Ucwaningo Lwesikhathi Esizayo Nezivivinyo Zemitholampilo ze-MS Progressive MS

-Delile

• Ukubuka konke
• Izinhlobo ze-MS
• Ukuqonda okuyisisekelo okuqhubekayo kwe-MS
• Ukwelashwa kwe-PPMS
• I-Ocrevus (Ocrelizumab)
• Izilingo zomtholampilo eziqhubekayo ze-PPMS
• Ukwelashwa kwe-NurOwn stem cell
• I-Biotin
• Masitinib
• Izivivinyo zomtholampilo eziqediwe
• Ibudilast
• Idebenone
• I-Laquinimod
• I-Fampridine
• Ucwaningo lwe-PPMS
• Ukuthatha

Ukubuka konke

I-Multiple sclerosis (MS) yisimo esingapheliyo sokuzivikela komzimba. Kwenzeka lapho umzimba uqala ukuhlasela izingxenye zesistimu yezinzwa emaphakathi (CNS).

Imithi eminingi yamanje kanye nokwelashwa kugxile ekubuyiseleni emuva i-MS hhayi kwi-MS (PPMS) eyinhloko eqhubekayo. Kodwa-ke, kwenziwa uvivinyo lomtholampilo ukusiza ukuqonda kangcono i-PPMS nokuthola ukwelashwa okusha, okusebenzayo.

Izinhlobo ze-MS

Izinhlobo ezine eziyinhloko ze-MS yilezi:

• isifo esihlukaniswe ngokwasemtholampilo (i-CIS)
• i-MS ebuyisa kabusha (RRMS)
• i-MS ehamba phambili eyinhloko (PPMS)
• i-MS yesibili eqhubekayo (SPMS)

Lezi zinhlobo ze-MS zenzelwe ukusiza abacwaningi bezokwelapha ukuthi bahlukanise abahlanganyeli besilingo semitholampilo ngokukhula kwezifo ezifanayo. Lokhu kuhlanganiswa kuvumela abacwaningi ukuthi bahlole ukusebenza nokuphepha kwemithi ethile ngaphandle kokusebenzisa inani elikhulu labahlanganyeli.

Ukuqonda okuyisisekelo okuqhubekayo kwe-MS

Amaphesenti ayi-15 kuphela noma bonke abantu abatholakale bene-MS abane-PPMS. I-PPMS ithinta abesilisa nabesifazane ngokulinganayo, kuyilapho i-RRMS ivame kakhulu kwabesifazane kunakubesilisa.

Izinhlobo eziningi ze-MS zenzeka lapho amasosha omzimba ehlasela i-myelin sheath. I-myelin sheath yinto enamafutha, evikelayo ezungeze izinzwa emgogodleni nasebuchosheni. Lapho le nto ihlaselwa, ibangela ukuvuvukala.

I-PPMS iholela ekulimaleni kwemizwa nezicubu ezibomvu ezindaweni ezilimele. Lesi sifo siphazamisa inqubo yokuxhumana kwemizwa, sidale isimo esingalindelekile sezimpawu nokwanda kwezifo.

Ngokungafani nabantu abane-RRMS, abantu abane-PPMS bahlangabezana nomsebenzi owehla kancane kancane ngaphandle kokubuyela emuva noma ukuxolelwa kusenesikhathi. Ngaphezu kokukhula kancane kokukhubazeka, abantu abane-PPMS nabo bangathola lezi zimpawu ezilandelayo:

• ukuzwa ukuba ndikindiki noma ukuhayiza
• ukukhathala
• inkinga ngokuhamba noma ngokunyakaza kokuxhumanisa
• izingqinamba ngombono, njengokubonwa kabili
• izinkinga ngememori nokufunda
• ukuqina kwemisipha noma ukuqina kwemisipha
• ukushintsha kwemizwa

Ukwelashwa kwe-PPMS

Ukwelapha i-PPMS kunzima ukwedlula ukwelapha i-RRMS, futhi kufaka phakathi ukusetshenziswa kwemithi yokwelapha yokuzivikela. Lezi zindlela zokwelapha zinikeza usizo lwesikhashana kuphela. Zingasetshenziswa kuphela ngokuphepha nangokuqhubekayo izinyanga ezimbalwa kuya onyakeni ngesikhathi.

