Kodi Mankhwala Amlomo a MS Amagwira Ntchito Motani?

Zamkati

• Udindo wa ma B maselo a T
• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Kuchuluka)
• Fingolimod (Gilenya)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)
• Mankhwala ena osintha matenda
• Zowopsa zomwe zingachitike kuchokera ku DMTs
• Kuthetsa chiwopsezo cha zotsatirapo
• Kutenga
• Izi ndi Zomwe Zimamvekera Kukhala ndi MS

Multiple sclerosis (MS) ndimatenda amthupi omwe chitetezo chanu chamthupi chimagwiritsa ntchito zoteteza kuzungulira mitsempha m'katikati mwa mitsempha yanu (CNS). CNS imaphatikizapo ubongo wanu ndi msana.

Mankhwala osinthira matenda (DMTs) ndi omwe amalimbikitsidwa kuti athandizire kukulitsa chitukuko cha MS. DMTs itha kuthandizira kuchedwetsa kulumala ndikuchepetsa kuchuluka kwa ma flares mwa anthu omwe ali ndi vutoli.

Food and Drug Administration (FDA) yavomereza ma DMTs angapo kuti athetse mitundu yobwerezabwereza ya MS, kuphatikiza ma DMTs asanu ndi amodzi omwe amatengedwa pakamwa ngati makapisozi kapena mapiritsi.

Werengani kuti mumve zambiri za DMTs yapakamwa ndi momwe amagwirira ntchito.

Udindo wa ma B maselo a T

Kuti mumvetsetse momwe DMTS pakamwa imathandizira kuthana ndi MS, muyenera kudziwa zaudindo wama cell ena amthupi ku MS.

Mitundu yambiri yamagulu amthupi ndi mamolekyulu amatenga nawo mbali pamagulu amthupi omwe amachititsa kutupa ndi kuwonongeka kwa MS.

Izi zikuphatikiza ma T cell ndi ma B, mitundu iwiri yama cell oyera omwe amadziwika kuti ma lymphocyte. Zimapangidwa m'thupi lanu lamtundu wa lymphatic.

Maselo a T akamachoka m'thupi lanu kupita m'magazi anu, amatha kupita ku CNS yanu.

Mitundu ina ya T imatulutsa mapuloteni otchedwa cytokines, omwe amayambitsa kutupa. Mwa anthu omwe ali ndi MS, ma cytokines omwe amateteza kwambiri amawononga myelin ndi maselo amitsempha.

Maselo a B amapanganso ma cytokines omwe amatulutsa zotupa, omwe amatha kuthandiza kuyendetsa zochitika za ma T omwe amachititsa matenda ku MS. Maselo a B amapanganso ma antibodies, omwe amatha kugwira ntchito mu MS.

Ma DMTs ambiri amagwira ntchito poletsa kuyambitsa, kupulumuka, kapena kuyenda kwa maselo a T, maselo a B, kapena zonse ziwiri. Izi zimathandiza kuchepetsa kutupa ndi kuwonongeka kwa CNS. Ma DMTs ena amateteza maselo amitsempha kuti asawonongeke munjira zina.

Cladribine (Mavenclad)

A FDA avomereza kugwiritsa ntchito cladribine (Mavenclad) kuchiza mitundu yobwerezabwereza ya MS mwa akulu. Mpaka pano, palibe maphunziro omwe adamalizidwa pakugwiritsa ntchito Mavenclad mwa ana.

Wina akamamwa mankhwalawa, amalowa m'maselo a T ndi ma B m'matupi awo ndikusokoneza ma cell kuti athe kupanga ndikukonzekera DNA. Izi zimapangitsa kuti ma cell afe, ndikuchepetsa ma cell T ndi ma B m'matenda awo.

Mukalandira chithandizo ndi Mavenclad, mutenga mankhwala awiriwa pazaka ziwiri. Njira iliyonse idzakhala ndi milungu iwiri yothandizira, yopatulidwa ndi mwezi umodzi.

Pa sabata iliyonse yothandizira, dokotala wanu akukulangizani kuti mutenge kamodzi kapena kawiri mlingo wa mankhwalawa kwa masiku 4 kapena 5.

Dimethyl fumarate (Tecfidera)

A FDA avomereza dimethyl fumarate (Tecfidera) pochiza mitundu yobwerezabwereza ya MS mwa akulu.

A FDA sanavomereze Tecfidera pochiza MS mwa ana. Komabe, madokotala amatha kupereka mankhwalawa kwa ana mumachitidwe omwe amadziwika kuti "osagwiritsa ntchito chizindikiro".

Ngakhale kafukufuku wina akufunika, kafukufuku mpaka pano akuwonetsa kuti mankhwalawa ndiotetezeka komanso othandiza pochiza MS mwa ana.

Akatswiri sakudziwa momwe Tecfidera imagwirira ntchito. Komabe, ofufuza apeza kuti mankhwalawa amatha kuchepetsa kuchuluka kwa mitundu ina yamaselo a T ndi ma B, komanso ma cytokines omwe amatulutsa zotupa.

