Ingaba i-Empagliflozin ekuphumeleleni kwabashukela besifo sikashukela abaneentsholongwane zesifo
Xa kufikelele ekuphatheni isifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sikashukela kunye nokunciphisa umngcipheko wokungaphumeleli kwezintso (kufuna i- dialysis okanye ukutshintshwa kweengtso ), akusiyo yonke imini esiva ngayo ngemichiza echaza imiqathango efana ne "Holy Grail", " ukuphulukana " , njl. Hayi, sinokuthi sibe ngenye yezihlandlo ezinqabileyo zonyango apho izilwanyana zibonise iziphumo ezithembisa ukuba zithethelele ezo zibhali.
Kukho imithi yokulawula isifo sikashukela, into ebizwa ngokuba yi- empagliflozin (eyaziwa ngokuba negama layo, Jardiance). Nangona kunjalo, ukuze uqonde inxaxheba ye-empagliflozin ekukhuseleni ukuhluleka kwezintso, kubalulekile ukwazi indawo ethile.
Kutheni isifo sikashukela sikhathaza kakhulu iiNtshontsho
Isifo sikashukela sinezandla phantsi kwesona sizathu esikhulu sesifo sezintso kunye nokungaphumeleli kwezintso kwilizwe elininzi eliphuhlisiweyo. Ukusabalalisa kwayo kuyaqhubeka ukunyuka ngelixa igalelo layo liqhubeka libonisa ubomi bezempilo. Kuyinto isifo esicacileyo, kulula ukuyihoxela de ukuba isigulane siqale ukuvelisa iingxaki.
Iizintso azizona kuphela izitho eziphazamiseke yilo mfo. Ekubeni isifo sikashukela sonakalisa imithana yegazi, ngokwezobugcisa, ngalinye iqumrhu lifanelekileyo umdlalo. Ngokuxhomekeka kubukhulu beemithwalo yegazi ezibandakanyekayo, isifo sesitya segazi esibangelwa yisifo sikashukela sele sihlulwe ngokwahlukileyo kwi- microvascular (umz.
isifo sesifo sesifo sikashukela emehlweni, isifo sesifo sesifo sikasifo sikasifo sikashukela, njl.) kunye neengxaki ezinzulu zesifo ( isib . isifo senhliziyo esisisongweni esichengeni kwingozi yokunyamekela intliziyo, izifo zentsholongwane kwimitshini yegazi yengqondo zandisa umngcipheko we-stroke, njl).
Oku kunikwe apha ngasentla, kuyaqondakala ukuba nayiphi na ixesha ukuphumelela kwenziwa kwinkalo yesifo sikashukela, ihlabathi liyawuqwalasela.
Oogqirha kunye nezigulane balindele iindaba ezilungileyo ngokuphefumula. Ngaba isilwanyana esitsha siya kunciphisa umngcipheko wokufa kwesifo sikashukela? Kutheni malunga nokuhlaselwa kwentliziyo okanye ukubetha? Mhlawumbi kunciphise umngcipheko wokuhluleka kwesifo sesifo sikashukela?
Okanye, njengokuba kunjalo njalo , ngaba oko kuyakuba sisigqibo esicasulayo apho ukulawulwa kwesifo sikashukela kuphuculi kwiziphumo ezingcono zonyango kwizigulane? Enyanisweni, kuye kwaba nezifundo ezibika ingozi ephezulu yokufa / isifo kunye neyeza ezithile zesifo sikashukela. Kungenxa yolu hlobo lubonakala lugxininiso lokuba i-FDA ngoku ifuna bonke abatsha bezonyango zomlomo wesifo sikashukela ukuba babonise ukuba amachiza abo amasha akayi kukubangela ingozi yeentliziyo kunye nezifo ze-vascular.
Ngaba amayeza omtsha angathuthukisa isifo sikashukela kunye neeNtsholongwane eziphathelene neengxaki?