Ngenkathi i-Food and Drug Administration (i-FDA) ivume imishanguzo eminingi ye-RRMS, akuyona yonke efanelekile ngezinhlobo eziqhubekayo ze-MS. Imithi ye-RRMS, eyaziwa nangokuthi izidakamizwa eziguqula izifo (ama-DMD), ithathwa ngokuqhubekayo futhi kaningi iba nemiphumela engemihle engabekezeleleki.

Ukuqeda izilonda ngokugcwele kanye nokulimala kwemizwa kungatholakala nakubantu abane-PPMS. Izilonda zivutha kakhulu futhi zingadala ukulimala emgodleni we-myelin. Okwamanje akucaci ukuthi imishanguzo enciphisa ukuvuvukala inganciphisa yini izinhlobo eziqhubekayo ze-MS.

I-Ocrevus (Ocrelizumab)

I-FDA igunyaze i-Ocrevus (ocrelizumab) njengokwelashwa kokubili i-RRMS ne-PPMS ngoMashi 2017. Kuze kube manje, ukuphela komuthi ovunyelwe yi-FDA ukwelapha i-PPMS.

Izilingo zomtholampilo zikhombisile ukuthi ikwazi ukwehlisa ukuqhubeka kwezimpawu ku-PPMS cishe ngamaphesenti angama-25 uma kuqhathaniswa ne-placebo.

I-Ocrevus nayo ivunyelwe ukwelashwa kwe-RRMS ne-"early" PPMS eNgilandi. Akukavunyelwa kwezinye izingxenye ze-United Kingdom.

AbeNational Institute for Health Excellence (NICE) baqale bamlahla u-Ocrevus ngesizathu sokuthi izindleko zokukuhlinzeka zidlula izinzuzo zakhe. Kodwa-ke, i-NICE, iNational Health Service (NHS), kanye nomenzi wezidakamizwa (Roche) bagcine bephinde baxoxisana ngentengo yayo.

Izilingo zomtholampilo eziqhubekayo ze-PPMS

Okubaluleke kakhulu kubacwaningi ukufunda kabanzi ngezinhlobo eziqhubekayo ze-MS. Izidakamizwa ezintsha kufanele zihlolwe ngokuqinile emtholampilo ngaphambi kokuba i-FDA ikwamukele.

Ukuhlolwa okuningi kwemitholampilo kuhlala iminyaka emi-2 kuya kwengu-3. Kodwa-ke, ngoba ucwaningo lukhawulelwe, kudingeka izivivinyo ezinde kakhulu ze-PPMS. Izilingo eziningi ze-RRMS zenziwa ngoba kulula ukwahlulela ukusebenza kwemithi ekubuyeni.

Bheka iwebhusayithi yeNational Multiple Sclerosis Society ukuthola uhlu oluphelele lwezivivinyo zokwelashwa e-United States.

Izilingo zokukhetha ezilandelayo ziyaqhubeka njengamanje.

Ukwelashwa kwe-NurOwn stem cell

I-Brainstorm Cell Therapeutics yenza isivivinyo somtholampilo sesigaba II ukuphenya ukuphepha nokusebenza kwamaseli we-NurOwn ekwelapheni i-MS eqhubekayo. Lokhu kwelashwa kusetshenziswa ama-stem cells atholakala kubahlanganyeli akhuthazwe ukukhiqiza izici ezithile zokukhula.

NgoNovemba 2019, iNational Multiple Sclerosis Society inikeze iBrainstorm Cell Therapeutics isibonelelo sokucwaninga esingu- $ 495,330 sokuxhasa le ndlela yokwelashwa.

Icala kulindeleke ukuthi liphothulwe ngoSepthemba 2020.

