Copaxone

Copaxone (Οξεική γκλατιραμέρη)

Σχεδόν με την ολοκλήρωση της πρώτης “φουρνιάς” των ιντερφερονών το 1996, ένα νέο μόριο ήρθε να προστεθεί σ’ αυτές: η οξεική γκλατιραμέρη (Glatiramer acetate). Το Copaxone μαζί με τις ιντερφερόνες μονοπώλησαν τη εξωνοσοκομειακή θεραπεία των ασθενών με πολλαπλή σκλήρυνση μέχρι την κυκλοφορία του πρώτου από του στόματος φαρμάκου για την Πολλαπλή Σκλήρυνση του Gilenya το 2010.glatiramermoleΕξαιρούνται βεβαίως δύο ενδονοσοκομειακές θεραπείες του Novantrone (2000) και του Tysabri (2004) οι οποίες εμφανίστηκαν στο μεσοδιάστημα.

To Copaxone είναι ένα πολυπεπτίδιο. Αποτελείται δηλαδή από αμινοξέα, συγκεκριμένα από 4 αμινοξέα, την λυσίνη, αλανίνη, τυροσίνη και το  γλουταμινικό οξύ σε διάφορους συνδυασμούς. Η θεραπευτική της δράση οφείλεται στο ότι προκαλούν τροποποίηση της αυτοάνοσης αντίδρασης που παρατηρείται στην Πολλαπλή Σκλήρυνση και αυτό αποδίδεται στην ιδιότητα που έχει η γκλατιραμέρη να τροποποιεί τα Τ-λεμφοκύτταρα. Η θεραπεία γίνεται με καθημερινές υποδόριες ενέσεις (1 ένεση κάθε μέρα).

Δεν υπήρχαν μελέτες που να έδειχναν καθαρά ότι η το Copaxone υπερτερεί έναντι των ιντερφερονών ούτε αδιαμφισβήτητα κριτήρια επιλογής της μιάς ή της άλλης θεραπείας.  Ετσι η επιλογή θεραπείας γινόταν με δευτερεύονται και τριτεύοντα κριτήρια. Πάντως η πεποίθηση της επιστημονικής κοινότητας σήμερα είναι ότι οι δύο θεραπείες είναι πρακτικά ισης αποτελεσματικότητας.

 

Τί πρέπει να προσέχουν όσοι κάνουν θεραπεία με Copaxone

Πρίν την έναρξη της θεραπείας
  • Καρδιολογικός έλεγχος, επειδή ορισμένες από τις παρενέργειες του φαρμάκουν μπορεί να μοιάζουν με συμπτώματα καρδιαγγειακής νόσου.
  • Τέστ εγκυμοσύνης, επειδή δεν έχει τεκμηριωθεί η ασφάλεια του φαρμάκου για το έμβρυο
Κατά τη θεραπεία: Τοπικές παρενέργειες
Είναι αρκετά συχνή μια τοπική ερυθρότητα (κοκίνισμα) στην περιοχή της ένεσης που υποχωρεί σε μερικές ώρες ή μια δερματική υπερευαισθησία στην περιοχή. Ενημερώνουμε το γιατρό σε περίπτωση που παρατηρηθούν στην περιοχή της ένεσης:

  • ατροφία του δέρματος
  • ψηλαφητή μάζα
  • δερματική αλλοίωση
Καρδιά - αναπνευστικό
Είναι δυνατόν να παρατηρηθούν, αμέσως μετά την ένεση είτε κάποιος πόνος στο στήθος, είτε ένα αίσθημα δυσφορίας, άγχους κλπ τα οποία υποχωρούν σε λίγη ώρα. Σε αντίθετη περίπτωση ενημερώνουμε το γιατρό μας
Αιματολογικά-θυρεοειδής
Το Copaxone προκαλεί αρκετά συχνά κάποιες αιματολογικές διαταραχές τις οποίες θα τις διαχειριστεί ο θεράπων ιατρός. Γι αυτό πρέπει να γίνονται τακτικές εξετάσεις αίματος.

Επίσης μπορεί να παρατηρηθεί λεμφαδενοπάθεια, δηλαδή διόγκωση κάποιων λεμφαδένων, συνήθως κοντά στις περιοχές των ενέσεων

Σπάνια μπορεί να προκληθούν διαταραχές της λειτουργίας του θυρεοειδή αδένα, γι αυτό χρειάζεται επίσης τακτικός ορμονικός έλεγχος (TSH)

Ανοσολογικές
Αρκετά συχνά επηρεάζεται ο αμυντικός μηχανισμός και μπορεί να έχουμε συχνές λοιμώξεις μικροβιακές ή ιογενείς. Σπανιώτερη είναι η εμφάνιση αποστημάτων

 

Σε όλα αυτά τα χρόνια της χρήσης του Copaxone έχει αποδειχτεί στην πράξη ότι (μαζί με τις ιντερφερόνες) είναι από τα πιό αθώα φάρμακα από όσα χρησιμοποιούνται στη θεραπεία της Πολλαπλής Σκλήρυνσης: έχει τις λιγότερες και λιγότερο σοβαρές παρενέργειες.Χαράλαμπος Καραγιαννίδης, Νευρολόγος Ψυχίατρος

Άλλα φάρμακα για την Πολλαπλή Σκλήρυνση:

 

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