Brolucizumab
Jeneng merek: Beovu
Kelas obat:
Agen Antineoplastik
Panganggone Brolucizumab
Degenerasi Makula sing gegandhengan karo Umur Neovaskular
Pengobatan degenerasi makula sing gegandhengan karo umur (AMD) neovaskular (wet). Nalika diterbitake saben 8 utawa 12 minggu (gumantung saka penilaian klinis babagan kegiatan penyakit), Brolucizumab-dbll ora kalah karo aflibercept sing diwenehake saben 8 minggu kanggo nambah ketajaman visual lan nyegah mundhut sesanti.
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Carane nggunakake Brolucizumab
Administrasi
Administrasi Oftalmik
Injeksi intravitreal menyang mripat sing kena pengaruh. Mung dokter sing mumpuni sing kudu menehi obat kasebut.
Amarga risiko infeksi lan endophthalmitis, gunakake teknik aseptik sing tepat nalika nyiapake lan menehi obat kasebut. (Deleng Endophthalmitis lan Efek Okular Serius Liyane ing Ati-ati.)
Kasedhiya komersil ing vial siji-sijine sing ngemot 6 mg obat kanggo injeksi intravitreal. Sadurunge administrasi, ngidini vial teka ing suhu kamar. Solusi kasebut kudu katon bening nganti rada opalescent lan ora ana warna nganti kuning rada coklat; aja digunakake yen ngandhut partikel utawa katon mendhung utawa wernane pucet.
Busak kabeh isi vial liwat jarum saringan 5-µm, 18-gauge steril (disedhiyakake pabrikan) menyang jarum suntik 1-mL. Sabanjure, ganti jarum panyaring nganggo jarum 30-gauge, ½ inci sing steril kanggo injeksi intravitreal. Mbusak hawa saka syringe lan selarasake tip plunger menyang tandha 0,05 ml ing jarum suntik. Diwenehi langsung sawise persiapan.
Injeksi ing kahanan aseptik (kalebu nggunakake disinfeksi tangan bedah, sarung tangan steril, drape steril, spekulum kelopak mata steril [utawa sing padha], lan kasedhiyan peralatan paracentesis steril [yen dibutuhake]) anestesi sing nyukupi lan administrasi mikrobisida topikal spektrum sing amba kanggo disinfeksi kulit periokular, kelopak mata, lan permukaan okular.
Saben vial mung ditrapake kanggo perawatan mripat siji. Yen mripat kontralateral mbutuhake perawatan, gunakake vial anyar; Ganti lapangan steril, jarum suntik, sarung tangan, drape, spekulum kelopak mata, lan jarum filter lan injeksi sadurunge menehi brolucizumab ing mripat liyane. perfusi saka kepala saraf optik. (Waca Tambah Tekanan Intraokular ing Ati-ati.)
Dosis
Dewasa
Neovascular Age-related Macular Degeneration Ophthalmic6 mg (0,05 mL saka solusi sing ngemot 120 mg /mL) kanthi injeksi intravitreal menyang mripat sing kena pengaruh sapisan saben sasi (kira-kira saben 25-31 dina) kanggo 3 dosis pisanan, banjur 6 mg sapisan saben 8-12 minggu.
Ing pivotal uji klinis, 51-56% pasien nampa brolucizumab-dbll 6 mg saben 12 minggu saka wiwitan perawatan pangopènan nganti minggu 48, dene 39-45% pasien nampa jadwal dosis iki nganti minggu 96. Pilihan interval dosis (8 utawa 12 minggu) ing panliten kasebut adhedhasar penilaian klinis babagan kegiatan penyakit.
Populasi Khusus
Gangguan Hepatik
Ora ana panyesuaian dosis sing dibutuhake kanggo pasien sing duwe gangguan hepatik.
Gagal ginjal
Ora ana panyesuaian dosis sing dibutuhake kanggo pasien sing duwe gangguan ginjel.
Pasien Geriatri
Ora ana panyesuaian dosis ing pasien sing umure ≥65 taun.
Pènget
Kontraindikasi
Pènget/PanandhapEndophthalmitis lan Efek Okular Serius Liyane
Injeksi intravitreal, kalebu brolucizumab, sing ana gandhengane karo endophthalmitis lan ablasi retina. Tansah nggunakake teknik injeksi aseptik sing tepat nalika ngatur obat kasebut. (Deleng Administrasi Ophthalmic ing Dosis lan Administrasi.)