Ilishumi elishumi elidlulileyo sele ibone iindidi ezintsha zonyango ezivunywe ukulawula isifo sikashukela. Imizekelo embalwa:
- I-GLP-1 I-Agonists yandisa i-insulin ekhutshwa yi-pancreas
- I-DPP-4 Inhibitors yandisa intshukumo ye-GLP-1 kwaye ngoko ke ingakhokelela ngqo kwisenzo esifana nesentla
- I-SGLT-2 Inhibitors ivimbela i- glucose (ushukela) ukubuyisela kwakhona intliziyo. Ezi zonyango zijolise kwingxoxo yam kweli nqaku
Indlela i-Dd SGLT-2 Inhibitors echaphazela ngayo iintso?
I-SGLT imele i-sodium-glucose cotransporter.
Ukuyibeka ngemigangatho elula, iprotheyini echaphazelekayo ekuthuthiseni iintlobo ezimbini zezinto ngaphakathi kweengso, ukusuka kumchamo ube yigazi. Esinye salezi i-sodium, enye enye i-glucose ebizwa ngokuba yi "piggybacks" ekuthuthweni kwe-sodium. Inombolo "2" ibhekisela kwihlobo elithile leprotheni efunyenwe kwiinkqubo zokugeleza kwamanzi, inxalenye ebizwa ngokuthi "i-tubul proximal." Kukho i-SGLT-1 kodwa leyo ixanduva kuphela kwiqhezu elincinci lolu thutho).
Imvelaphi ye-biology ye-molecular iyakunceda ukuqonda ukuba kutheni i-endocrinology ne-nephrology yinto yonke iya kuhamba ngalezi ziyobisi, i-SGLT-2 inhibitors.
Ngoku ukuba siyazi ukuba yiyiphi indima ye-SGLT-2, kusenokuba lula ukuqonda ukuba kuya kwenzeka ntoni ukuba "uvimba" isenzo se protein . Iinjongo zazingasakwazi ukufumana i-glucose eyayisele ifakwe kumchamo (oko yinto eyenzekayo), kwaye ngokuqinisekileyo i- sugare / glucose yaya yonke indlu yangasese . Oko kuthetha ukuba i-glucose encinci igcinwe egazini lakho, kwaye mhlawumbi ulawulo olungcono lwesifo sikashukela.
Isilwanyana esixoxwe kule nqaku sibizwa ngokuba yi-empagliflozin (iJardiance), i-inhibitor yeSGLT-2 evunywe yi-FDA kunyango lwe-2 lweswekile. Nangona ezinye zeyeza zintsholongwane zesifo sikashukela ziye zahamba kunye nokuthengiswa ngokukhawuleza kwazo, izilingo ezininzi ziye zahluleka ukubonisa umngcipheko omncinci weziphumo ezinzima zekliniki (njengokuphuculwa kwintliziyo yesifo okanye ingozi yokuphaphazeleka) ngala mayeza amasha, xa kuthelekiswa namayeza endala ukulawula isifo sikashukela. Utshintsho, nangona kunjalo, xa iyeza elitsha libonisa isibonakaliso esinamandla sokunciphisa ukuhlasela kweentliziyo, ukubetha, okanye ukungaphumeleli kwezintso, kuya kufuneka ibe yinkalo yokuqwalasela.
Ukunyangwa kweMveli yeSifo seSifo sesifo seSifo
Ngelishwa, kwimihla emibini edlulileyo, asizange senze nayiphi na inxaxheba enkulu ekuphuculeni unyango lwezigulane zesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo. Umgangatho wamanje wonyango ngokusekelwe kumanyathelo anjengeendlela zokulawula uxinzelelo lwegazi, okanye ukunciphisa iphrotheni yokulahleka emcini (usebenzisa imithi ebizwa ngokuba yi-ACE-inhibitors okanye i-angiotensin receptor blockers). Sinokubambisana nezi ngongenelelo ngezinye iinjongo, njengokunyusa amazinga e-alkali egazini, ukuphathwa kakuhle kwesifo sikashukela, nokunciphisa amazinga e-uric acid. Nangona kunjalo, kwiimeko ezininzi ezi ngenelelo zingenakwanela ukuba zenze umehluko ocacileyo kumathuba omguli ophuhliswa yintliziyo.
Ngaba I-Empagliflozin Ngaba Yimpawu Yonyango Ye-Diabetes Nephropathy?
