezi zonyango zokukhusela ezilandelayo:
- I-Divalproex i-sodium, i-valproate ye-sodium, kunye ne-topiramate (iziyobisi ezinqanda i-antiepileptic)
- I-Metoprolol, propranolol, timolol, i-atenolol, ne-nadolol (beta-blockers)
- Amitriptyline kunye ne-venlafaxine (i-anti-depressants)
Ngaphezu koko, i-gabapentin, i-lamotrigine, i-clomipramine, ne-fluoxetine, enqunyelwe ukukhusela i-migraine, mhlawumbi ayinakusebenza ekukhuseleni imigraines.
Ingqalelo, unyango kunye nezidakamizwa ezinqabileyo zifuna ukulandelwa ngokucophelela kwe-pancreatitis, ukungaphumeleli kwesibindi kunye nemiphumo ye-teratogenic ezifana neziphene zokuzalwa. Ngaphezu koko, i-divalproex sodium ingenza uzuze ubunzima. Kuze kube ngoku, kubonakala ukuba i-Aimovig ayinayo imiphumo emibi.
Enye into esiyaziyo malunga nee-OMPM kukuba ukunyanzelisa kuphantsi. Ngamanye amagama, abaninzi abantu abathabatha la mayeza bayeke ukuthatha.
Kuphando oluthile olupapashwe kwiCephalagia ngo-2015, u-Hepp kunye noogxa bakhe bahlola ukuphumelela kweentlobo ezili-14 ze-OMPM ukwenzela unyango lwe-migraines engapheliyo. Phakathi kwezigulane ezingama-8688, ukunyanzelwa kweenyanga kwiinyanga ezintandathu kwaphakathi kweepesenti ezingama-26 kunye neepesenti ezingama-29. Kwiinyanga ezili-12, ukunyanzelwa kwemilinganiselo yehlelwa phakathi kweepesenti ezili-17 kunye neepesenti ezingama-20.
Ngokutsho kwababhali:
Nangona izizathu zokungahambisani nokungabikho nto zifakwe kwiibango zedatha, uphando olusandulweyo lwangaphambili lubonisa ukuba ukunyanzeliswa okuphantsi kunokuba kubangelwe kwizinto eziliqela, kubandakanywa nemiphumo emibi kunye / okanye ukungabikho kokusebenza kwe-OMPM. Ukongezelela, izikhokelo zonyango ze-AAN zibonisa ukuba kuphela i-OMPM ekhoyo kuphela ebonisa ukuba yinkqubela efanelekileyo yokukhusela i-migraine ikhanda.
Kuyathakazelisa ukuba abaphandi bafumanisa ukuba kwii-OMPM ezili-14 zivivinywe, i-amitriptyline, i-nortriptyline, i-gabapentin, kunye ne-divalproex inexabiso elincinci lokunamathela xa lifaniswa ne-topiramate.
Neurostimulation
Nantsi imbambano ebalulekileyo kunye ne-migraines: Asiyiqondi kakuhle indlela abasebenza ngayo. Ngaphandle kokuqonda okucacileyo kweendlela zokugula, kunzima ukudala unyango olutsha kunye nokukhusela okujoliswe kuzo okujoliswe kuyo.
Cinga inqaku elilandelayo ukusuka kwinqaku elihlaziywa ngo-2013 elibizwa ngokuthi "iMigraine: isimo sengqondo":
Iingcamango ze-migraine pathogenesis ziye zagxila kummandla oyintloko wokuqalisa njengokusasazeka kwi-cortex okanye 'i-generator migraine' kwingqondo yobuchopho. Kodwa ukuqhubela phambili kwexesha lokuhlaselwa kwe-migraine kubonisa utshintsho olufanayo ngexesha lomsebenzi weengingqi ezininzi zeengqondo, kwaye akucaci ukuba kukho ummandla omnye wama-anatomical apho i-migraine iqala kuzo zonke izigulane.