I-Biotin

IMedDay Pharmaceuticals SA njengamanje yenza isivivinyo somtholampilo wesigaba III ekusebenzeni komthamo omkhulu we-biotin capsule ekwelapheni abantu abane-MS eqhubekayo. Isivivinyo futhi sihlose ukugxila ngqo kubantu abanezinkinga zokuhamba.

I-Biotin iyi-vithamini ebambe iqhaza ekuthonyeni izici zokukhula kwamaselula kanye nokukhiqizwa kwe-myelin. I-capsule ye-biotin ifaniswa ne-placebo.

Isivivinyo asisaqashi ababambiqhaza abasha, kodwa akulindelekile ukuthi siphele kuze kube nguJuni 2023.

Masitinib

I-AB Science yenza isivivinyo somtholampilo sesigaba III kumuthi wezidakamizwa. IMasitinib yisidakamizwa esivimba impendulo yokuvuvukala. Lokhu kuholela ekuphenduleni okuphansi kokuzivikela komzimba kanye namazinga aphansi okuvuvukala.

Isivivinyo sihlola ukuphepha nokusebenza kwe-masitinib uma kuqhathaniswa ne-placebo. Izinhlobo ezimbili zokwelashwa kwe-masitinib zifaniswa ne-placebo: Uhlobo lokuqala lusebenzisa isilinganiso esifanayo kulo lonke, kanti olunye lubandakanya ukukhuphuka komthamo ngemuva kwezinyanga ezintathu.

Isivivinyo asisaqashi ababambiqhaza abasha. Kulindeleke ukuthi kuphothulwe ngoSepthemba 2020.

Izivivinyo zomtholampilo eziqediwe

Izilingo ezilandelayo zisanda kuqedwa. Kwabaningi babo, imiphumela yokuqala noma yokugcina ishicilelwe.

Ibudilast

IMediciNova isiqede ukuhlolwa kwesigaba sesibili somtholampilo ku-ibudilast yezidakamizwa. Inhloso yalo bekuwukuthola ukuphepha nokusebenza komuthi kubantu abane-MS eqhubekayo. Kulolu cwaningo, ibudilast yaqhathaniswa ne-placebo.

Imiphumela yokuqala yocwaningo ikhombisa ukuthi ibudilast yehlise ukukhula kwe-atrophy yobuchopho uma iqhathaniswa ne-placebo esikhathini esingamasonto angama-96. Imiphumela emibi kakhulu ebikiwe kwakuyizimpawu zesisu.

Yize imiphumela ithembisa, kudingeka ezinye izivivinyo ukubona ukuthi imiphumela yalesi silingo ingakhiqizwa kabusha nokuthi ibudilast ingaqhathaniswa kanjani ne-Ocrevus nezinye izidakamizwa.

Idebenone

I-National Institute of Allergy and Infectious Diseases (NIAID) isanda kuqeda ukuhlolwa komtholampilo wesigaba I / II ukuhlola umphumela we-idebenone kubantu abane-PPMS. I-Idebenone inguqulo yokwenziwa kwe-coenzyme Q10. Kukholakala ukuthi kunciphisa ukulimala kwesistimu yezinzwa.

Kuyo yonke iminyaka yokugcina ye-2 yalolu vivinyo lweminyaka engu-3, ​​ababambiqhaza bathatha umuthi noma i-placebo. Imiphumela yokuqala ikhombisile ukuthi, phakathi nesikhathi socwaningo, i-idebenone ayinikanga nzuzo nge-placebo.

I-Laquinimod

I-Teva Pharmaceutical Industries ixhase ucwaningo lwesigaba II ngemizamo yokusungula ubufakazi bomqondo wokwelapha i-PPMS nge-laquinimod.

Akuqondakali ngokugcwele ukuthi i-laquinimod isebenza kanjani. Kukholelwa ukuthi kuguqula ukusebenza kwamaseli omzimba, ngakho-ke kuvimbela ukulimala kwesistimu yezinzwa.