Kukho izizathu zokukholelwa ukuba i-empagliflozin ingayiphula into ephazamisayo "ye-inertia inertia" kwiminyaka engamashumi amabini edlulileyo. I-Empagliflozin yaqala ukugqithisa kwisifo sikashukela ngasekupheleni kuka-2015 xa iziphumo ze-EMPA-REG zetyala zibonise ukuba zinefuthe elikhulu ekunciphiseni ukufa komzimba, ukuhlaselwa yintliziyo kunye nokubetha. Iziphumo zagqitywa kamva kwiNew England Journal of Medicine.
Isifundo ngokwayo sisilingo esikhulu esibandakanya izigulane ezingama-7000 zesifo sikashukela kumazwe angama-42 kumaziko amaninzi. Kubalulekile ukuba uqaphele ukuba ngaphezu kwama-80 ekhulwini abathathi-nxaxheba sele sele befumana unyango oluqhelekileyo lwesifo sesifo sesifo sesifo sesifo sesifo sikashukela (kunye neepesenti ezingaphezu kwama-80 kuba kwi-ACE inhibitors okanye i-angiotensin receptor blockers). Phantse zonke izigulane zazibangelwa yingozi enkulu yokugula kwesifo senhliziyo. Ubungakanani besilingo beyinye yezinto ezongezelela ukuthembeka kwizigqibo zayo.
Ngenxa yeziphumo ezikhuthazayo, uhlalutyo olongezelelweyo lwemiphumo ye-empagliflozin kwinqanaba lokuphuhliswa nokunyuka kwesifo seengtso. Oku kwakhokelela kwinqaku lesibini epapashwe ngo-Juni 2016, ejolise kwiyiphi into eyenziwa yiziyobisi kwiintso. Ngokuchanekileyo, uhlalutyo lubhekisele kwisantya sokuqhuma kwesifo sezintso (kwizigulane ezingafaniyo kunye neziyobisi). Oku kwenziwa ngokulinganisa ukunyuka kwezinga le- creinine okanye ukulahleka kweprotheyini kumchamo. Iziphumo zokugqibela zibonisa ukuba izifo zesifo sesifo sikasifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sesifo sikasifo esineengozi eziphezulu zesifo senhliziyo, kwaye ngubani othabatha i-empagliflozin (eyongezwa "ukunyamekela okuqhelekileyo") mhlawumbi unokubona ukuhla kwexesha elide kunaloo abangenayo. Izigulana ezithatha le meyile nazo zinolawulo olungcono lweshukela egazini, kunye nokuxinzelelo lwegazi oluphantsi, isisindo somzimba, ubunzima, kunye namazinga e-uric acid.
Iimiphumo ezimbi kunye nemibuzo engaphenduliweyo
Naliphi na ixesha isigqirha sichazwa ngokuba "ngumtshintshi wezemidlalo", ngokuqhelekileyo yinto efanelekileyo yokubuyela emva kwaye ijonge ngeqondo elincinci lokungathembeki kwezenzululwazi. Buza imibuzo malunga nokusebenza kwayo, mhlawumbi? Nayi eminye imibuzo ekufuneka iphendulwe ngokunyanisekileyo ngeli xesha:
- Ngaba kukho into ekhethekileyo malunga ne-empagliflozin? Ngaba siya kubona iintlobo ezifanayo kwezinye iziyobisi eziseklasini efanayo yamachiza (SGLT-2 Inhibitors, umz. Canagliflozin, dapagliflozin)?
- Ngaba iinjongo ezifunyenweyo zibangelwa ngumxhesho wegazi ophantsi okanye ubunzima, obonwe kwizigulane ezithatha i-empagliflozin?
- Ngaba ingcono ukulawula ishukela yegazi ichaza ubukhulu be-empagliflozin?
