Ukwelashwa "sofosbuvir": ukubuyekezwa. "Sofosbuvir" + "Daklatasvir": Izibuyekezo Ochwepheshe. "Sofosbuvir": ukulaya odokotela Izibuyekezo

Isibindi uhlobo lokuhlanza okuhlanza umzimba womuntu. Isimo salo mzimba sinomthelela ekusebenzeni kwezinhlelo eziningi nasemkhakheni wokuphila komuntu wonke. Esinye sezilimaza kakhulu zesibindi yi-hepatitis C. Okwamanje, izidakamizwa eziningi zakhiwe ukulwa nalesi sifo. Enye yezindlela eziphumelelayo kakhulu kucatshangelwa (okuqinisekiswa yizikhombisi zezokwelapha), i-Sofosbuvir.

Izinkomba zokusetshenziswa

Ngokuvamile, i-cofactor ibizwa ngokuthi isithako esebenzayo kumaphilisi, futhi umnikazi ngokwawo unegama lokuhweba elithi "Sowaldi". Ngakho-ke, singasho ukuthi le mithi ishicilelo eshibhile - i-generic "Sofosbuvir", okubuyekezwa kwayo ichaza izidakamizwa njengenye yemithi ephumelelayo kakhulu yokwelapha i- virus ye- virus ye- virus ye- virus .

Into eyinhloko, i-sophosbuvir, iyisimiso se-virus ye-viral polymerase NS5B, okungukuthi, isusa inqubo yokusakazwa kwegciwane lesandulela ngculazi. Kodwa-ke, ochwepheshe abaningi bezokwelapha abaphakamisi iSoffosbuvir monotherapy (nakuba lokhu kusemthethweni kungenzeka). Kodwa njengengxenye eyinhloko yokwelashwa kwe-antiviral eyinkimbinkimbi, ukubuyekezwa kwezidakamizwa "Sofosbuvir" kunesiqondiso esihle kuphela, sibonisa ukuthi siyindlela ephumelelayo kakhulu. Ngokwezifundo zemitholampilo, izidakamizwa ezinomuthi neminye imithi yabonisa imiphumela emihle ngokuphathelene nokuphathwa kwegciwane le-hepatitis C (genotypes 1, 2, 3).

Ukwelashwa kweSofosbuvir nabasebenzi bezempilo kubhekwa kahle hhayi kuphela iziguli ezingakaze zelashwe, kodwa nalabo abaye bathola ukwelapha i-anti-antiretroviral nezinye imithi futhi ekupheleni kokwelashwa, ngemuva kokubuyiselwa emuva.

Ngaphandle kwendawo echazwe ngenhla yokuchayeka, "ukubuyekezwa kwe-Sofosbuvir" odokotela nezincomo zezincomo kuvumela ukusebenzisa ekwelapheni kweziguli ezine-cirrhosis yesibindi.

Ngokuqondene nokusebenza komuthi wokwelapha ngokutheleleka nge-HIV nesifo sofuba (isimo esivamile), ulwazi olunjalo alukatholakali, nakuba lo muthi uboniswa ukuthi usebenzise ezimweni ezinjalo.

Ukungafani

Ezimweni eziningi, izidakamizwa ngokwazo kanye nezidakamizwa zayo zazibekezelela iziguli.

Kodwa-ke, izidakamizwa zokwelashwa kwesifo sofuba sohlobo lwe-hepatitis C "Sovvaldi" (noma "Sofosbuvir"), okubuyekezwa kwazo okunembile, njenganoma imuphi umuthi wanamuhla osebenza kahle, unemibandela ethile yokuphikisa.

Okokuqala, yi-hypersensitivity yomuntu oyedwa ezingxenyeni ezisemqoka nezizayo zomuthi. Abesifazane abaneminyaka yobudala yokubeletha kufanele baqaphe uma besisebenzisa. Ngokuyinhloko, uma i- "Sowaldi" ("Sofosbuvir") inqunywe ngokubambisana ne-"Ribavirin" ne-"Interferon alfa" (yangempela yama-genotypes 3, 4, 5, 6, i-hepatitis), kufanele ibe yizo zonke izindlela zokugwema ukukhulelwa. Kuyinto engathandeki kakhulu ukwenza ukwelashwa nalezi zidakamizwa ngesikhathi sokukhulelwa nangesikhathi sokukhulelwa.

