Dab tsi yog qhov cuam tshuam ntawm semaglutide?

Semaglutide yog qhov ntev - ua glucagon- zoo li peptide-1 (GLP-1) receptor agonist. Nws yog ib qho hluavtaws analogue ntawm tib neeg cov tshuaj hormones incretin GLP-1, tsim kom muaj zog tiv thaiv kev degradation los ntawm dipeptidyl peptidase-4 (DPP-4) enzyme, uas ua rau lub neej ntev ntev.

Smegglutinin yog GLP-1 receptor agonist uas ua haujlwm los ntawm kev ua raws li cov tshuaj hormones hauv plab zais cia tom qab noj mov.

1. Poob Poob (FDA pom zoo rau kev tswj qhov hnyav)

Kev tshaib plab: Smegglutinin tuaj yeem hla cov ntshav- lub hlwb teeb meem thiab ua rau cov chaw tswj kev noj qab haus huv xws li arcuate nucleus ntawm hypothalamus, activating POMC neurons thiab inhibiting AgRP neurons, yog li txo qis kev tshaib kev nqhis, txhim kho postprandial satiety, thiab pab cov neeg mob ib txwm txo qis calorie kom tsawg. Cov kev tshawb fawb soj ntsuam pom tau hais tias cov neeg siv tuaj yeem txo lawv cov calories txhua hnub los ntawm kwv yees li 20-30%.

Ncua plab plab: Cov tshuaj inhibits antral contractions thiab relaxes lub plab hnyuv, qeeb tus nqi ntawm cov khoom noj thiab kua zaub mov nkag mus rau hauv duodenum, ncua lub sij hawm nyob rau hauv lub plab cov ntsiab lus, yog li ncua kev nqus ntawm qabzib, txo qis postprandial ntshav qabzib hloov, thiab ncua lub sij hawm ntawm satiety. Cov nyhuv no yog feem ntau hais nyob rau hauv thawj theem ntawm kev siv; qee qhov kev ua siab ntev txhim kho nrog kev siv sijhawm ntev -, tab sis qhov kev poob phaus tseem nyob.

Clinical Efficiency

Hauv STEP series Phase 3 kev sim tshuaj, cov neeg rog rog lossis rog rog (tsis muaj ntshav qab zib) tau kho nrog semaglutide 2.4 mg ib zaug txhua lub lim tiam:

Qhov hnyav poob ntawm 15.3% (kwv yees li 15-18 kg) ntawm lub lim tiam 68

Ntau tshaj ib tug -feem peb ntawm cov neeg koom tau ntsib qhov hnyav tshaj 20%

Poob poob toj siab nyob ib ncig ntawm lub lis piam 60, nrog qeeb yuag rov qab los tom qab txiav kev kho mob.

Piv nrog rau kev ua neej nyob ib leeg, kev kho mob semaglutide ua ke ua rau ntau tshaj li 3 npaug ntawm kev poob phaus.

2. Txo cov ntshav qabzib (rau hom 2 mob ntshav qab zib)

Txhawb nqa Insulin secretion: Smegglutide muaj cov piam thaj -nyob ntawm cov tshuaj insulinotropic: nws txhim kho cov tshuaj insulin tsuas yog thaum cov ntshav qabzib nce siab, thiab yuav luag tsis muaj kev cuam tshuam thaum cov ntshav qabzib qis lossis qis dua. Yog li, kev pheej hmoo ntawm hypoglycemia yog qhov tsawg heev thaum siv los ua monotherapy.

Inhibiting Glucagon: Hauv lub xeev hyperglycemic, cov tshuaj inhibits kev tso tawm ntawm glucagon los ntawm pancreatic hlwb, txo cov kab mob siab gluconeogenesis thiab glycogenolysis, yog li txo qis cov piam thaj endogenous. Cov txheej txheem no txhawb kev ua haujlwm ntawm insulin, ua rau "dual-txoj kev" cov nyhuv hypoglycemic.

Hydremic Efficiency: Hauv SUSTAIN series ntawm theem 3 kev sim tshuaj, smegglutide 1.0 mg ib zaug ib lub lim tiam:

txo HbA1c los ntawm qhov nruab nrab ntawm 1.5–1.8 feem pua ​​​​cov ntsiab lus

Ntau tshaj 80% ntawm cov neeg mob pom HbA1c poob qis dua 7.0%

piv nrog kev tswj hwm kev kho mob xws li sitagliptin, exenatide txuas ntxiv - tso tawm, thiab insulin glargine, nws pom tau tias muaj txiaj ntsig zoo rau kev ua haujlwm ntawm lub cev.

