Yanayin Nishaji mai kyau don Wasu Mutane
Hanyoyi daban-daban na DMARDs ( maganin cututtukan maganin cututtukan cututtuka ) za'a iya wajabta don bi da cututtuka na rheumatoid kamar yadda ya saba da DMARD daya. Saurin sau uku, wanda yake cikin zaɓuɓɓukan magani, yana nufin amfani da DMARDs guda uku; wani lokaci kuma yana iya komawa zuwa DMARDs guda biyu da nauyin glucocorticoid kadan.
Menene Saurin Sau Uku?
Hakanan hadewar DMARDs da aka yi amfani da shi a matsayin maganin sau uku don cututtuka na rheumatoid sun hada da methotrexate , sulfasalazine (sunan Azulfidine), da hydroxychloroquine (Plaquenil).
Yawancin lokaci, za'a fara gwagwarmaya DMARD (monotherapy), amma idan mayar da martani bai dace ba, likita da mai haƙuri zasuyi la'akari da wasu zaɓuɓɓukan magani.
Wane ne ya kamata ya yi la'akari da farfadowa uku?
A shekarar 2012, sharuɗɗan kulawa daga Cibiyar Kwalejin Rheumatology na Amirka, da kuma Ƙungiyar Rheumatology ta Kanada, sun bada shawarar yin amfani da maganin tare da DMARDs-ciki har da sau uku-ga mutanen da ke dauke da maganin kututtukan jini, tare da matsanancin matsananciyar cutar, da matalauci prognosis. Sauran maganin sau uku za'a iya la'akari da su sosai ga waɗanda suka sami amsar rashin dacewa ga DMARD daya.
Ƙungiyar Turai kan Rheumatism (EULAR) shawarwari game da maganin cututtukan cututtuka a shekara ta 2013 ba su da mahimmanci kuma sun bayyana cewa ga marasa lafiya wanda ba a ba da Dokar DMARD ba tukuna, maganin ƙwaƙwalwar ƙwayar cuta ko haɗin gwiwa zai dace. Idan dabarun DMARD ta farko ta kasa, za a iya la'akari da sauyawa zuwa DMARD daban-daban.
Cibiyar Nazarin Kasuwancin Amirka ta Amirka na Rheumatology a shekara ta 1957 ta nuna cewa a farkon kututtuka, idan cutar ta ci gaba da matsakaicin matsayi tare da DMARD monotherapy (tare da ko ba tare da glucocorticoid), mahallin DMARD ko TNF mai hanawa ko wani ilimin halitta banda TNF inhibitor (ba tare da zaɓi ga tsari, tare da ko ba tare da methotrexate) ya kamata a yi la'akari maimakon ci gaba da monotherapy.
(Lura: Yanayin zaɓi ya ɓace saboda binciken da aka kai kan kai zuwa ga magungunan kwayoyi.
Menene An Yi Nazarin Nazarin Game da Saurin Sau Uku?
Na farko binciken da ya bayyana da amfani na sau uku maganin idan aka kwatanta da monotherapy ya bayyana a cikin kimiyya kimiyya a cikin 1990s. Nazarin 1999 ya kimanta tasiri da kuma jurewa na sau uku (matakan, sulfasalazine, da plaquenil) da kuma ƙaddarar kashi-kashi idan aka kwatanta da monotherapy tare da ko ba tare da maganganun maganganu ba a cikin mutanen da suka fara da ciwon maganin rheumatoid. An ƙaddara cewa sau uku sauƙaƙa ya fi tasiri ba tare da rashin lafiya ba fiye da monotherapy lokacin da la'akari da ikonsa na jawo gafara .
Wani binciken da aka buga a shekara ta 2002 ya tabbatar cewa a cikin mutanen da ke dauke da cututtuka na rheumatoid, sau uku da farfajiya, sulfasalazine, da plaquenil sun kasance sun yi haƙuri sosai kuma sun fi tasiri fiye da hadewa tare da methotrexate da sulfasalazine. Saurin farfesa shi ne "mai karfin gaske" ga methotrexate da hydroxychloroquine.
A shekara ta 2010, nazarin mahimmanci na Cochrane da ƙaddamarwa, wanda yayi la'akari da yadda ake amfani da maganin monotherapy tare da hadewa, ya tabbatar da cewa akwai bambanci tsakanin sassan.