Njengamanje, alukho ulwazi mayelana nomthelela weSofosbuvir emsebenzini wokuzala womuntu. Akukho futhi ulwazi mayelana nokuphepha nokusebenza komuthi kwiziguli ezingaphansi kweminyaka engu-18 ubudala.

Izindlela kanye nobude besikhathi sokwelapha

Okokuqala, kufanele kuthiwe ukuthi ukwelashwa kwe-antiviral kuvunyelwe kuphela kulabo ochwepheshe bezokwelapha abanokuhlangenwe nakho okwanele ekwelapheni iziguli ezine-hepatitis C. Uhlobo olujwayelekile luyi-tablet eyodwa (400 mg yesithako esisebenzayo) phakathi nosuku nganoma isiphi isikhathi sokudla. Njengoba amaphilisi amuncu (okufana nezimpendulo ezivela emithini eyathola imithi), "I-Sofosbuvir" kufanele igonywe ngaphandle kokuhlafuna futhi ingayiphuli.

Uma ithebhulethi ithathwe, futhi ngemuva kwalokho emahoreni amabili alandelayo, ukuhlanza kuqale, kutuswa ukuthatha ithebhulethi engu-1 ngaphezulu. Uma ukuhlanza kuvela ngemuva kwesikhathi esingaphansi kwamahora amabili, akudingeki umthamo owengeziwe.

Uma ukudliwa okulandelayo kwesidakamizwa nganoma yisiphi isizathu kungaphuthelwa (isikhathi sokulibaziseka asikho ngaphezu kwamahora angu-18), kunconywa ukuba uthathe umthamo ongekho, bese uqhubeka ukwelashwa ngesikhathi esivamile. Uma ukubambezeleka kudlula amahora angu-18 - thatha isilinganiso esilandelayo ngesikhathi esivamile.

Izindlela zokwelashwa okuhlangene

Njengengxenye yokwelashwa okuyinkimbinkimbi yokwelashwa kwesifo sofuba, kanye ne "Sofosbuvir", umkhuba wokuqokwa kwe "Ribavirin", "Interferon alfa", "Daklatasvira", "Ladipasvira", "Asunaprevir".

Ngokuvamile, ukuhlolwa kwe-Sofosbuvir "+" Daklatasvir "yezempilo nezakhamuzi kubonakala sengathi kuyaphumelela ekulwa nesifo se-hepatitis C 1,2,3.

Kuze kube manje, "i-Daklataswir" ingahle ilandelwe kwiWWW.ARV24.COM iwebhusayithi ngokuletha ngesandla - enkampanini enegama elide. Kuncike ekutheni izandla zinezo zonke ulwazi oludingekayo mayelana nokuba khona kwesifo.

I-Genotypes 4, 5, 6 iphathwa ngeyinkimbinkimbi yemithi "Sofosbuvir", "Ribavirin" ne "Interferon alfa". Inkathi yokwelapha evamile okungenani amasonto angu-12. Ezimweni lapho iziguli ezine-genotypes 1, 4, 5, 6 zinemibono yokuthatha i-Interferon alfa noma i-hypersensitivity kulokhu, i-Sofosbuvir ne-Ribavirin inqunyelwe ukuvunyelwa amasonto angu-24.

Isiqu "Ribavirin" nesidakamizwa esithi "Sofosbuvir" se-2 genotype ukubuyekezwa kochwepheshe futhi sibonisa njengenhlanganisela ephumelelayo kakhulu, ekhethwe ukufakwa okwesikhashana samasonto angaphansi kwama-12. Imithi emibili efanayo, kepha isikhathi esingenani amasonto angu-24, isetshenziselwa i-genotype engu-3 ye-hepatitis C.

Ulwazi mayelana nokuphumelela kokwelashwa okuyinkimbinkimbi nge "Ribavirin" ne "Interferon" yokwelashwa kwe-genotype 1 ayitholakali.

Uma kwenzeka isiguli sigula i-hepatocarcinoma futhi / noma silindele ukusebenza kokufakelwa kwesibindi, umkhuba we "Sofosbuvira" ohlangene ne "Ribavirin" uqhutshwa amaviki angu 48 noma kuze kube khona ukungenelela kokuhlinzekwa komzimba. Lokhu kubalulekile ukuze kuvinjelwe ukutheleleka kwesibindi emva kokufakelwa kwesitshalo.