Imiba engentla iphakamisa i-specter yesithembiso esiphezulu. Kuthekani ukuba sinokudubula i-sugar sugar engcono / ukulawula uxinzelelo lwegazi usebenzisa iyeza ezikhoyo kunye nokulungiswa kwendlela yokuphila (cinga into efana ne-metformin + lisinopril + yokutya / ukuzivocavoca) ? Ngaba loo nto ingasinika i-bang efanayo enye, mhlawumbi ngexabiso eliphantsi? Le mibuzo kunye neminye iya kuba zezifundo zophando kwiminyaka ezayo.
Okokugqibela, gcina ingqalelo kwimiphumo emibi yeempagliflozin ezichazwe kwilingo, ezinye zazo ziyi:
- Usulelo lwezentsholongwane
- Urosepsis
- Ngelixa isilingo se-empagliflozin singakhange sichaze oku, i-FDA isanda kukhupha isilumkiso ngomngcipheko wezintso ekusebenziseni "abazala" (canagliflozin, dapagliflozin)
Umyalezo weKhaya lokuThatha loMguli
- Iziphumo zezi zilingo ezimbini, (kwimiphumo ye-empagliflozin engozini yenhliziyo, i-vascular, nesifo sesifo) eshicilelwe kwisithuba seenyanga ezimbalwa ngokungathandabuzekiyo iyamangalisa kodwa kuya kufuneka iqinisekiswe kwikamva.
- Iziphumo zibonisa ukuba i-empagliflozin inganciphisa ubungozi bokuhlaselwa kwintliziyo, izibetho, nokufa xa zongezwa kwi-standard diabetes management kwizigulane ezine-type 2 zesifo sikashukela esengozini enkulu yokugula kwesifo senhliziyo.
- I-Empagliflozin inokuthi yanciphise ukuhla kwexesha lokungenakukugwema kwintsebenzo yezintso ebonwa kwi-diabetics ephezulu. Asisazi ngokupheleleyo ukuba oku kungenxa yempembelelo ekukhuseleni kwiintso ngaphezu kwe-glycemic (ushukela wegazi).
- Ukuba iziphumo zibonakaliswe kwizilingo ezongezelelweyo, okokuqala ngethuba mhlawumbi, sinokukwazi ukuhambisa ukungenelela kwamandulo okwangoku kusetyenziswa ukuphatha isifo sesifo sesifo sikashukela (njengengcinezelo yegazi kunye nokulawula ushukela). Oku kunokwenzela izigulana into enokunciphisa ngokwenene ithuba lokuphelisa i-dialysis.
Ndiyathemba ukuba, oku kuphuhliswa kwezinto ezintsha / ukuphumelela akuyona nje into yokuba "inhlanhla yokuqala", njengokuba kunjalo nangenye imithi yesifo sesifo sesifo sikashukela ngexesha elidlulileyo (iBardoxolone yimeko kwinqanaba). Ekubeni iilingo ezimbini zashicilelwe, ndibone inani elididayo leempawu ezingenakulungelelaniso kwi-press layout kumda we-hyperbole. Isicatshulwa esivela kumhleli owashicilelwa kwiNew England Journal of Medicine (kanye kanye iphephancwadi apho izifundo zangaphambili zapapashwa khona) zichitha into ebalulekileyo yento esiyaziyo ngoku kude:
... "sishiywe ngantlukwano ebonakalayo ikhuthazayo, kodwa ayingekho" ukuhamba ekhaya "malunga nokulawulwa kwesifo sikashukela. Kule minyaka ezayo, izilingo ezifanelekileyo ezilawulwayo nokuthelekiswayo ezidibanisa ngokufanayo amagosa amatsha kunye namaziko asebekhulile zinganceda cwangcisa isicwangciso sonyango esiluncedo ngakumbi kwizigidi zabantu abaphila ubomi babo bachaphazelekayo ngohlobo lwesibini sikashukela ".
> Imithombo:
> Empagliflozin kunye noPhuculo lweSifo seNtsholongwane ngohlobo lwe-2 lwesifo sikashukela. I-EMPA-REG INDLELA Abaphandi. N Engl J Med. 2016 Juni 14
> Empagliflozin, Iziphumo Zomdlavuza, kunye nokufa ngohlobo lwe-2 lweswekile. Zinman B, et al; I-EMPA-REG INDLELA Abaphandi.INgl J Med.2015 uNd 26