Njengo-Aimovig, uCefaly uhlose ukuphazamisa ngqo i-pathogenesis ye-migraine ngokucwangcisa iindlela. Ngokungafani ne-Aimovig, enikezwa njengesilwanyana, iCefaly iyisisombululo se-neurostimulation esibekwe phezu kwebunzi. Ikhuthaza i-nerve trigeminal, ecinga ukuba idlala indima enkulu kwimigraines.
UCefaly usanda kuvunywa yi-FDA kungekhona nje ngokuba kungenelela kokuthintela kodwa kwanefuthe elinzima, naye. Iza ngeendlela ezintathu: Cefaly Acute, Cefaly Prevent, kunye neCefaly Dual. (I-Cefaly Dual ineemodare zombini kunye nokukhusela okukhuselweyo kwemigraines.)
Ngokwabenzi balo, uCefaly Prevent ilawula ukusetyenziswa kwexesha eliphantsi elingasetyenziselwa imihla ngemihla ukukhusela ukuhlaselwa kwe-migraine.
Kwiimvavanyo zeclini, ezenzeke phakathi ko-2009 no-2012, abo bafumana unyango lwe-Cefaly ukukhusela imigraines bafumana ukuhla kwehla kokubili kwintsuku ye-migraine kunye nentloko emva kweenyanga ezintathu zokusetyenziswa.
Ngokukodwa, izigulane ezithe zafumana unyango lwe-Cefaly zafumana i-29.7 yeepesenti ezincinane iintsuku ze-migraine kunye ne-32.3 yeepesenti ezincinci iintsuku. Ukongezelela, iipesenti ezingama-38.2 zezigulane ezitholayo iCefaly zafumana ubuncinane bokunciphisa ipesenti ezingama-50 kwiintsuku ze-migraine zenyanga.
Ukongezelela kokufumana iintsuku ezimbalwa ze-migraine kunye neentloko, abo basebenzisa uCefaly nabo bafuna unyango olungaphantsi kwe-anti-migraine ("imithi yokuhlangula"). Ingqalelo, akukho miphumo emibi kakhulu kulabo bafumana unyango lweCefaly.
Ngexesha lokuphononongwa kwentengiso eyenziwa nguCefaly, ama-53 eepesenti zezigulane ezithe zafumana isixhobo savuya. Iipesenti ezi-4 kuphela zabasebenzisi babika ukunganeliseki kwaye babika imiphumo emibi embi, njengobuthongo, ikhanda, okanye ukubetha okubangelwa kwisixhobo. Njengazo zilingo zekliniki, akukho miphumo embi engaphantsi kweCefaly.
ILizwi
Nangona asiyiqondi ngokupheleleyo indlela i-migraines esebenza ngayo, ukungenelela kwintshukumo efana ne-biologic i-Aimovig, kunye ne-device ye-neurostimulation yeCefaly, ijolise ukuphazamisa iindlela zeli gulo. I-Aimovig ayisayi kuvunywa yi-FDA, kodwa iCefaly iyatholakala. Ukuba unomdla kulezi okanye ezinye izibonelelo zonyango, xubusha nge-neurologist yakho.
> Imithombo:
> Charles, A. Migraine: isimo sengqondo. Iingcamango zangoku kwi-Neurology. 2013: 26: 235-239.
> I- De Novo Ukufowunelwa Isicelo seCefaly Device . FDA.
> Goadsby PJ, et al. Uvavanyo olulawulwayo lwe-Erenumab ye-Episodic Migraine. I-New England Journal of Medicine. 2017; 377: 2123-2132.
> Hepp Z, et al. Ukuhambelana nemilomo yokukhusela imithi ye-migraine phakathi kwezigulane ezine-migraine ezingapheliyo, iCephalagia. 2015; 35: 478-488.
> Umculi F, i-penning S, i-Schoenen J. I-Supraorbital Nerve Ukuxilisa (T-SNS) kunye neCefaly Device for Prevention Migraine: Ukuhlaziywa kweeData ezifumanekayo. Ubuhlungu kunye neNyango. 2015; 4: 135-137.