Ucwaningo lwezokwelapha lubonisa ukuthi ukusetshenziswa okuhlanganyelwe kweSofosbuvir nezinye izidakamizwa kungabangela ukuphendula okuqhubekayo kwe-virologic ngamaphesenti angu-92 wezokwelapha eziyinkimbinkimbi ekwelapheni kwesifo sofuba esibangwa yi-viral hepatitis C.

Imiphumela emibi engenzeka

Enkambeni yokuqhuba ukuvivinywa kwemitholampilo, lesi sidakamizwa sasibekezeleleke kakhulu iziguli (lokho kwakuyimpendulo yabo). "I-Sofosbuvir" ibangela imiphumela emibi kakhulu ezimweni eziningi uma isetshenziselwa inhlanganisela ne "Ribavirin" ne-"Interferon".

Uma kuhlanganiswa iSoffosbuvira neRibavirin, ukuhlushwa kwe-hemoglobin kunciphisa ekubunjweni kwegazi kaningi (amacala angaphezu kwezingu-10%) namazinga e-bilirubin akhula, ukukhathala, ukucasuka nokuqwashisa, isicanucanu singase senzeke.

Ngaphansi kancane (amacala angaphansi kwezingu-10%), lokhu kuhlanganiswa kwezidakamizwa kubangela ukucindezeleka, i-anemia, i-rhinopharyngitis, ukunakekelwa kokulahlekelwa kokukhathazeka, i-dyspepsia, ukuqothulwa kanye nokuphazamiseka kwamathumbu, ukubonakaliswa kwezilwane esikhumbeni (ukucheka, ukuhlukumeza). Ngezinye izikhathi iziguli zishiya imibono enjalo: "I-Sofosbuvir", esetshenziselwa ukufana ne "Ribavirin", yabangela ukulahleka kwezinwele nokubuhlungu emuva, ukuhlukunyezwa, i-myalgia ne-asthenia.

Uma kusetshenziselwa imishanguzo emithini emithathu (i-"Interferon-alpha" ingeziwe kulezi ezimbili ezibalwe ngenhla), uhlu olubanzi kakhulu lwezenzakalo ezimbi kakhulu kaningi (amacala angaphezu kuka-10%). Lapha bakhuluma ngezinguquko ekubunjweni kwegazi: ukwehla kwenani lama-lymphocytes, amaplatelets kanye neutrophils, i-anemia, ukwanda ezingeni le-bilirubin. Kusukela emgodleni wokugaya kungakha ukuhuda, isicanucanu, ukuhlanza. Ngaphezu kwalokho, i-Sofosbuvir (imiyalelo, ukubuyekezwa kweziguli kanye nezisebenzi zezempilo kuqinisekisa) kungabangela ukukhanda ikhanda nokusizwa, ukukhwehlela, ukuphefumula, ukuphika nokuphuza, ubuhlungu be-myalgia nobuhlungu obuhlangene. Ngokuvamile iziguli zikhuluma ngokukhathala, ukucasula, ukukhukhumeza, umkhuhlane.

Isikhathi esingaphansi (ezivela ku-1 ukuya ku-10%) iziguli zikhuluma ngokumesaba nokuthuthukiswa kokucindezeleka, ngokulahlekelwa kwesisindo, mayelana nenkumbulo nokuhlukumeza okungavamile, mayelana nemigraines. Kukhona ulwazi lokulimala kombono, ukulahlekelwa izinwele, ukuthuthukiswa kwe-reflux ne-dyspnea ngomthwalo owengeziwe. Ngezinye izikhathi iziguli zikhuluma ngobuhlungu ngemuva nangesifuba, ukuxubana kanye ne-asthenia.

Yini engiyidingayo ukuze ngazi?

Uma isiguli sinesisindo esisodwa noma ngaphezulu - okokuqala umthamo omkhulu wegciwane lesandulela ngculazi, i- fibrosis eqhubekayo, isikhumba esimnyama kakhulu, kanti ukwelashwa kweSofosbuvir (ukubuyekezwa kochwepheshe kanye nemiyalelo yokusetshenziswa kuqinisekisa) kunganyuswa kuze kube amasonto angu-24. Uma ukwelashwa okuhlangene kusetshenziswa, umthamo osebenzayo we "Ribavirin" ukhethwe ngokuhambisana nesisindo somzimba wesiguli, okungukuthi u-75 kg wesisindo somzimba kudinga u-1.2 g wemithi. Umthamo wonke wezidakamizwa uhlukaniswe waba izingxenye ezimbili futhi uthathwe ngokudla.

Akunconywa ukwehlisa umthamo we "Sofosbuvira".