3. Kev tiv thaiv kab mob plawv: Kev ywj pheej muaj txiaj ntsig dhau ntawm cov piam thaj txo qis thiab poob phaus

SELECT Cardiovascular Outcomes Trial tau tso npe kwv yees li 18,000 tus rog rog lossis rog uas tsis yog- cov neeg mob ntshav qab zib uas muaj keeb kwm ntawm cov kab mob plawv. Cov txiaj ntsig tau pom:

Kev txo qis 20% ntawm qhov kev pheej hmoo ntawm cov teeb meem tsis zoo hauv plawv (mob plawv tuag, tsis yog-fatal myocardial infarction, tsis yog{2}} mob stroke).

Kev soj ntsuam ntxiv qhia tau hais tias kwv yees li ob -feem peb ntawm cov txiaj ntsig ntawm cov hlab plawv yog ywj siab ntawm kev poob phaus, qhia txog kev tiv thaiv vascular ncaj qha ntawm cov tshuaj.

4. Lwm yam qhia

Hauv Tebchaws Meskas, Wegovy (semaglutide txhaj) kuj tau txais kev pom zoo rau kev kho mob ntawm metabolic dysfunction -associated steatohepatitis (MASH).

Cov kev phiv tshwm sim feem ntau yog cov tshuaj tiv thaiv kab mob plab, feem ntau me me mus rau nruab nrab:

• xeev siab, ntuav
• Mob plab, cem quav
• Poob qab los noj mov
• Mob plab

Kev pom zoo: Pib nrog ib koob tshuaj tsawg thiab maj mam nce qhov koob tshuaj kom txo tau qhov tsis xis nyob hauv plab.

1.Black Box Ceeb Toom: Risk ntawm Thyroid hlav

Cov kev tshawb fawb tsiaj tau pom tias smegglutinin tuaj yeemnce qhov kev pheej hmoo ntawm medullary thyroid carcinoma. Cov neeg hauv qab no yuav tsumzam kiag licov tshuaj no:

• Cov neeg uas muaj tus kheej lossis tsev neeg keeb kwm ntawm medullary thyroid carcinoma
• Cov neeg uas muaj ntau yam endocrine neoplasia syndrome hom 2

2.Lwm yam contraindications:

Cev xeeb tub: Contraindicated, tej zaum yuav ua mob rau fetus; cov kev npaj cev xeeb tub yuav tsum tsis txhob siv yam tsawg kawg 2 lub hlis ua ntej.

Kev pub niam mis: Tsis pom zoo.

Hom 1 Ntshav Qab Zib: Tsis siv tau.

Severe Gastroparesis (hnyav qeeb plab plab khoob): Contraindicated.

3.Contraindications yuav tsum tau ceev faj:

• Cov neeg mob uas muaj keeb kwm ntawm pancreatitis
• Cov neeg mob uas mob raum tsis txaus
• Cov neeg mob uas muaj keeb kwm ntawm kev nyuaj siab lossis kev xav tua tus kheej
• Cov neeg mob ntshav qab zib retinopathy (tej zaum yuav ua rau cov tsos mob hnyav dua)

4. Cov tsos mob xwm txheej ceev uas yuav tsum tau txiav tam sim ntawd:

• Tam sim txiav kev siv thiab nrhiav kev kho mob yog tias muaj ib qho hauv qab no tshwm sim:
• Kev ua xua: pob khaus, ua pa nyuaj, lub ntsej muag / laryngeal o
• Pancreatitis: mob plab heev tawg mus rau sab nraub qaum, ntuav hnyav
• Cov teeb meem ntawm lub gallbladder: mob hnyav sab xis sab sauv, jaundice (daj ntawm daim tawv nqaij / dawb ntawm lub qhov muag), kub taub hau
• Cov tsos mob ntawm hypoglycemia: tsis meej pem, convulsions, syncope
• Kev puas tsuaj rau lub raum hnyav: txo cov zis tso zis, qis qis edema
• Cov tsos mob ntawm cov qog thyroid: caj dab loj, hoarseness, nqos nyuaj
• Suicidal ideation: tshiab los yog kev nyuaj siab zuj zus ntxiv / kev xav tua tus kheej

5. Kev sib cuam tshuam ntawm yeeb tshuaj:

-Tsis txhob siv nrog lwm tus GLP-1 receptor agonists.

Kev hloov tshuaj yuav tsum tau siv thaum siv ua ke nrog insulin lossis sulfonylureas los tiv thaiv kev mob ntshav qab zib ntau.

Qhia rau koj tus kws kho mob txog txhua yam tshuaj uas koj tab tom siv tam sim no (nrog rau cov tshuaj noj, tshaj -- tshuaj tiv thaiv, thiab tshuaj ntsuab npaj) ua ntej siv.