Atur gejala sing nuduhake endoftalmitis utawa detasemen retina kanthi tepat (contone, nyeri mripat, abang mata, fotofobia, penglihatan kabur). (Deleng Nasehat kanggo Pasien.)
Peningkatan Tekanan Intraokular
Peningkatan akut IOP diamati sajrone 30 menit sawise injeksi intravitreal, kalebu brolucizumab. Tambah terus-terusan ing IOP uga dilaporake. Monitor IOP lan perfusi sirah saraf optik lan atur kanthi tepat. (Deleng Administrasi Ophthalmic ing Dosis lan Administrasi.)
Kedadeyan Thromboembolic Arteri
Potensi risiko kedadeyan thromboembolic arteri (contone, stroke nonfatal, MI nonfatal, pati vaskular [kalebu kematian saka sabab sing ora dingerteni]) ing pasien sing nampa antagonis VEGF intravitreal. Ing studi fase 3 pivotal, kedadeyan tromboembolik arteri kacarita sajrone 96 minggu perawatan ing 4,5 utawa 4,7% pasien sing nampa brolucizumab-dbll utawa aflibercept.
Imunogenisitas
Antibodi anti-brolucizumab sing dideteksi ing sampel serum pretreatment ing 36-52% pasien naif perawatan; sawise miwiti terapi brolucizumab-dbll, antibodi anti-brolucizumab dideteksi ing ≥1 sampel serum ing 53-67% pasien. Peradangan intraokular diamati ing 6% pasien kanthi antibodi anti-brolucizumab sing dideteksi sajrone terapi. Potensi antibodi anti-brolucizumab mengaruhi khasiat utawa safety obat kasebut ora dingerteni.
Populasi Tertentu
KandhutanOra ana studi sing nyukupi lan dikontrol kanthi apik ing wanita ngandhut.
Adhedhasar mekanisme tumindak, bisa nyebabake perkembangan embriofetal utawa kapasitas reproduksi. Ing studi kewan, inhibisi VEGF nyebabake malformasi, resorpsi embriofetal, lan bobot janin sing mudhun lan uga kena pengaruh perkembangan folikel, fungsi korpus luteum, lan kesuburan.
Gunakake nalika meteng mung yen keuntungan potensial mbenerake risiko potensial kanggo janin. Wanita potensial reproduksi kudu nggunakake metode kontrasepsi sing efektif banget sajrone terapi lan ≥1 sasi sawise dosis pungkasan.
LaktasiOra dingerteni manawa brolucizumab nyebar menyang susu, mengaruhi bayi sing disusu, utawa mengaruhi produksi susu. .
Nyusoni ora dianjurake sajrone terapi brolucizumab lan kanggo ≥1 sasi sawise dosis pungkasan.
Panggunaan PediatrikKeamanan lan khasiat ora ditetepake ing pasien pediatrik.
Panggunaan GeriatrikKira-kira 90% pasien sing diobati brolucizumab-dbll ing uji klinis yaiku ≥65 taun lan 60% umur ≥75 taun; Ora ana bedane sing signifikan ing khasiat utawa safety sing diamati kanthi umur.
Ora ana pangaturan dosis sing dibutuhake ing pasien ≥65 taun.
Gangguan HepatikEfek gangguan hepatik ing farmakokinetik brolucizumab ora dingerteni.
Ora ana panyesuaian dosis sing dibutuhake kanggo pasien sing duwe gangguan hepatik amarga injeksi intravitreal brolucizumab ora bakal nyebabake paparan sistemik sing penting sacara klinis. 70 mL/menit) ora ngowahi farmakokinetik sistemik brolucizumab-dbll. Efek gagal ginjel abot ing farmakokinetik obat ora dingerteni.
Ora ana panyesuaian dosis sing dibutuhake kanggo pasien sing nandhang gagal ginjal amarga injeksi brolucizumab intravitreal ora bakal nyebabake paparan sistemik sing penting sacara klinis.
Efek Umum sing Sabar
Pandangan kabur, katarak, pendarahan konjungtiva, nyeri mata, floaters vitreous.
Apa obatan liyane bakal mengaruhi Brolucizumab
Ora ana studi interaksi obat resmi nganti saiki.
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