Uma ukubonakaliswa okuhlangene kweSolfosbuvira ne-Interferon alfa kuhlakulela izimpawu ezingezona eziyimpawu zomuthi wokugcina, umthamo we-Interferon othathwe ukunciphisa noma ukuqeda ngokuphelele imithi (imiyalelo eningiliziwe yokunciphisa inani noma ukukhanselwa kwezidakamizwa iyatholakala kumilayezo ekhethekile).

Kuyinto efanayo lapho inhlanganisela ye "Sofosbuvira" ne "Ribavirin" isetshenziswa, nemiphumela emibi ithuthukiswa ekumukelweni kwalokhu okulandelayo - umthamo wehlisa noma ukwamukelwa "kwe-Ribavirin" kuphelile ngokuphelele. Ngemuva kokuthi imiphumela yokuhlolwa kwegazi ithuthukisiwe, kuvunyelwe ukuzama ukuqhubeka nokuthatha i-Ribavirin, kusukela ku-600 mg futhi kancane kancane ikhuphuke ibe ngu-800 mg. Akunconywa ukwandisa umthamo kumthamo owunqunywe ekuqaleni.

Uma ukhansela omunye wemithi yokwelapha eyinkimbinkimbi, kufanele uyeke ukuthatha i- "Sofosbuvir" ngokugcwele - imibono yezobuchwepheshe kanye nemiyalo yokufundisa yokusetshenziswa kule ndaba ifanayo.

Ukuxhumana nezinye izinto

Izisebenzi zezokwelapha aziphakamisi iziguli ngokufana nomuthi osubuzwayo ukusebenzisa ezinye izidakamizwa (ngaphandle kwalezo ezibekwe udokotela oya khona) ngesikhathi sokuphathwa kwesifo sofuba. Ukubuyekezwa kochwepheshe be-Sofosbuvir kubheka ukuthi kungenzeka ukuhlanganisa nenye into kuphela kulezo zinkathi uma inzuzo ekulindeleke ngokuhlanganiswa kwezidakamizwa kudlula ingozi yemiphumela engafuneki.

Kukhona futhi amaqembu ezidakamizwa, ukusetshenziswa okuhlanganyelwe ngakho ngeSofosbuvir kunganciphisa kakhulu ukukhipha ("Sofosbuvira") emathunjini. Emithi enjalo - evela kuma-anticonvulsants - kungenzeka ukuthi ithwale i- "Phenytoin", "Phenobarbital", "Carbamazepine" ne "Oxcarbazepine". I-antimycobacterial group yemithi iqukethe nemithi enjalo: Rifabutin, Rifampicin, Rifapentin. Emithini ye-herbal supplement, ukungena kwe-Sofosbuvir kunganciphisa kakhulu ukumunca kwe-St John's wort. Akunconywa ukuthi kuhlanganiswe izidakamizwa ezine-HIV protease inhibitors: "I-Tipranavir", "i-Ritonavir".

Imiyalo ekhethekile

Udokotela ozofika kuphela unelungelo lokukhetha uhlobo lwezokwelapha lwe-hepatitis C kanye nemithi eyobekwa enyango yokwelashwa: "Ladipasvir", "Asunaprevir", "Sofosbuvir", "Daklatasvir". Ukubuyekezwa kweziguli zabo bonke abaphathi be "Sovvaldi" bahle.

Noma kunjalo, kufanele kukhunjulwe ukuthi ezigulini ezinezinhlobo ezinzima zokwehluleka kwenqunu, ivolumu yesilinganiso kufanele ikhethwe ngokuqondile. Asikho isidingo sokuphindaphinda izilinganiso kulabo ababhekene nokugula okuncane futhi okulinganiselayo. Ngokuqondene nokungasebenzi kahle, asikho isidingo sokulungisa umthamo weziguli nganoma yiluphi uhlobo lokuqina kwesifo.

Lapho ukwelashwa kwesifo sofuba nesibindi sokusebenzisa i-combination yokwelashwa ngesisekelo se- "Sofosbuvira" akukhuthazwa ukuba uhlanganyele kulezo zinto ezidinga ukugxila okuphezulu nokuziphendulela kwe-psychomotor reaction.

Uhlu lwamanani

Izindleko zemithi eboshiwe eJalimane ziphakathi kwama-euro angu-18 kuya kwangu-20 ayizinkulungwane. Futhi ukuzithenga, ngisho nangalesi intengo, uzodinga isiguli esivela kudokotela olaphayo. Izindleko ezinjalo zibangelwa ukuthi inkampani yonjiniyela kufanele ibuyisele zonke izindleko zayo zocwaningo lwesayensi, ukuthuthukiswa nokuhlolwa kwemithi.