Bugu da ƙari, mutane 9 daga cikin 100 sun dakatar da yin la'akari saboda sakamako masu illa, yayin da 14 daga cikin 100 sun daina yin amfani da hanya tare da wani DMARD.
Sakamakon da aka gabatar a shekara ta 2013 na nazarin kimiyya na shekara-shekara na Cibiyar Rheumatology na Amirka ya nuna cewa yawancin mutanen da ke dauke da ciwon maganin ƙwaƙwalwar jini sun ƙare sau uku a bayan shekaru daya ko biyu. Kayyade dalilin da yasa akwai wanzuwa mai girma ba sauki bane, amma daya dalili shine na mutane sun fi yawan kwayoyi don daukar, ba kwayoyi ba.
An Sau da yawa Saurin Sauka Sau Uku?
Duk da amincinsa da tasirinta, sau uku ba sau da yawa shi ne tafiya-magani a aikin likitancin lokacin da hanya kawai bai dace ba.
An ruwaito shi (Sparks JA et al.), Daga shekara ta 2009 zuwa 2014, kashi 0.7 na kimanin mutane 25,000 marasa lafiya na jini suka koma zuwa sau uku daga farfadowa na DMARD. Ta hanyar kwatanta, kashi 11.1 na marasa lafiya sun hada da maganin kwayoyi da suka hada da DMARD. Wannan shi ne yanayin, kodayake binciken binciken ya nuna cewa sau uku sauƙaƙe ne a matsayin ilimin halittu don ilimin cututtuka na rheumatoid-kuma lalle ne mafi yawan kuɗi.
Saurin farfadowa (methotrexate, sulfasalazine, plaquenil) yana da muhimmanci fiye da haɗuwa da methotrexate da Enbrel (etanercept) -sasantawa dubban ƙananan haƙuri a kowace shekara. An ba da shawara cewa a yi amfani da sau uku sau uku kafin nazarin halittu, kamar Enbrel, saboda ƙimar kudin. Za a iya yin mataki zuwa Enbrel daga bisani, a cikin marasa lafiya waɗanda basu da amsa mara dacewa zuwa sau uku.
Duk da yawan tasiri na sau uku, a cikin aikin asibiti, mai hana magunguna na TNF ita ce zabi mafi kyau da aka yi idan magani bai dace ba. Abin sha'awa shine, tare da ci gaba da sabuwar magungunan ƙwayoyin magani, wanda aka sani da biosimilars , wanda zai sake canzawa kuma. A biosimilar wata samfurin halitta ne wanda yayi kama da magungunan likitancin Amurka. A zahiri, wannan ya kamata a yi jiyya da ke da tasiri kamar kwayoyin halitta a farashin mai rahusa. Mai yiwuwa biosimilars na iya zama hanyar da aka fi dacewa idan hanya kawai ta kasa.
> Sources:
> Katchamart, W et al. Cochrane Review. Methotrexate kadai a kan hanya a hade tare da wasu magunguna don rheumatoid arthritis. Afrilu 14, 2010.
> Mottonen, TT et al. Hadin DMARD Farko tare da Corticosteroids a Arthritis na Early Rheumatoid. Rheumatology Clinical da gwaji. 1999.
> O'Dell, JR, et al. Ka'idojin Ƙwayar Arthritis Aiki Bayan Rashin Ƙaddamarwa. New England Journal of Medicine. Yuli 25, 2013.
> O'Dell, JR, et al. Jiyya na rheumatoid arthritis tare da methotrexate da hydroxychloroquine, methotrexate da sulfasalazine, ko hade da magunguna guda uku. Sakamako na shekaru biyu, bazuwar, sau biyu makafi, gwajin gwajin wuribo. Arthritis & Rheumatology 46: 1164-1170. 2002.
> Fasalolin, JA, et al. Rahoton Bidiyo: Ƙin ƙarfafawa zuwa Saurin Sau Uku Bayan Jiyya Tare da Dabbobi marasa Lafiyar Abinci da Rigakafi na Rheumatoid a Amurka Daga shekara ta 2009 zuwa 2014. Arthritis da Rheumatology. Yuni 24, 2016.