Ukufakwa kweRituxan yeRheumatoid Arthritis: Yintoni onokuyilindela

Umxholo

• Ushwankathelo
• Ngubani umgqatswa ofanelekileyo kolu nyango?
• Luthini uphando?
• Isebenza njani iRituxan yeRA?
• Yintoni onokuyilindela ngexesha lokufakwa
• Zithini iziphumo ebezingalindelekanga?
• Ukuthatha

Ushwankathelo

I-Rituxan sisiyobisi se-biologic esivunyiweyo savunywa yi-US Food and Drug Administration (FDA) ngo-2006 ukunyanga isifo samathambo (RA). Igama lalo eliqhelekileyo liyi-rituximab.

Abantu abane-RA abangaphendulanga kwezinye iintlobo zonyango banokusebenzisa i-Rituxan ngokudibeneyo ne-methotrexate yeziyobisi.

I-Rituxan lulwelo olungenambala olunikezwe ngokufakwa. Yintsholongwane eyakhiwe ngokwemfuza ejolise kwiiseli ze-B ezichaphazelekayo kukudumba kweRA. I-FDA ikwamkele iRituxan ye-non-Hodgkin's lymphoma, i-lymphocytic leukemia, kunye ne-granulomatosis ene-polyangiitis.

Zombini i-rituximab kunye ne-methotrexate, i-immune-system suppressor, yaqala yaphuhliswa kwaye yasetyenziswa njengeziyobisi ezichasene nomhlaza. I-Rituxan iveliswa nguGenentech. EYurophu, kuthengiswa njengeMabThera.

Ngubani umgqatswa ofanelekileyo kolu nyango?

I-FDA ilwamkele unyango ngeRituxan kunye ne-methotrexate:

• ukuba une-RA yokumodareyitha
• ukuba awuphendulanga kakuhle kunyango ngokubamba iiarhente zethumba necrosis factor (TNF)

I-FDA icebisa ukuba i-Rituxan kufuneka isetyenziswe ngexesha lokukhulelwa kuphela xa isibonelelo esinokubakho kumama sikogqitha nawuphi na umngcipheko kumntwana ongekazalwa. Ukhuseleko lokusetyenziswa kweRituxan nabantwana okanye oomama abangabongikazi alukasekwa.

I-FDA icebisa ngokuchasene nokusetyenziswa kweRituxan kubantu abaneRA abangakhange banyangwe ngearhente enye okanye ezingaphezulu zokuthintela i-TNF.

I-Rituxan ayikhuthazwanga kubantu abane-hepatitis B okanye abaphethe intsholongwane, kuba i-Rituxan inokuphinda isebenze i-hepatitis B.

Luthini uphando?

Ukusebenza kwe-rituximab kwisifundo sophando kwaba. Olunye uvavanyo lwezonyango lwalandelwa.

Ukuvunywa kwe-FDA yokusetyenziswa kweRituxan yeRA kwakusekwe kwizifundo ezithathu ezingaboniyo ngokuthelekisa unyango lwe-rituximab kunye nonyango lwe-methotrexate kunye ne-placebo kunye ne-methotrexate.

Esinye sezifundo zophando yayiyiminyaka emibini yophando olungenamsebenzi olubizwa ngokuba yiREFLEX (uVavanyo oluQhelekileyo lokuSebenza ngokuSebenza kweXesha elide kwiRituximab kwiRA).Ukusebenza ngokulinganayo kwakulinganiswa kusetyenziswa iAmerican College yeRheumatology (ACR) kuvavanyo lokuphucuka kwithenda edibeneyo kunye nokudumba.

Abantu abafumene i-rituximab babene-infusions ezimbini, iiveki ezimbini ngokwahlukana. Emva kweeveki ezingama-24, iREFLEX yafumanisa ukuba:

• Iipesenti ezingama-51 zabantu abaphathwe nge-rituximab xa kuthelekiswa neepesenti ezili-18 baphathwa nge-placebo babonisa ukuphuculwa kwe-ACR20
• Iipesenti ezingama-27 zabantu baphathwa nge-rituximab xa kuthelekiswa neepesenti ezi-5 zabantu abaphathwe nge-placebo babonisa ukuphuculwa kwe-ACR50
• Iipesenti ezili-12 zabantu abaphathwe nge-rituximab xa kuthelekiswa neepesenti ezi-1 zabantu abaphathwe nge-placebo babonisa ukuphuculwa kwe-ACR70

Amanani e-ACR apha abhekisa kuphuculo olusuka kwiimpawu ezisisiseko zeRA.

Abantu abaphathwe nge-rituximab babenokuphucuka okubonakalayo kwezinye iimpawu ezinjengokudinwa, ukukhubazeka, kunye nomgangatho wobomi. IX-reyi ikwabonakalise imeko yokuya kumonakalo omncinci ngokudibeneyo.

Abanye abantu kolu phononongo baba neziphumo ebezingalindelekanga, kodwa ezi bezinobuzaza obuphakathi ukuya kophakathi.

okoko i-2006 ifumene izibonelelo ezifanayo kunyango lwe-rituximab kunye ne-methotrexate.

