nkhani

Masiku ano, Zenotevir, mankhwala ang'onoang'ono opangidwa ndi placebo odzipangira okha, ali pagulu. NEJM>. Kafukufukuyu, wofalitsidwa pambuyo pa kutha kwa mliri wa COVID-19 ndipo mliriwu walowa mumkhalidwe watsopano wa mliri, ukuwonetsa kafukufuku wovuta wamankhwala omwe adayambitsidwa panthawi ya mliri, ndipo amapereka chidziwitso chabwino pakuvomerezedwa kwadzidzidzi kwa mliri watsopano wamatenda opatsirana.

Kuchuluka kwa matenda obwera chifukwa cha matenda obwera chifukwa cha kupuma kwa ma virus ndi ambiri, kuphatikiza matenda asymptomatic, matenda azizindikiro (ochepa mpaka ocheperako osagonekedwa m'chipatala), owopsa (ofunikira kuchipatala), ndi imfa. Zingakhale zabwino ngati miyeso yazachipatalayi ingaphatikizidwe mu mayeso azachipatala kuti aunikire phindu la mankhwala oletsa mavairasi oletsa mavairasi, koma pamavuto omwe ayamba kuchepa kwambiri pakachitika mliri, ndikofunikira kusankha chofunikira kwambiri pachipatala ndikuwunika mphamvu yamankhwala oletsa ma virus.

Zolinga zofufuza za mankhwala oletsa tizilombo toyambitsa matenda zimatha kugawidwa mochepa kuti kuchepetsa kufa, kulimbikitsa kusintha kwa matenda oopsa, kuchepetsa matenda oopsa, kufupikitsa nthawi ya zizindikiro ndi kupewa matenda. Pazigawo zosiyanasiyana za mliri, mathero azachipatala omwe amasankhidwa nthawi zambiri amasiyana kwambiri. Pakadali pano, palibe mankhwala oletsa ma virus a Covid-19 omwe awonetsedwa kuti ali abwino pochepetsa kufa komanso kulimbikitsa kukhululukidwa kwakukulu.

Kwa mankhwala oletsa tizilombo toyambitsa matenda a matenda a COVID-19, Nematavir/Ritonavir adachita mayeso achipatala a EPIC-HR (NCT04960202) [1], EPIC-SR (NCT05011513) ndi EPIC-PEP (NCT05047601), motsatana. Zolinga zitatuzo zinali kuchepetsa matenda oopsa, kufupikitsa nthawi ya zizindikiro ndi kupewa matenda. Nematavir/ritonavir adangowonetsedwa ndi EPIC-HR kuti achepetse kudwala kwambiri, ndipo palibe zotsatira zabwino zomwe zidapezedwa pazotsatira ziwiri zomalizazi.

Ndi kusinthika kwa mliri wa COVID-19 kukhala omicron komanso kuchuluka kwa katemera, kuchuluka kwa anthu omwe ali pachiwopsezo chatsika kwambiri, ndipo ndizovuta kupeza zotsatira zabwino potengera kapangidwe kake kofanana ndi EPIC-HR ndi kusinthana kolemera ngati pomaliza. Mwachitsanzo, NEJM yatulutsa kafukufuku wofananiza wa VV116 motsutsana ndi Nematavir/Ritonavir [2] kuwonetsa kuti wakaleyo siwoyipa kuposa womalizayo potengera nthawi yochira kwa akulu omwe ali ndi Covid-19 wofatsa mpaka wochepera omwe ali pachiwopsezo chopita patsogolo. Komabe, mayesero oyambirira achipatala a VV116 adagwiritsa ntchito kusintha kwa kulemera monga mapeto a phunziro, ndipo ndi kusinthika kwachangu kwa mliri, kunali kovuta kuwona chiwerengero choyembekezeredwa cha zochitika. Maphunzirowa akusonyeza kuti momwe mungayesere momwe mungagwiritsire ntchito mankhwala atsopano ndi zomwe zimathera pamapeto zomwe ziyenera kugwiritsiridwa ntchito monga chiyeso chowunikira bwino zakhala zovuta zofufuza zachipatala pa nkhani ya kusinthika kwa matenda mofulumira, makamaka kuchepetsa mofulumira kwa kutembenuka kwa thupi.

Kuyesa kwa Nematavir/Ritonavir EPIC-SR, komwe kudatenga zizindikiro 14 za COVID-19 ndikugwiritsa ntchito nthawi yothetsa zizindikiro ngati pomaliza, kudaperekanso zotsatira zoyipa. Titha kupanga zongopeka zitatu: 1. Njira zogwirira ntchito ndizodalirika, zomwe zikutanthauza kuti nemavir ndiyosathandiza pakuwongolera zizindikiro zachipatala za COVID-19; 2. Mankhwalawa ndi othandiza, koma miyezo yogwira ntchito ndi yosadalirika; 3. Muyezo wothandiza siwodalirika, ndipo mankhwalawo sagwiranso ntchito paziwonetserozi.

Pamene mankhwala odziyimira pawokha a Covid-19 aku China akuchoka ku labotale kupita kumalo oyeserera azachipatala, tikukumana ndi vuto lalikulu - kusowa kwa njira zowunika momwe chipatala chikuyendera. Ndizodziwikiratu kuti mbali iliyonse yofunikira pakupanga mayeso azachipatala ndi yolondola, ndipo ndizotheka kutsimikizira mphamvu ya mankhwala. Momwe mungaganizire za zotsatira zoyipazi zimatsimikizira ngati mankhwala odziyimira pawokha aku China angakhale opambana.