Tecfidera imawonekeranso kuti imayambitsa puloteni yotchedwa nuclear factor erythroid 2-factor factor (NRF2). Izi zimayambitsa mayankho am'manja omwe amateteza ma cell amitsempha ku nkhawa yama oxidative.

Ngati mwapatsidwa Tecfidera, dokotala wanu akukulangizani kuti mutenge Mlingo wa 120-milligram (mg) patsiku masiku asanu ndi awiri oyamba a chithandizo. Pambuyo pa sabata yoyamba, adzakuuzani kuti mutenge mlingo wa 240-mg patsiku mosalekeza.

Diroximel fumarate (Kuchuluka)

A FDA avomereza diroximel fumarate (Vumerity) kuti athetse mitundu yobwerezabwereza ya MS mwa akulu. Akatswiri sakudziwabe ngati mankhwalawa ndi otetezeka kapena othandiza kwa ana.

Kuchuluka kwake ndi gawo limodzi la mankhwala monga Tecfidera. Monga Tecfidera, amakhulupirira kuti amatsegula puloteni NRF2. Izi zimayankha mayankho am'manja omwe amathandiza kupewa kuwonongeka kwa maselo amitsempha.

Ngati njira yanu yothandizira ikuphatikizira Kuchulukitsa, dokotala wanu akukulangizani kuti mutenge 231 mg ya mankhwalawo kawiri patsiku masiku asanu ndi awiri oyamba. Kuyambira pamenepo, muyenera kumwa 462 mg wa mankhwalawo kawiri patsiku.

Fingolimod (Gilenya)

A FDA avomereza fingolimod (Gilenya) pochiza mitundu yobwerezabwereza ya MS mwa akulu komanso ana azaka 10 kapena kupitirira.

A FDA sanalandirebe mankhwalawa pochiritsira ana aang'ono, koma madotolo amatha kuwapatsa mankhwala osapitirira zaka 10.

Mankhwalawa amatseka mtundu wa ma molekyulu otchedwa sphingosine 1-phosphate (S1P) kuti asamangidwe ndi T cell ndi ma B maselo. Komanso, izi zimalepheretsa ma cell amenewo kuti asalowe m'magazi ndikupita ku CNS.

Maselowa akaimitsidwa kuti apite ku CNS, sangayambitse kutupa ndi kuwonongeka kumeneko.

Gilenya amatengedwa kamodzi patsiku. Mwa anthu omwe amalemera mapaundi oposa 88 (40 kilograms), mlingo woyenera wa tsiku ndi tsiku ndi 0,5 mg. Mwa iwo omwe amalemera ochepera apo, mlingo woyenera wa tsiku ndi tsiku ndi 0.25 mg.

Mukayamba kumwa mankhwalawa ndikusiya kuugwiritsa ntchito, mutha kuyaka kwambiri.

Anthu ena omwe ali ndi MS adakula kwambiri olumala ndi zotupa zatsopano muubongo atasiya kumwa mankhwalawa.

Siponimod (Mayzent)

A FDA avomereza siponimod (Mayzent) pochiza mitundu yobwerezabwereza ya MS mwa akulu. Pakadali pano, ofufuza sanamalize maphunziro aliwonse ogwiritsa ntchito mankhwalawa kwa ana.

Mayzent ali mgulu lomweli la mankhwala monga Gilenya. Monga Gilenya, imatchinga S1P kuti isamange mpaka ma T cell ndi ma B. Izi zimaletsa ma cell amthupi awo kupita kuubongo ndi msana, komwe amawononga.

Mayzent amatengedwa kamodzi patsiku. Kuti mudziwe mulingo woyenera wa tsiku ndi tsiku, dokotala wanu ayamba kukuwonani kuti mupeze cholozera chomwe chingakuthandizeni kudziwa momwe mungayankhire mankhwalawa.

Zotsatira zakubadwa kwanu zikuwonetsa kuti mankhwalawa atha kukuthandizani, dokotala wanu angakupatseni kamtengo kochepa koti muyambe. Pang'ono ndi pang'ono adzawonjezera mlingo wanu woyenera munjira yotchedwa titration. Cholinga ndikukulitsa zabwino zomwe zingapindule ndikuchepetsa zovuta.

Mukamamwa mankhwalawa ndikusiya kuwagwiritsa ntchito, matenda anu akhoza kukulirakulira.

Teriflunomide (Aubagio)

A FDA avomereza kugwiritsa ntchito teriflunomide (Aubagio) pochiza mitundu yobwerezabwereza ya MS mwa akulu. Palibe maphunziro omwe adasindikizidwa pakadali pano zakugwiritsa ntchito mankhwalawa kwa ana.

Aubagio amatseka enzyme yotchedwa dihydroorotate dehydrogenase (DHODH). Enzyme imeneyi imakhudzidwa ndikupanga pyrimidine, chinthu chomanga DNA chomwe chimafunikira pakupanga kwa DNA m'maselo a T ndi ma B.

Ma enzymewa sangathe kupeza pyrimidine yokwanira kuti apange DNA, amalepheretsa kupangika kwa maselo atsopano a T ndi ma B.