Kuyabiza kakhulu ukubiza imithi yemikhiqizo yomthengi (ama-analogues ashibhile womkhiqizo ngesithako esisebenzayo esifanayo). Lezi zihlanganisa i- "Daklatasvir", "Asunaprevir", "Ladipasvir" ne "Sofosbuvir". Ukubuyekezwa kwabathengi kuqukethe ulwazi mayelana nezindleko eziphezulu zala mithi, kodwa akusho ngamashumi ezinkulungwane zama-euro.

Kusukela ngo-Mashi 2015, ngokusho kwelayisensi yenkampani yonjiniyela, ukukhululwa kweSofosbuvira okwaqala inkampani yezokwelapha yaseNdiya uNatko (ngokwemvelo, ngemvume ye-Ministry of Health of India).

Njengamanje, eRussia kungenzeka ngempela ukuthenga iphakethe (amaphilisi angu-28) omuthi "Sofosbuvir" ngentengo yama-ruble angu-39 900 (ithebhulethi elilodwa lizobiza cishe ama-ruble angu-1800). Lokhu akushibhile, kodwa impela emaphaketheni afakwe ngokuthi "i-Sowaldi" izodinga izimali zezimali ezilinganiselwa ku-1,500,000 ruble, okuyizicucu ezingaba ngu-35 ngaphezulu kunezinye izizukulwane.

Ngokusebenzisa amaketanga ekhemisi, ayikho indlela yokuthenga le mithi, ngoba inqubo yokuqinisekiswa kwemithi emisha eRussia ide kakhulu.

Umbono wabathengi nodokotela

Isidakamizwa sithathwe iziguli ezine-hepatitis genotypes ezahlukene, amazinga ahlukene e-fibrosis, ane-transaminases ephakeme kakhulu kunokwejwayelekile futhi, njengomthetho, umthamo omkhulu wegciwane.

Inqwaba yeziguli ezithatha imishanguzo yokushiya izidakamizwa ezinhle mayelana nomuthi weSofosbuvir. Ubani ophathwayo (ukubuyekezwa ngokuvamile aqukethe ulwazi olunjalo) ngaphambili kusuka kuma-interferon C we-hepatitis C, ukhombisa ukuthi izidakamizwa azikwazi ngisho ukufaniswa. Ama-interferons enza imiphumela eminingi, futhi akuzona zonke iziguli ezinamandla okwanele okuzithwala. Ngokuqondene nokuhlanganiswa kweSofosbuvir neDadlatasvir (iziguli eziningi zikhuluma ngalesi sihlabelelo), amaphesenti amancane alabo abaphathwa ngalezi zidakamizwa akhulume ngokuthuthukiswa kwemiphumela emincane engalungile ngendlela yokondla, ikhanda eliphansi kanye nokulahlekelwa isikhathi esifushane kokuhlanganiswa. Kodwa-ke, lezi zibonakaliso azikwazi ukuqhathaniswa nemiphumela emibi ye-Interferon kanye nemiphumela ye-hepatitis ngokwayo. Ngemuva kwamasonto angu-2-3 yokwelapha, okuqukethwe kwe-transaminases esibindi kufinyelela kuvamile kwiziguli eziningi. Kusukela ngesonto lesithathu yokwelapha elinomshini wezidakamizwa zokulwa namagciwane "Sofosbuvir" kanye ne "Daklatasvir" ezigulini eziningi, umphumela wokuba khona kwegciwane lesifo se-hepatitis C emzimbeni awubi.

Futhi, iziguli eziningi zibika ukunciphisa okukhulu kwe-fibrosis ngemva kwezinyanga eziningana zokwelashwa okunzima.

Labo abathengi abathatha imishanguzo yemithi emithathu - i-Sofosbuvir, i-Daklatasvir, i-Ribaverin - nayo yajabula kakhulu ngemiphumela yokwelapha.

Cishe bonke abathengi be-Sofosbuvir baxoxisana ngokuphumelela kwangempela ekwelapheni kwesifo sofuba se-viral hepatitis C uma kuqhathaniswa ne-interferon therapy. Ukuphuthukisa ngokuphawulekayo impilo nemfanelo yokuphila kweziguli - lokho kuwubufakazi obuqondile.