Multipl Sklerozda Oral Tedaviler
Özet
Multipl skleroz tedavisi için onaylanan oral ilaçlar; dimetil fumarat, fingolimod, teriflunomid ve kladribindir. Dimetil fumarat, fumarik asit esterlerinin bir bileşimidir. Dimetil fumarat, tüm lenfosit alt popülasyonlarının bileşimini değiştirir, en önemli azalmalar sitotoksik ve efektör T hücrelerinde görülür ve immün yanıtı proinflamatuar bir fenotipten önce antiinflamatuar bir fenotipe doğru kaydırır. Fingolimod sfingozin 1- fosfat reseptörünü modüle etmektedir. Böylece reseptörde internalizasyona ve degradasyona sebep olur. Bu durum otoreaktif T lenfositlerinin sekonder lenfoid organlarda lenf düğümlerini terk etme yeteneğini bozar. Teriflunomid, sitotoksisiteye neden olmadan B ve T hücrelerinin proliferasyonunu azaltır. Bu işlemi dihidroorotat dehidrogenazı inhibe ederek yapar. Kladribin, hücrelerde yüksek miktarda deoksisitidin kinaz ile fosforillenerek aktif formu olan 2-klorodeoksiadenozin-ATP’ye dönüşen ve nükleusta biriken bir purin nükleozididir. Bu durum, hücresel metabolizmanın bozulmasına, DNA hasarına ve hücre ölümüne neden olur. Bu bölümde, oral yol ile alınabilen MS terapötik ilaçlarının genel nitelikleri, temel etki mekanizmaları, klinik çalışmalar, doz-uygulama şekilleri, kontrendikasyonlar incelenmiştir.
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