Ngati nthawi ya kuzimiririka kwa zizindikiro za Covid-19 simathero oyenera kuyesa mankhwala odana ndi SARS-CoV-2, zikutanthauza kuti mankhwala odziyimira pawokha aku China amatha kupitiliza kuyesa ndikuchepetsa kulemera kwawo kuti atsimikizire kuti ali ndi mphamvu, ndipo mseu uwu wa kafukufuku ndi chitukuko udzamalizidwa mliriwu ukamaliza kufalikira padziko lonse lapansi komanso chitetezo cha ziweto chimakhazikitsidwa pang'onopang'ono. Zenera lokwaniritsa zolinga za kafukufuku wachipatala ndi kulemera kopepuka monga mapeto oyambirira akutseka.

Pa Januware 18, 2023, kuyesa kwachipatala kwa gawo la 2-3 la chithandizo cha matenda a coronavirus ofatsa a Cenotevir opangidwa ndi Cao Bin et al. inasindikizidwa mu New England Journal of Medicine (NEJM) [3]. Kafukufuku wawo akuwonetsa nzeru zamomwe mungagonjetsere kusowa kwa njira zowunikira mphamvu ya mankhwala oletsa antiviral a COVID-19 pamayesero azachipatala.

Clinicaltrials.gov iyi, yolembetsedwa pa Ogasiti 8, 2021 (NCT05506176), ndiye kuyesa koyamba koyendetsedwa ndi placebo kwa mankhwala aku China oletsa COVID-19. Mu gawo ili la 2-3 kuyesa kwakhungu, kosasinthika, koyendetsedwa ndi placebo, odwala omwe ali ndi COVID-19 pang'ono kapena pang'ono mkati mwa masiku atatu kuyambira pomwe adayambika adapatsidwa 1: 1 ku senotovir/ritonavir (750 mg/100 mg) kawiri tsiku lililonse kapena placebo kwa masiku asanu. Mapeto amphamvu kwambiri anali nthawi yokhazikika yazizindikiro zazikulu za 11, mwachitsanzo, kuchira kwa zizindikiro kunatenga masiku a 2 popanda kubwereranso.

Kuchokera m'nkhaniyi, titha kupeza mapeto atsopano a "zizindikiro zoyambirira za 11" za matenda ofatsa. Ofufuzawo sanagwiritse ntchito zizindikiro 14 za COVID-19 za mayeso azachipatala a EPIC-SR, komanso sanagwiritse ntchito kusinthana kolemera ngati pomaliza.

Odwala okwana 1208 adalembedwa, 603 mwa iwo adatumizidwa ku gulu lamankhwala la senotevir ndi 605 ku gulu la mankhwala a placebo. Zotsatira za kafukufukuyu zidawonetsa kuti pakati pa odwala a MIT-1 omwe adalandira chithandizo chamankhwala mkati mwa maola 72 atangoyamba kumene, nthawi yakuthana ndi zizindikiro za COVID-19 mu gulu la senotevir inali yayifupi kwambiri kuposa yomwe ili mgulu la placebo (maola 180.1 [95% CI, 162.1-201.6] vs. 216.0 maola [216.0; −35.8 maola [95% CI, -60.1 mpaka -12.4]; Patsiku la 5 la kulembetsa, kuchepetsa kuchuluka kwa mavairasi kuchokera pachiyambi kunali kwakukulu mu gulu la senotevir kusiyana ndi gulu la placebo (kusiyana kwakukulu [±SE], -1.51± 0.14 log10 makope / ml; 95% CI, -1.79 ku -1.24). Kuphatikiza apo, zotsatira za kafukufukuyu m'mapeto onse achiwiri komanso kuwunika kwamagulu ang'onoang'ono akuti zenotevir ikhoza kufupikitsa nthawi yazizindikiro mwa odwala a COVID-19. Zotsatira izi zikuwonetsa kuti Cenotevir ili ndi phindu lalikulu pachiwonetserochi.

Chomwe chili chofunikira kwambiri pa kafukufukuyu ndikuti atenga njira yatsopano yowunika momwe angagwiritsire ntchito bwino. Titha kuwona kuchokera pamapepalawa kuti olembawo adapereka nthawi yochulukirapo kuti awonetse kudalirika kwa izi, kuphatikiza kusasinthika kwa miyeso yobwerezabwereza yazizindikiro za 11, komanso kuyanjana kwake ndi zizindikiro za 14. Anthu omwe ali pachiwopsezo, makamaka omwe ali ndi vuto lachipatala komanso omwe ali onenepa kwambiri, amapindula kwambiri ndi kafukufukuyu. Izi zimatsimikizira kudalirika kwa kafukufukuyu kuchokera kumbali zambiri, komanso zimasonyeza kuti Cenotevir yachoka pamtengo wofufuza kupita ku mtengo wachipatala. Kutulutsidwa kwa zotsatira za kafukufukuyu kumatithandiza kuwona kupambana kwa ofufuza achi China kuti athetse mwachidwi mavuto odziwika padziko lonse lapansi. Popanga mankhwala atsopano m'dziko lathu, tidzakumana ndi zovuta zofananira zamayesero azachipatala zomwe ziyenera kuthetsedwa mtsogolo.