Imithi yokuqala yokuLawula zonke iintlobo ze-HCV Infection
I-Epclusa (i-sofosbuvir kunye ne-velpatasvir) yinto edibeneyo yezilwanyana ezisetyenziselwa ukunyangwa kosuleleko lwe- hepatitis C (HCV) . Amachiza amabini aquka umsebenzi we-Epclusa ngokukhusela zombini i-enzyme (i-RNA polymerase) kunye neprotheni (NS5A) ibalulekile ekuphindaphindiwe kwintsholongwane.
Sibanzi
I-Epclusa yavunywa ngoJuni, ngo-2016 yi-US Food and Drug Administration (FDA) ekusebenziseni abantu abadala abaneminyaka engama-18 ubudala nangaphezulu kwaye igosa elisebenza ngokuthe ngqo elikwazi ukuphatha zonke iinqununu ze-HCV ezininzi .
I-Epclusa ifanelekile kokubili izigulane zangaphambili ezingaphatulwanga (unyango-naïve), kunye nalabo abanengxenye okanye ababikho mpendulo kwi-HCV ngaphambili (unyango-nolwazi).
I-Epclusa ingasetyenziselwa abantu abaxilongwa nge- cirrhosis , nangona kunconywa ukuba i- ribavirin ilawulwa ngokufanelekileyo kwiimeko ze -cirrhosis ezenzelwe ukutshatyalaliswa (oko kukuthi, apho isibindi asisasebenzi khona). I-Epclusa ibikwa ukuba amayeza okunyanga afinyelela kuma-100 ekhulwini kwamanye amaqela, ngelixa i-efficacy yayo kubantu abane-cirrhosis ekhutshiwe kuthiwa iphezulu njengama-94 ekhulwini.
I-Epclusa ikhishwe kwixabiso eliqhelekileyo lamaxabiso angamaRandi angama-74,760, okanye i-$ 890 ipilisi nganye kwiiklasi ezili-12 zonyango.
Ukwanda kwe-Hepatitis C
Phantse iipesenti ezingama-75 zamaMerika ezine-HCV zine-genotype 1, ngelixa i-20 kuya kuma-25 ekhulwini inama-genotype 2 okanye 3. Ngona nje inani elincinci labantu base-US lijongene ne-genotypes 4, 5, okanye-6, ihlala yimizila ebalulekileyo EMbindi Mpuma, eMzantsi Afrika, nase-Asia.
EYiputa, ilizwe elinabantu abakhulu be-HCV, phantse omnye kubantu abasixhenxe (i-14.5 ekhulwini) bakholelwa ukuba unesifo.
Phakathi kwabantu abaphila ne-HIV, izinga le-HCV lokusuleleka kwintsholongwane liqhubela phezulu njengama-30 ekhulwini eMelika naseYurophu. Ehlabathini lonke, umthwalo wonke we-HIV / HCV usulelo lwe-HCV luphakathi kwabantu abane-4-5, okanye phakathi kwe-10 ne-15 ekhulwini.
Phakathi kwala manani, iiprogram ze-HCV zibhekwa njengento ebalulekileyo kunye namazinga aphezulu okukhubazeka kwesibindi. Ukuphumelela kwe-Epclusa ekuphatheni zonke ii-genotype eziphambili ze-HCV kwenza kubekho izidakamizwa ezibalulekileyo kwihlabathi jikelele, kunye neenkcazo ezimbalwa zokunyanga. (Jonga "ukuchasana kunye nokuqwalasela" ngezansi.)
Isistim
Isisombululo sinye ipilisi (400mg sofosbuvir / 100mg velpatasvir) ithathwa imihla ngemihla okanye ngaphandle kokutya. Iipilisi ze-epclusa zine-pink diamond-shaped, kunye nefilimu eboshwe, kunye ne "GSI" emacaleni kwelinye icala kunye ne "7916" kwelinye.
Ukucetyiswa kweengcebiso
I-Epclusa imiselwe kwiikhosi ezili-12 zeeveki kubantu abane-HCV yokusuleleka, okanye ngaphandle kwe-cirrhosis ehlawulwayo (apho isibindi sisasebenza). Kubantu abane-cirrhosis ehlawulweyo, i-Epclusa imiselwe kwikhosi yeeveki ezili-16 ngokudibanisa ne- ribavirin yeziyobisi.
Iziphumo eziPhakathi
Iziphumo eziqhelekileyo ezimalunga nokusetyenziswa kwe-Epclusa (okwenzeka okungenani ama-5 ekhulwini kwezigulane) zi:
- Intloko
- Ukukhathala
- I sizathu
- Ubuthathaka kunye nokulahlekelwa kwamandla
- Ukungabikho
- Ukutshatyalaliswa
Kuphando lwekliniki, iziphumo zecala ngokuqhelekileyo zazibhekwa njengezinga eliphantsi kunye neepesenti ezingaphantsi kwe-1 yabathathi-nxaxheba abashiya unyango ngenxa yeziganeko ezichasene neziyobisi.