Isebenza njani iRituxan yeRA?

Indlela yokusebenza kwe-rituximab kunyango lwe-RA kunye nezinye izifo. Kucingelwa ukuba i-rituximab antibodies ijolise kwimolekyuli (i-CD20) kumphezulu weeseli ezithile ze-B ezinxulunyaniswa nenkqubo yokuvuvukala kweRA. Ezi seli ze-B kucingelwa ukuba ziyabandakanyeka ekuveliseni i-rheumatoid factor (RF) kunye nezinye izinto ezinxulumene nokudumba.

I-Rituximab ibonwa kukudodobala okwethutyana kodwa ngokucokisekileyo kweeseli ze-B egazini kunye nokuncipha kwenxalenye kumongo wethambo nakwizicubu. Kodwa ezi seli ze-B ziphinda ziphinde zivele. Oku kunokufuna ukuqhubeka nokunyanga kwe-rituximab.

Uphando luyaqhubeka ukukhangela ukuba iiseli ze-rituximab kunye ne-B zisebenza njani kwi-RA.

Yintoni onokuyilindela ngexesha lokufakwa

I-Rituxan inikwa nge-drip kwi-vein (i-infravenous infusion, okanye i-IV) kwisibhedlele. Umthamo we-1,000-milligram (mg) infusions ezahlulwe ziiveki ezimbini. Ukufakwa kwe-Rituxan akubuhlungu, kodwa unokuba nohlobo oluthile lokungaziphenduli kwichiza.

Ugqirha wakho uya kujonga impilo yakho yonke ngaphambi kokuba anike unyango kwaye akubeke iliso ngexesha lokufakwa.

Isiqingatha seyure ngaphambi kokuba kuqalwe ukumiliselwa kweRituxan, uya kunikwa ukumiliselwa kwe-100 mg ye-methylprednisolone okanye i-steroid efanayo kwaye mhlawumbi ne-antihistamine kunye ne-acetaminophen (iTylenol). Oku kuyacetyiswa ukunceda ukunciphisa nayiphi na impendulo enokwenzeka ekungenisweni.

Ukufakwa kwakho kokuqala kuya kuqala kancinci kwinqanaba lama-50 mg ngeyure, kwaye ugqirha uya kuhlala ejonga imiqondiso yakho ebalulekileyo ukuze uqiniseke ukuba awunampendulo imbi ekungenisweni.

Inkqubo yokuqala yokumnika ingathatha malunga neeyure ezi-4 kunye nemizuzu eli-15. Ukucoca ibhegi ngesisombululo sokuqinisekisa ukuba ufumana idosi epheleleyo yeRituxan ithatha enye imizuzu eli-15.

Unyango lwesibini lokunyuswa kufuneka luthathe malunga neyure enye.

Zithini iziphumo ebezingalindelekanga?

Kuvavanyo lweklinikhi lweRituxan yeRA, malunga neepesenti ezili-18 zabantu baneziphumo ebezingalindelekanga. Iziphumo ebezingalindelekanga eziqhelekileyo, ezinamava ngexesha kunye neeyure ezingama-24 emva kokufakwa, zibandakanya:

• ukuqina komqala
• Iimpawu ezinjengomkhuhlane
• irhashalala
• ukucheba
• isiyezi
• umqolo obuhlungu
• isisu esimoshakele
• isicaphucaphu
• ukubila
• ukuqina kwemisipha
• uvalo
• ukuba ndindisholo

Ngokwesiqhelo inaliti ye-steroid kunye ne-antihistamine oyifumanayo ngaphambi kokufakwa kuya kunciphisa ubuzaza beziphumo ebezingalindelekanga.

Ukuba unempawu ezinzima, biza ugqirha wakho. Oku kunokubandakanya:

• usulelo oluphezulu lokuphefumla
• ebandayo
• usulelo lomchamo
• inyumoniya

Shayela ugqirha wakho ngokukhawuleza ukuba ufumana utshintsho lombono, ukudideka, okanye ukulahleka kwemali. Iziphumo ezinzulu kwiRituxan zinqabile.

Ukuthatha

I-Rituxan (i-generic rituximab) iye yamkelwa yi-FDA kunyango lwe-RA ukusukela ngo-2006. Malunga ne-1 kwabathathu abantu abanyangelwe i-RA abaphenduli ngokwaneleyo kwezinye iindlela zonyango ze-biologic. Ke iRituxan ibonelela ngenye indlela enokubakho. Ukusukela ngo-2011, ngaphezulu kwe-100,000 yabantu abane-RA kwihlabathi liphela babefumene i-rituximab.

Ukuba ungumgqatswa weRituxan, funda ngokusebenza kwayo ukuze wenze isigqibo esifanelekileyo. Kuya kufuneka ulungelelanise izibonelelo kunye nobungozi obunokubakho xa kuthelekiswa nezinye iindlela zonyango (ezinje nge-minocyline okanye amachiza amatsha kuphuhliso). Xoxa ngesicwangciso sakho sonyango kunye nogqirha wakho.