Lemtrada – alemtuzumab

Lemtrada (Alemtuzumab)

Όπως αναφέρουμε και στην αρχική σελίδα μας για την Πολλαπλή Σκλήρυνση, τα πράγματα όσον αφορά τη θεραπεία της αλλάζουν με πολύ γρήγορους ρυθμούς. Ένα από τα τελευταία φάρμακα που έχει προστεθεί στη φαρέτρα του γιατρού είναι και η alemtuzumab ή όπως είναι γνωστή με την εμπορική της ονομασία: Lemtrada. Στην Ευρώπη και την Ελλάδα κυκλοφόρησε από το 2014 από την εταιρεία Genzyme/Sanofi.

Με ποιόν τρόπο δρά το Lemtrada

Η βασική φλεγμονή με την οποία ξεκινά κάθε ώση της Πολλαπλής Σκλήρυνσης οφείλεται στη τοξική δράση των Τ και Β λεμφοκυττάρων πάνω στα νευρικά κύτταρα. Αυτό που κάνει το Lemtrada είναι να εξαντλεί πλήρως (depletion) τα αποθέματα αυτών των κυττάρων στον οργανισμό ελαχιστοποιώντας με αυτόν τον τρόπο τις ώσεις της Πολλαπλής Σκλήρυνσης. Τα κύτταρα αυτά εξακολουθούν να παράγονται από τον οργάνισμό και μετά από μερικούς μήνες ώς ένα χρόνο ξαναφτάνουν στα φυσιολογικά επίπεδα (repopulation). Με τη διαφορά όμως ότι τα νέα Τ και Β λεμφοκύτταρα δεν έχουν την “κακή συνήθεια” να επιτίθενται στα νευρικά κύτταρα. Έτσι πετυχαίνουμε  όπως έχουν δείξει πολλές εργασίες πολύ μεγάλη μείωση ώς και σταμάτημα των ώσεων της Πολλαπλής Σκλήρυνσης για αρκετά χρόνια, σταμάτημα της προόδου -και μερικές φορές αναστροφή- της αναπηρίας του ασθενούς και μείωση των ρυθμών της εγκεφαλικής ατροφίας.

Πώς χορηγείται – Οι ιδιαιτερότητες του φαρμακου

Ο τρόπος χορήγησης του Lemtrada είναι ιδιαίτερος: Γίνεται η αρχική έγχυση του φαρμάκου με ορρό επί πέντε συνεχείς ημέρες, και η έγχυση αυτή επαναλαμβάνεται σε ένα χρόνο επί τρείς συνεχείς ημέρες.

Επειδή το φάρμακο εμφανίζει αρκετά συχνές και μερικές φορές σοβαρές ώς πολύ σοβαρές παρενέργειες παίρνονται πολλές προφυλάξεις, ώστε ο,τιδήποτε εμφανιστεί να αντιμετωπιστεί έγκαιρα.

  1. Η πρώτη σειρά των εγχύσεων γίνονται σε νοσοκομείο επί πέντε συνεχείς ημέρες και μάλιστα σε μονάδα που να διαθέτει όλα τα απαραίτητα για την αντιμετώπιση τυχόν παρενεργειών που μπορεί να παρατηρηθούν. Τέτοιες παρενέργειες μπορεί να είναι απλές και συνηθισμένες όπως ρίγη, μυαλγίες κεφαλαλγίες ενώ σε ένα μικρότερο ποσοσστό της τάξης του 3% μπορεί να  εμφανιστούν σοβαρότερες παρενέργειες οι οποίες όμως αντιμετωπίζονται.
  2. Ακολουθεί μια μεγάλη περίοδος ενός έτους κατά την οποία ο ασθενής δεν παίρνει καμμία θεραπεία αλλά κάνει τακτικούς ελέγχους αίματος, ούρων, θυρεοειδούς και δερματολογικούς.
  3. Ενα χρόνο μετά την πρώτη σειρά των εγχύσεων ακολουθεί δεύτερη σειρά εγχύσεων του φαρμάκου, αυτή τη φορά επί τρείς συνεχείς ημέρες, με τις ίδιες προφυλάξεις.
  4. Τέλος, μετά και την τελευταία έγχυση, επι 4 χρόνια ο ασθενής δεν παίρνει κανένα φάρμακο για τη νόσο του απλά υποβάλλεται σε τακτικό αιματολογικό και δερματολογικό έλεγχο.

 

Άν και η αλεμτουζουμάμπη έχει αποτελεσματικότητα που φαίνεται οτι υπερεχει από πολλά άλλα φαρμακα, εχουν αναφερθεί ορισμένες σοβαρες παρενέργειες από τη χρήση της:
– Αντιδράσεις που σχετίζονται με την έγχυση του φαρμάκου,
– Αύξηση του κινδύνου για λοιμώξεις,
– Αυτοάνοσες αντιδράσεις κυρίως από το θυρεοειδή.
– Πιό σπάνια αναφέρθηκαν αλλες αυτοάνοσες αντιδράσεις από το αίμα και από τα νεφρά.
Ολα αυτά μαζί με το γεγονός ότι το Lemtrada κυκλοφορεί για λιγα χρόνια δημιουργούν την ανάνγκη για αυστηρή παρακολουθηση όσων βρίσκονται στην αγωγή.
Alemtuzumab: a review of efficacy and risks in the treatment of relapsing remitting multiple sclerosis

Άλλα φάρμακα για την Πολλαπλή Σκλήρυνση:

 

 

Αναφορές

1. CARE MS-I (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61769-3/abstract), access date 6.1.2018
2. CARE MS-II (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61768-1/fulltext), access date 6.1.2018

 

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