A lokacin rani na shekara ta 2017, masu binciken sun ruwaito sakamakon sakamakon gwajin CANTOS, inda magani tare da maganin ƙwayar cuta mai cike da ƙwayar cuta (Illaris, Novartis) ya rage yawan halayyar manyan cututtukan zuciya a cikin mutanen da ke cikin haɗari.
Yawancin masana sunyi imanin cewa CANTOS za a tuna da shi a matsayin gwaji mai ban mamaki, tun da yake shi ne karo na farko da aka tabbatar da maganin ƙwaƙwalwar ƙwayoyin magani cewa maganin maganin ƙwayar magungunan magani musamman don rage ƙonawa zai iya inganta sakamakon zuciya.
Tabbatar da ƙumburi a matsayin sabuwar manufa don maganin rigakafi hakika dalilin dalili ne, kuma zamu iya tsammanin yawan bincike yanzu za a mayar da hankali a wannan hanya. Duk da haka, ya kamata mu zama masu shakka cewa ƙwayar magani da aka yi amfani da shi a CANTOS-canakinumab-zai zama wani zaɓi mai mahimmanci don magance mutane da ke dauke da cutar da jijiyoyin jini.
Kumburi da Atherosclerosis
An san shekaru da dama cewa kumburi yana taka muhimmiyar rawa a atherosclerosis , kuma musamman, kwayoyin ƙwayoyin ƙwayoyin halitta sune fasalin fasalulluran atherosclerotic. A cikin wa] annan alamun, macrophages (wani nau'in jini mai tsabta) wanda suka karbi LDL cholesterol sunadarai yalwacin abubuwa masu ƙin ƙananan jini, masu haifar da kumburi. An yi imani da shekaru cewa wannan kumburi yana taimakawa wajen haifar da cikewar plaque kuma har ma da rushewa. Rupture na plaque na iya zama m. Rushewar plaque shine yawancin abin da ke haifar da ciwo na rashin jijiyar zuciya , wanda zai haifar da angina marar ƙarfi ko ciwon zuciya .
Akwai kuma shaida daga jarrabawar gwaji da karfi da ya nuna cewa ƙonewa yana da mahimmanci a ƙayyade sakamakon mutum tare da atherosclerosis. Musamman, matakan jini da alamomi guda biyu na ƙumburi - Furotin-C-reactive protein (CRP) da interleukin-6-suna haɗuwa da ƙari ƙwayar zuciya, da kuma sauran abubuwan da ke ciki na zuciya.
Bugu da ƙari, nazarin ya nuna cewa kwayoyin magunguna- wadanda aka shahara don rage yawan ƙwayoyin cholesterol, amma sun rage rage kumburi-suna da tasiri wajen inganta sakamakon asibiti na mutane masu haɗari waɗanda ke da matakan CRP masu girma, koda kuwa a lokacin da ba a haɓaka ƙananan cholesterol ba. (Masana da dama sunyi imani cewa saboda statins sunyi yawa fiye da "kawai" rage cholesterol wanda ya sa su zama tasiri a rage rashin lafiyar zuciya. Karanta abin da ke sa statins "daban". )
Duk da haka, har sai gwajin CANTOS, babu binciken binciken asibiti ya nuna cewa rage ƙananan ƙwayar cuta, ba tare da rage ƙananan cholesterol ba, zai inganta sakamako na asibiti.
CANTOS Trial
Jarabar CANTOS ta yi amfani da kwayar cutar ta musamman wanda ke kai hari ga wani bangare na mayar da martani. Canakinumab shi ne wanda ya saba da shi wanda ya hana interleukin-1b, cytokine wanda yake da mahimmanci a cikin hanyar ƙwayar cuta mai alaka da interleukin-6. An amince da Canakinumab shekaru da yawa don magance wasu cututtuka masu tsanani na rheumatologic, amma ba a taɓa amfani dasu ba saboda cutar cututtukan zuciya.
A cikin jarrabawar CANTOS, fiye da mutane 10,000 da suka tsira daga zuciya, da kuma wadanda suka daukaka jini na CRP, an baje su don samun injections na ko canakinumab ko placebo.
Bayan kimanin shekaru 3.7 na biyo baya, mutanen da aka ba da izinin karɓar maganin mikiya 150 na canakinumab (amma ba wadanda suka samu kora miliyan 50 ko 300 MG) sun rage hadarin cututtukan zuciya na zuciya (kamar yadda aka auna ta hanyar ƙarshe wanda ya kunshi ciwon zuciya mai rauni, rashin cututtuka, ko cututtukan zuciya). Yakin da canakinumab bai shafi mace ba.
Amfanin da aka samu tare da inganci 150 mg, yayin da yake da mahimmanci, ya kasance mai girman girma, da kuma muhimmancin asibiti. A cikin rukuni, akwai 4.11 abubuwan da suka faru a asibiti da shekaru 100, da 3.86 abubuwan da suka faru a kowace shekara 100 a cikin mutane da suka sami 150 mg canakinumab.
A wasu kalmomi, cikakken rage yawan haɗari a cikin masu binciken ya kasa kasa da kashi 1 bayan kusan shekaru hudu na magani. Yayin da wannan matsala ba ta da ban sha'awa, har yanzu yana da muhimmanci. Ta haka ne, sakamakon binciken CANTOS ya nuna, a karo na farko, cewa maganin anti-inflammatory zai iya inganta cikakkiyar magungunan cututtukan zuciya a cikin mutane masu haɗari.
