Ngokuqhelekileyo Ichongiwe ukuba iMethotrexate ayinakuthethi
I-Arava (i-leflunomide) ichazwa njengesichengiso se-anti-rheumatic drug (DMARD). Isilwayo, esavunywe yi-US FDA ngoSeptemba 11, 1998, isetyenziselwa ukunyanga ngokuthe ngqo kwi- arthritis ye-rheumatoid esebenzayo kubantu abadala. Isetyenziswa ekunciphiseni iimpawu kunye neempawu zesifo se-rheumatoid arthritis, ukuvimbela umonakalo wesakhiwo (umz., Ubungqina be-x-ray ye-erosions kunye neendawo ezidibanisayo) kunye nokuphucula umsebenzi womzimba.
I-Arava idla ngokumiselwa xa ezinye i-DMARD, ngokukodwa i- methotrexate , ayikwazi ukunyamezela okanye ukuvelisa impendulo enganeleyo (okt, ukuhluleka ukulawula iimpawu).
Ukufumaneka kunye noDoses
I-Arava ifumaneka kwi-10 mg kunye ne-20 mg iipilisi ezifakwe kwifilimu (iibhotile eziyi-30). I-Arava ifumaneka kwi-100 mg 3-count pack blister. Ngenxa yesigxina-ubomi se-Arava kwizigulane ze-rheumatoid arthritis kunye nexesha eliphakanyisiweyo leeyure ezingama-24 zokufaka i-dosing, kucetyiswa ukuba i-Arava iqalwe nge-dose yokulayisha ye-tablet 100 mg ngosuku ngosuku lweentsuku ezintathu. Emva kokuba umthamo wokulayisha uphelele, umthamo wansuku zonke we-20 mg u-Arava unconywa kunyango lwe-arthritis ye-rheumatoid. I-tablet ye-10 mg ifumaneka kwizigulana ezifuna umthamo ophantsi ngenxa yeziphumo ezichaphazelekayo ezineziphumo eziphezulu. Ingathatha iiveki ezimbalwa ngaphambi kokuphucuka okubonakalayo kwintlungu edibeneyo okanye ukuvuvukala ngokuhlanganyela. Iintlawulo ezipheleleyo azinakuze zifezeke kwiiveki ezi-6 ukuya kwe-12 emva kokuba i-Arava iqalwe.
Ingaba isebenza kanjani
I-Arava yi-isoxazole e-immunomodulatory agent eyenza inhibits dihydroorotate dehydrogenase, i-enzyme ebandakanyekayo kwi-pyrimidine synthesis. Iiprimrimidines zakha iibhloko ze-nucleic acid. I-Arava inxulumene nomsebenzi ongenakuphikisana nentsholongwane (intsingiselo, inqanda ukusabalala kweeseli) kunye nezilingo, ibonise imiphumo echasayo.
Ivalela ukubunjwa kwe-DNA efunekayo ekuphuhliseni iiseli, njengamajoni omzimba omzimba. Ngokwenza njalo, iyakunqanda i- immune system . Indlela esebenza ngokukodwa ukulawula i-rheumatoid arthritis ayiqondi kakuhle.
Iimpembelelo eziPhakathi kunye nezimpembelelo ezimbi
Impendulo eyingozi kakhulu echaphazelekayo ehambisana neArava ibandakanya ukuhanjiswa, isicupunu, intloko yesifo, isifo sokuphefumula, ii-enzyme zesibindi (i-ALT kunye ne-AST) ephakamileyo, i-alopecia, ne-rash. Ukuphakama kwama-enzyme yesibindi kuthintela ngaphantsi kwe-10% yezigulane ezithatha i-Arava, kodwa ngenxa yokuba kunokubangela ukulimala kwesibindi, ngokukodwa ngokusetyenziswa kotywala okanye ngezinye iziyobisi, kufuneka kwenziwe iimvavanyo zegazi rhoqo ukuze zijonge isibindi.
Iziganeko ezimbi zichazwe ukuba zichaphazele i-1% ukuya ngaphantsi kwe-3% yezigulane ze-rheumatoid arthritis ezithatha inxaxheba kwizilingo ze-Arava. Iingxaki zomlenze, kuquka ukukhwehlela okanye ukuphefumula okufutshane, zibhekwa njengemiphumo engavumelekanga. Izigulane kufuneka zenziwe ziqaphele iimpawu zokuqala zezifo zamaphaphu kwaye zixele ezo zimpawu xa zifumana.
Isifo sohudo, isiphumo esivame kakhulu, sithintela malunga ne-20% yezigulane eziphathwe nge-Arava. I-diarrhea ngenxa yokusetyenziswa kwe-Arava idla ngokuphucula kunye nexesha okanye ngokuthatha amachiza ukukhusela isifo sohudo.
Kwezinye iimeko, umthamo we-Arava ungadinga ukuhla.
Izilumkiso kunye nokuchasene
I-Arava akufanele isetyenziswe ngabafazi abakhulelweyo okanye ngabasetyhini abakwazi ukukhulelwa kwaye abasebenzisanga ukukhulelwa. Ukukhulelwa kufuneka kugwenywe ngethuba lonyango kunye ne-Arava kunye nangaphambi kokuba kugqitywe inkqubo yokuchithwa kweziyobisi emva kokuba unyango kunye no-Arava.
Ukulimala kwesibindi, kubandakanya ukungaphumeleli kwesibindi, kuye kwabikwa kwezinye izigulana ezaphathwa nge-Arava. Izigulane ezinesifo esilukhulile okanye esingasigxina sesifo kufuneka singaphathwa nge-Arava.
I-Arava ayikhuthazwa izigulane ezinomzimba okhuselekileyo, i-bone marrow dysplasia, okanye izifo ezinokungalawulwa.
Iingxelo ezikhoyo ze-pancytopenia, i-agranulocytosis, kunye ne-thrombocytoplenia ziye zabikwa. Ukubala kwegazi kufuneka kwenziwe ngokuqhelekileyo ukuba ubukele ukungabikho.
Iziganeko eziqhelekileyo ze-Stevens-Johnson syndrome kunye nesifo esiyingozi se-epidermal necrolysis, kunye ne-DRESS (impendulo yezilwanyana kunye ne-eosinophilia kunye neempawu zesistim) ziye zaxelwa kwizigulane eziphathwe nge-Arava. Ukuba oko kwenzeka, i-Arava kufuneka imiswe kwaye inkqubo yokuqeda iziyobisi ingaqaliswa.
I-peripheral neuropathy ibiwe kwezinye izigulane ezithatha i-Arava. Nangona kunjalo kwiimeko ezininzi, iimpawu zixhaswe ngokuyeka iArava, ezinye izigulane zineempawu eziqhubekayo.
Imithombo:
IArava Tablets. Ulwaziso loLwazi. I-Sanofi-Aventis US ehlaziywe ngoNovemba 2014.
Leflunomide (Arava). Ikholeji yaseMerika yaseRheumatology. Ukuhlaziywa ngoMeyi 2015.