Kwizigulane ezine-cirrhosis ezichithwayo, i-anemia kunye ne-diarrhea nazo zixelwa ngokuqhelekileyo. Uphando lwezonyango luye lwaphakamisa ukuba iziphumo ezichaphazelekayo ezinxulumene ne-Epclusa kunye ne-ribavirin, ngelixa ziqhelekileyo, zaziqhelekile zibe ziyingqinisiso, kwaye kuphela ama-5 ekhulwini abathathi-nxaxheba abayeka unyango ngenxa yeziganeko ezichasene neziyobisi.
Ukusebenzisana kweziyobisi
Oku kulandelayo kufuneka kuphetshwe xa usebenzisa i-Epclusa:
- Imithi yokulwa nomhlaza: Hycampin
- Anticonvulsants: Tegretol, Dilantin, Trileptal, phenobarbital
- Iyeza-anti-tuberculosis: i-Mycobutin, iRifater, i-Rifamate, i-Rimactane, i- Rifadin, i-Priftin
- Iyeza-HIV : Sustiva (efavirenz), ikhulise i-Aptivus (tipranavir / ritonavir)
- Ukuncedisa ama-Herbal: iSt. John's Wort
Ukungqinelana nokuqwalasela
Isidakamizwa sokulwa nesigqirha seCodarone (amiodarone), esetyenziselwa ukuphatha intliziyo engavumelekanga, ayikhuthazwa ukuba isebenzise ne-Epclusa ngaphandle kokuba kuthathwa njengemfuneko yempilo. Ukusetyenziswa okudibeneyo kwezi ziyobisi kungabangela ukuthoba okukhulu kwenhliziyo (bradycardia), umphumo wayo awusayiqondi kakuhle. Ukuba ukulawulwa ngokubambisene, ukubeka amehlo kwenyama kunconywa kakhulu.
I-proton pump inhibitors ayinakunyuswa ukuba isebenziswe ne-Epclusa ngaphandle kokuba ithathwa njengemfuneko yempilo. Kwimeko enjalo, i-Epclusa kufuneka ithathwe ngokutya iiyure ezingama-4 ngaphambi kwe-proton pump inhibitor dose.
Kubantu abanentsholongwane kaGawulayo abasebenzisa izidakamizwa ze-tenofovir (ezifumaneka eTruvada , Atripla, Complera, neStribild), kufuneka kuthathelwe ingqalelo xa kunikwa i-Epclusa. Xa zisetyenzisene kunye, i-Epclusa inokuphucula isifo esichaphazelekayo sezintso ezinxulumene ne-tenofovir. Ukuqapha kwenyango rhoqo kunconywa.
I-Antacids (mhlawumbi i-aluminium okanye i-magnesium-based based) kufuneka ithathwe ngokwahlukileyo kwiiyure ezingama-4 ngaphambi okanye emva kweDisksi ye-Epclusa, ngelixa i- H2 receptor inhibitors (aka H2 blockers) imele ithathwe kunye ne-Epclusa okanye iiyure ezili-12 ngaphandle.
Imilinganiselo yezilwanyana ze-statin I-Lipitor (avorvastatin) kunye neCrestor (rovustatin) ingadinga ukunciphisa ukuba imiselwe kunye ne-Epclusa njengendlela yokubambisana kwezi ziyobisi kunokunyusa zombini uxinzelelo kunye nemiphumo emibi ye-cholesterol-downing medication.
Nangona kungekho ukuphikisana nokusetyenziswa kwe-epclusa ekukhulelweni, idatha encinci yeklinikhi yabantu iyatholakala. Nangona kunjalo izifundo zezilwanyana ekusebenziseni zombini i-sofosbuvir kunye ne-velpatasvir azibonisanga niphumo ekuphuhlisweni komntwana. Ukucebisana kwenzululwazi kunconywa ngexesha lokukhulelwa ukuvavanya ukuphuthuma kwe-Epclusa unyango, ngokukodwa ukuba uqale ngokukhawuleza okanye ulinde de emva kokunikezelwa.
Kunconywa ukuba bonke abafazi abaneminyaka engama-50 ubudala bahlolwe rhoqo ngenyanga ngokukhulelwa ngexesha loqeqesho. Kucetyiswa kwakhona ukuba bobabini umfazi kunye nomlingani wakhe wesilisa banikezelwe ubuncinane iindlela ezimbini ezingekho ze-hormonal zokukhulelwa kwezilwanyana kwaye zisetyenziswe ngexesha lokunyanga kunye neenyanga ezintandathu emva koko.
Imithombo:
YeGiliyadi. "AMANQAKU OKUHLAWULWA KWEENKCUKACHA IINKCUKACHA - EPCLUSA ." Foster City, California
Mohamoud, D .; Mumtaz, G; Riome, S; okqhubekayo. "I-epidemiology yegciwane lesifo se-hepatitis C eYiputa: uhlolo oluhlelekile kunye nolwazi lweenkcukacha." IiMBC ezithathelwanayo. 2013; 13 (288): INGXELO 10.1186 / 1461-2334-13-288.