Imiphumela yesilingo edumazayo iholele umkhiqizi wayo, i-Active Biotech, ukuba ayeke ukwakhiwa kwe-laquinimod njengomuthi we-MS.

I-Fampridine

Ngo-2018, i-University College Dublin iqede ukuhlolwa kwesigaba IV ukuhlola umphumela we-fampridine kubantu abanokukhubazeka kwezitho zomzimba phezulu kanye ne-PPMS noma i-SPMS. I-Fampridine yaziwa nangokuthi i-dalfampridine.

Yize leli cala seliphothuliwe, ayikho imiphumela ebikiwe.

Kodwa-ke, ngokusho kocwaningo lwango-2019 lwase-Italy, lesi sidakamizwa singathuthukisa isivinini sokucutshungulwa kolwazi kubantu abane-MS. Ukubuyekezwa kwe-2019 kanye nokuhlaziywa kwe-meta kuphethe ngokuthi kunobufakazi obuqinile bokuthi umuthi uthuthukise ikhono labantu abane-MS ukuhamba amabanga amafushane kanye namandla abo okuhamba abonakalayo.

Ucwaningo lwe-PPMS

INational Multiple Sclerosis Society ithuthukisa ucwaningo oluqhubekayo ezinhlotsheni eziqhubekayo ze-MS. Umgomo ukudala ukwelashwa okuphumelelayo.

Olunye ucwaningo selugxile umehluko phakathi kwabantu abane-PPMS nabantu abaphilile. Ucwaningo lwakamuva luthole ukuthi ama-stem cells ebuchosheni babantu abane-PPMS abukeka emdala kunamaseli ama-stem afanayo kubantu abaphilile beminyaka efanayo.

Ngokwengeziwe, abacwaningi bathole ukuthi lapho ama-oligodendrocyte, amaseli akhiqiza i-myelin, evezwa kulawa maseli ezinhlayiya, aveza amaprotheni ahlukile kunabantu abaphilile. Lapho le nkulumo yamaprotheni ivinjelwe, ama-oligodendrocyte aziphatha ngendlela ejwayelekile. Lokhu kungasiza ukuchaza ukuthi kungani i-myelin isengozini kubantu abane-PPMS.

Olunye ucwaningo luthole ukuthi abantu abane-MS eqhubekayo banamazinga aphansi ama-molecule abizwa nge-bile acid. Ama-acid ebile anemisebenzi eminingi, ikakhulukazi ekugayeni. Futhi zinomphumela wokulwa nokuvuvukala kwamanye amaseli.

Ama-receiver we-bile acid nawo atholakala kumaseli wezicubu ze-MS. Kucatshangwa ukuthi ukwengezwa nge-bile acid kungazuzisa abantu abane-MS eqhubekayo. Eqinisweni, isivivinyo somtholampilo sokuhlola ngqo lokhu siyaqhubeka njengamanje.

Ukuthatha

Izibhedlela, amanyuvesi, nezinye izinhlangano kulo lonke elase-United States zisebenza ngokuqhubekayo ukuze zifunde kabanzi nge-PPMS ne-MS jikelele.

Kuze kube manje munye kuphela umuthi, i-Ocrevus, ovunyelwe yi-FDA ekwelashweni kwe-PPMS. Ngenkathi i-Ocrevus ibambezela ukuqhubekela phambili kwe-PPMS, ayimisi ukuqhubeka.

Ezinye izidakamizwa, njenge-ibudilast, zibonakala zithembisa ngokususelwa ekuhlolweni kokuqala. Eminye imithi, efana ne-idebenone ne-laquinimod, ayiboniswanga ukuthi iyasebenza.

Izilingo ezingeziwe ziyadingeka ukukhomba ezinye izindlela zokwelapha ze-PPMS. Buza umhlinzeki wakho wezokunakekelwa kwezempilo mayelana nezivivinyo zakamuva zomtholampilo nocwaningo olungakusiza.