Ukufakwa Kwe-Rituxan Ye-Rheumatoid Arthritis: Ongakulindela

-Delile

• Ukubuka konke
• Ubani umuntu ofanele ukwelashwa?
• Uthini ucwaningo?
• Isebenza kanjani iRituxan yeRA?
• Yini ongayilindela ngesikhathi sokufakwa
• Iyini imiphumela emibi?
• Ukuthatha

Ukubuka konke

I-Rituxan yisidakamizwa se-biologic esivunyelwe yi-US Food and Drug Administration (FDA) ngo-2006 ukwelapha i-rheumatoid arthritis (RA). Igama layo elijwayelekile lingu-rituximab.

Abantu abane-RA abangaphendulanga kwezinye izinhlobo zokwelashwa bangasebenzisa i-Rituxan ngokuhlangana ne-methotrexate yezidakamizwa.

I-Rituxan inguketshezi olungenambala olunikezwa ukumnika. I-antibody eyenziwe ngofuzo ekhomba amangqamuzana e-B abandakanyeka ekuvukeleni kwe-RA. I-FDA iphinde yamukele i-Rituxan ye-non-Hodgkin's lymphoma, i-chronic lymphocytic leukemia, ne-granulomatosis ene-polyangiitis.

Kokubili i-rituximab ne-methotrexate, i-immune-system suppressor, yaqale yasungulwa futhi yasetshenziswa njengemithi elwa nomdlavuza. I-Rituxan ikhiqizwa ngabakwaGenentech. EYurophu, ithengiswa njengeMabThera.

Ubani umuntu ofanele ukwelashwa?

I-FDA ivume ukwelashwa ngeRituxan ne-methotrexate:

• uma une-RA elinganiselayo kuya kwelinzima
• uma ungaphendulanga kahle ekwelashweni ngama-ejenti wokuvimba we-tumor necrosis factor (TNF)

I-FDA yeluleka ukuthi iRituxan kufanele isetshenziswe ngesikhathi sokukhulelwa kuphela lapho inzuzo engaba khona kumama idlula noma iyiphi ingozi engaba khona enganeni engakazalwa. Ukuphepha kokusetshenziswa kweRituxan nezingane noma omama abahlengikazi akukasungulwa.

I-FDA incoma ngokungahambisani nokusetshenziswa kwe-Rituxan kubantu abane-RA abangazange belashwe nge-ejenti eyodwa noma amaningi okuvimba i-TNF.

I-Rituxan nayo ayinconywa kubantu abane-hepatitis B noma abaphethe igciwane, ngoba i-Rituxan ingavuselela i-hepatitis B.

Uthini ucwaningo?

Ukusebenza kwe-rituximab ocwaningweni lokucwaninga kwaba. Kwalandela ezinye izivivinyo zokwelashwa.

Ukuvunyelwa kwe-FDA kokusetshenziswa kweRituxan kweRA kwakususelwa ezifundweni ezintathu eziyimpumputhe ezimbili eziqhathanisa ukwelashwa kwe-rituximab ne-methotrexate nge-placebo ne-methotrexate.

Esinye sezifundo zocwaningo kwakuyisifundo seminyaka emibili esingahleliwe esibizwa nge-REFLEX (Randomised Evaluation of Long-Term Performance of Rituximab in RA). Ukusebenza kahle kukalwe kusetshenziswa ukuhlolwa kwe-American College of Rheumatology (ACR) kokuthuthuka kuthenda elihlangene nokuvuvukala.

Abantu abathole i-rituximab babene-infusions ezimbili, amasonto amabili ehlukene. Ngemuva kwamasonto angama-24, i-REFLEX ithole ukuthi:

• Amaphesenti angama-51 abantu abaphathwe nge-rituximab uma kuqhathaniswa namaphesenti ayi-18 aphathwe nge-placebo akhombise ukwenziwa ngcono kwe-ACR20
• Amaphesenti angama-27 abantu abaphathwe nge-rituximab uma kuqhathaniswa namaphesenti ama-5 abantu abaphethwe nge-placebo bakhombise ukuthuthuka kwe-ACR50
• Amaphesenti ayi-12 wabantu abaphathwe nge-rituximab kuqhathaniswa nephesenti le-1 labantu abaphathwe nge-placebo bakhombise ukuthuthuka kwe-ACR70

Izinombolo ze-ACR lapha zibhekisa ekuthuthukisweni kusuka kwizimpawu eziyisisekelo zeRA.

Abantu abaphathwe nge-rituximab babe nokuthuthuka okuphawulekayo kwezinye izimpawu njengokukhathala, ukukhubazeka, kanye nekhwalithi yempilo. I-X-ray iphinde ikhombise ukuthambekela kokulimala okuhlangene okuncane.

Abanye abantu ocwaningweni babhekana nemiphumela engemihle, kepha lokhu kwakunzima kakhulu.

kusukela ngo-2006 bathole izinzuzo ezifanayo ekwelashweni nge-rituximab ne-methotrexate.