Yana da kyau a sake maimaita cewa canakinumab ba sa kwayar cutar mai cike da kumburi ba. Maimakon haka, an yi niyya ne a wani bangare na musamman da ke cikin ƙananan kullun. Ba a bayyana a fili cewa kwayoyi da ke shafan wasu fannoni na ƙonewa zai kasance da amfani. A gaskiya ma, an san cewa kwayoyin anti-inflammatory marasa steroidal (NSAIDS) sun kamu da cututtukan zuciya. Sabili da haka, amfanin daji na zuciya da jijiyoyin da aka gani tare da canakinumab ba ya shafi wasu kwayoyi masu guba.
A matsayin bayanin kula na gefe, mutane a cikin gwajin CANTOS da suka karbi canakinumab an lura cewa suna da mummunan haɗarin mutuwa daga ciwon huhu na huhu - wani yanayin da ake zaton ƙonawa ya zama muhimmiyar rawa. Saboda haka jarrabawar CANTOS ta buɗe wani sabon hanya don bincike game da kumburi da ciwon daji.
Babban babban abin da aka gani da canakinumab a cikin CANTOS jarrabawar karamin karar ne a cikin mutuwa saboda cututtuka. Tun lokacin da aka mayar da martani ga mai da hankali akan ƙwayar cutar ƙwayar cuta, wajibi ne a yunkurin yaki da cututtuka, wannan binciken bai zama babban mamaki ba.
Abin da Duk Wannan Yake nufi
Babu shakka cewa gwajin CANTOS zai haifar da yin amfani da canakinumab don rage yawan ciwon zuciya na zuciya a cikin mutanen da ke cikin haɗari. Ba wai kawai da ainihin asibiti amfani da canakinumab yayi kyau m, amma kuma wannan miyagun ƙwayoyi yana da tsada tsada. Maganin yau da kullum tare da canakinumab, a cikin mutane masu fama da mummunar yanayi, suna kashe kimanin $ 200,000 a kowace shekara. Matsayi mai zurfi na amfani da cututtukan zuciya da aka gani a cikin gwajin CANTOS ba zai tabbatar da amfani da wannan magani mai tsada ba.
Don haka, mafi mahimmanci, muhimmancin nazarin CANTOS ba shine ya gano wani sabon maganin rigakafi na cututtukan zuciya ba, amma dai, ya gano sabon manufa don bincike.
Har zuwa yanzu, rage haɗarin cutar na zuciya da magani an ƙayyade yawanci ga cholesterol ragewa (yafi da statins), kuma watakila hana cin zarafi (tare da aspirin ). Yanzu ya bayyana, fiye da yadda ya fi gabanin haka, cewa kawar da wasu sifofi na maganganun ƙananan jini a cikin tasoshin jini zai iya rage rashin lafiyar cutar na zuciya.
Zamu iya sa ran kamfanonin sayar da kayan magani su yi amfani da wannan sabuwar hanya don farfadowa, kuma za su ci gaba da bunkasa ci gaban wasu jami'o'i wanda zai iya magance ƙonewar jijiyoyin jini. Idan wannan ƙoƙarin ya sa wani abu kamar abin da masana da yawa suka riga sun yi la'akari da shi, za a iya ganin CANTOS a matsayin babban mahimmanci a maganin cututtuka na zuciya-ko dai ko amfani da canakinumab kanta ya zama sananne.
Kalma Daga
Yanzu ya bayyana kusan wasu cewa ƙumburi yana taka muhimmiyar rawa wajen bunkasa atherosclerosis, kuma a sakamakon mutanen da ke fama da cututtukan ƙwayar cutar asherosclerotic. Jirgin CANTOS ya nuna cewa manufar da aka yi amfani da su a wasu bangarori na amsawar ƙoshin lafiya zai iya inganta kyakkyawan sakamako na mutanen da ke cikin haɗari.
Yayinda mayakinumab-miyagun ƙwayoyi ke aiki a gwajin CANTOS-bazai taba amfani da ita ba saboda cutar cututtukan zuciya, masu bincike sun riga sun kafa sabuwar hanya don magance wannan cuta. A cikin shekaru masu zuwa za mu iya sa ran jin labarin da yawa game da kumburi a matsayin hanyar atherosclerosis, kuma game da sababbin hanyoyin kwantar da hankali da nufin kawar da wannan ƙonewa.
> Sources:
> Libby P, Ridker PM, Hansson GK, Leducq Transatlantic Network a kan Atherothrombosis. Kumburi a Atherosclerosis: Daga Pathophysiology don Yarda. J Am Coll Cardiol 2009; 54: 2129.
> Ridker PM, Everett BM, Thuren T, et al. Magungunan ciwon kumburi da Canakinumab na cutar Atherosclerotic. N Engl J Med 2017; DOI: 10.1056 / NEJMoa1707914.
> Weber C, Noels H. Atherosclerosis: Tsarin Harkokin Tsarin Kwafi da Harkokin Kiwon Lafiya. Nat Med 2011; 17: 1410.