Mukalandira chithandizo ndi Aubagio, dokotala wanu akhoza kukupatsani mankhwala a 7 kapena 14-mg tsiku lililonse.

Mankhwala ena osintha matenda

Kuphatikiza pa mankhwala akumwawa, a FDA avomereza ma DMTs angapo omwe amabayidwa pansi pa khungu kapena kupatsidwa kudzera kulowetsedwa mkati.

Zikuphatikizapo:

• alemtuzumab (Lemtrada)
• glatiramer nthochi (Copaxone, Glatect)
• interferon beta-1 (Avonex)
• interferon beta-1a (Rebif)
• interferon beta-1b (Betaseron, Extavia)
• mitoxantrone (Novantrone)
• natalizumab (Tysabri)
• ocrelizumab (Ocrevus)
• peginterferon beta-1a (Plegridy)

Lankhulani ndi dokotala wanu kuti mudziwe zambiri za mankhwalawa.

Zowopsa zomwe zingachitike kuchokera ku DMTs

Chithandizo cha DMTs chingayambitse mavuto, omwe nthawi zina amakhala ovuta.

Zotsatira zoyipa zamankhwala zimasiyana kutengera mtundu wa DMT womwe mumatenga.

Zotsatira zoyipa zambiri ndi izi:

• mutu
• nseru
• kusanza
• kutsegula m'mimba
• zotupa pakhungu
• kutayika tsitsi
• kugunda kwa mtima pang'ono
• nkhope kumaso
• kusapeza m'mimba

Ma DMTs amalumikizananso ndi chiopsezo chowonjezeka cha matenda, monga:

• fuluwenza
• chifuwa
• chifuwa chachikulu
• zomangira
• matenda ena a mafangasi
• kupita patsogolo kwa leukoencephalopathy, mtundu wosowa wa matenda amubongo

Kuwonjezeka kwa chiopsezo chotenga kachilombo chifukwa chakuti mankhwalawa amasintha chitetezo cha mthupi lanu ndipo amachepetsa kuchuluka kwa maselo oyera amthupi mthupi lanu.

Ma DMTs atha kubweretsa zovuta zina zoyipa, monga kuwonongeka kwa chiwindi ndi zovuta zina. Ma DMTs ena amatha kuyambitsa kuthamanga kwa magazi. Zina zingayambitse kugunda kwa mtima wanu.

Kumbukirani kuti adotolo amalimbikitsa a DMT ngati akukhulupirira kuti zabwino zomwe zingapitirire kuposa chiwopsezo chake.

Kukhala ndi MS komwe sikuyendetsedwa bwino kumakhalanso ndi zoopsa zazikulu. Lankhulani ndi dokotala wanu kuti mudziwe zambiri za zovuta zomwe zingachitike ndi maubwino a DMTs zosiyanasiyana.

Ma DMTs samawerengedwa kuti ndi otetezeka kwa anthu omwe ali ndi pakati kapena akuyamwitsa.

Kuthetsa chiwopsezo cha zotsatirapo

Musanayambe kumwa mankhwala ndi DMT, dokotala wanu akuyenera kukuwonetsani matenda opatsirana, kuwonongeka kwa chiwindi, ndi mavuto ena azaumoyo omwe angayambitse chiopsezo chomwa mankhwalawo.

Dokotala wanu angakulimbikitseninso kuti mulandire katemera musanayambe kulandira chithandizo ndi DMT. Muyenera kudikirira milungu ingapo mutalandira katemera musanayambe kumwa mankhwalawa.

Mukalandira chithandizo ndi DMT, dokotala wanu akhoza kukulangizani kuti mupewe mankhwala ena, zowonjezera zakudya, kapena zinthu zina. Afunseni ngati pali mankhwala aliwonse kapena zinthu zina zomwe zingagwirizane kapena kusokoneza DMT.

Dokotala wanu akuyeneranso kukuyang'anirani ngati muli ndi zovuta zina mukamalandira chithandizo ndi DMT. Mwachitsanzo, atha kuyitanitsa kuyezetsa magazi pafupipafupi kuti aone kuchuluka kwama cell anu ndi michere ya chiwindi.

Ngati mukuganiza kuti mwina mukukumana ndi zovuta, dokotala wanu adziwe nthawi yomweyo.

Kutenga

Ma DMTs angapo avomerezedwa kuchiza MS, kuphatikiza mitundu isanu ndi umodzi yamankhwala amkamwa.

Ena mwa mankhwalawa akhoza kukhala otetezeka kapena oyenererana ndi anthu ena kuposa ena.

Musanayambe kumwa DMT, funsani dokotala wanu za zomwe zingakuthandizeni komanso kuopsa kogwiritsa ntchito mankhwalawa. Amatha kukuthandizani kumvetsetsa momwe mankhwala osiyanasiyana angakhudzire thupi lanu komanso malingaliro anu a nthawi yayitali ndi MS.

Izi ndi Zomwe Zimamvekera Kukhala ndi MS