Isebenza kanjani iRituxan yeRA?

Indlela yokusebenza kwe-rituximab ekwelapheni i-RA nezinye izifo. Kucatshangwa ukuthi ama-antibodies e-rituximab akhomba i-molecule (i-CD20) ebusweni bamaseli athile we-B ahambisana nenqubo yokuvuvukala kwe-RA. Lawa maseli B kucatshangwa ukuthi ayabandakanyeka ekukhiqizeni i-rheumatoid factor (RF) nezinye izinto ezihambisana nokuvuvukala.

I-Rituximab ibonwa ekunciphiseni kwesikhashana kodwa okuphelele kwamaseli we-B egazini kanye nokuncipha okuyingxenye emnkantsheni nethishu. Kepha lawa maseli B aphinde avuseleleke ngaphakathi. Lokhu kungadinga ukwelashwa okuqhubekayo kwe-rituximab infusion.

Ucwaningo luyaqhubeka ukucwaninga ukuthi amaseli e-rituximab nama-B asebenza kanjani ku-RA.

Yini ongayilindela ngesikhathi sokufakwa

I-Rituxan inikezwa nge-drip emthanjeni (ukumnika ngaphakathi, noma i-IV) esimweni esibhedlela. Umthamo u-infusions amabili we-1,000-milligram (mg) ahlukaniswe amasonto amabili. Ukufakwa kwe-Rituxan akubuhlungu, kepha ungaba nokusabela kohlobo lokungezwani nomuthi.

Udokotela wakho uzohlola impilo yakho yonke ngaphambi kokukunikeza ukwelashwa futhi akuqaphele ngesikhathi sokumnika.

Isigamu sehora ngaphambi kokuqala kokufakwa kwe-Rituxan, uzonikezwa ukumnika okungu-100 mg we-methylprednisolone noma i-steroid efanayo futhi mhlawumbe ne-antihistamine ne-acetaminophen (iTylenol). Lokhu kunconywa ukusiza ukunciphisa noma yikuphi ukuphendula okungenzeka kumuthi.

Ukufakwa kwakho kokuqala kuzoqala kancane ngesilinganiso esingu-50 mg ngehora, futhi udokotela uzoqhubeka nokuhlola izimpawu zakho ezibalulekile ukuze aqiniseke ukuthi awunakho ukusabela okuphikisayo ekufakweni.

Inqubo yokuqala yokumnika ingathatha cishe amahora amane nemizuzu engu-15. Ukugcwalisa isikhwama ngesisombululo ukuqinisekisa ukuthi uthola umthamo ophelele weRituxan kuthatha eminye imizuzu engu-15.

Ukwelashwa kwakho kwesibili kokumnika kufanele kuthathe cishe ihora elilodwa ngaphansi.

Iyini imiphumela emibi?

Ekuhlolweni kwemitholampilo kweRituxan yeRA, cishe amaphesenti ayi-18 wabantu aba nemiphumela engemihle. Imiphumela emibi kakhulu, etholwa ngesikhathi nangemuva kwamahora angama-24 ngemuva kokufakwa, ifaka:

• ukuqina komphimbo omncane
• izimpawu ezinjengomkhuhlane
• ukuqubuka
• ukulunywa
• isiyezi
• ukuhlungu obusemhlane
• isisu esibuhlungu
• isicanucanu
• ukujuluka
• ukuqina kwemisipha
• uvalo
• ukuba ndikindiki

Imvamisa umjovo we-steroid ne-antihistamine oyithola ngaphambi kokufakwa kuyanciphisa ukuqina kwale miphumela emibi.

Uma unezimpawu ezimbi kakhulu, shayela udokotela wakho. Lokhu kungafaka:

• izifo eziphezulu zomgudu wokuphefumula
• umkhuhlane
• ukutheleleka komgudu womchamo
• i-bronchitis

Shayela udokotela wakho ngokushesha uma uhlangabezana nezinguquko zombono, ukudideka, noma ukulahlekelwa ibhalansi. Ukusabela okujulile ku-Rituxan akuvamile.

Ukuthatha

I-Rituxan (i-generic rituximab) ivunyelwe i-FDA ukwelashwa kwe-RA kusukela ngonyaka ka-2006. Cishe umuntu oyedwa kwabathathu abelashelwa i-RA akaphenduli ngokwanele kwezinye izindlela zokwelapha ze-biologic. Ngakho-ke iRituxan inikeza enye indlela engenzeka. Kusukela ngo-2011, abantu abangaphezu kuka-100 000 abane-RA emhlabeni wonke bathole i-rituximab.

Uma ubhalisela i-Rituxan, funda ngokusebenza kwayo ukuze ukwazi ukuthatha isinqumo unolwazi. Kuzodingeka ukuthi ulinganise izinzuzo nezingozi ezingaba khona uma kuqhathaniswa nezinye izindlela zokwelapha (njenge-minocyline noma imishanguzo emisha ekwakhiweni). Xoxa nodokotela wakho ngezinketho zohlelo lwakho lokwelashwa.