{"id":29531,"date":"2021-02-18T11:17:45","date_gmt":"2021-02-18T04:17:45","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=29531"},"modified":"2025-01-08T08:41:04","modified_gmt":"2025-01-08T01:41:04","slug":"ribavirin-copegus","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/ribavirin-copegus\/","title":{"rendered":"Ribavirin &#8211; Copegus"},"content":{"rendered":"<p><em>Thu\u1ed1c Copegus l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Copegus (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;)<\/em><\/p>\n<p><strong>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: <\/strong><\/p>\n<p><strong><em>Ho\u1ea1t ch\u1ea5t :<\/em> <\/strong><a href=\"https:\/\/pharmog.com\/wp\/ribavirin\/\"><strong>Ribavirin<\/strong><\/a><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u1ed1c kh\u00e1ng virus.<\/em><\/p>\n<p><strong><em>Nh\u00f3m<\/em><\/strong> <strong><em>ph\u00e1p l\u00fd: <\/em><\/strong><em>Thu\u1ed1c k\u00ea \u0111\u01a1n ETC \u2013 (Ethical drugs, prescription drugs, Prescription only medicine)<\/em><\/p>\n<p><strong><em>M\u00e3 ATC<\/em><\/strong> (Anatomical Therapeutic Chemical): J05AB04, L03AB60.<\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c: <\/em><\/strong><a href=\"https:\/\/pharmog.com\/wp\/ribavirin-rebetol\/\">Rebetol<\/a><\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c:<\/em><\/strong> Copegus<\/p>\n<p><strong><em>H\u00e3ng s\u1ea3n xu\u1ea5t <\/em><\/strong>: Patheon Inc &#8211; Canada<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng: <\/strong><\/p>\n<p><strong><em>D\u1ea1ng thu\u1ed1c v\u00e0 h\u00e0m l\u01b0\u1ee3ng<\/em><\/strong><\/p>\n<p>Vi\u00ean n\u00e9n 200 mg<\/p>\n<p><strong><em>Thu\u1ed1c tham kh\u1ea3o:<\/em><\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong><em>COPEGUS<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><em>M\u1ed7i vi\u00ean n\u00e9n bao phim c\u00f3 ch\u1ee9a:<\/em><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Ribavirin<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>200 mg<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1 d\u01b0\u1ee3c<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>v\u1eeba \u0111\u1ee7 (Xem m\u1ee5c 6.1)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"357\" height=\"376\" class=\"wp-image-29532\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/02\/word-image-247.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/02\/word-image-247.png 357w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/02\/word-image-247-285x300.png 285w\" sizes=\"auto, (max-width: 357px) 100vw, 357px\" \/><\/p>\n<p><strong>3. Video by Pharmog:<\/strong><\/p>\n<p><strong>[VIDEO D\u01af\u1ee2C L\u00dd]<\/strong><\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p>\u25ba K\u1ecbch B\u1ea3n: PharmogTeam<\/p>\n<p>\u25ba Youtube: https:\/\/www.youtube.com\/c\/pharmog<\/p>\n<p>\u25ba Facebook: https:\/\/www.facebook.com\/pharmog\/<\/p>\n<p>\u25ba Group : H\u1ed9i nh\u1eefng ng\u01b0\u1eddi m\u00ea d\u01b0\u1ee3c l\u00fd<\/p>\n<p>\u25ba Instagram : https:\/\/www.instagram.com\/pharmogvn\/<\/p>\n<p>\u25ba Website: pharmog.com<\/p>\n<p><strong>4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng: <\/strong><\/p>\n<p><strong>4.1. Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Copegus \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a trong \u0111i\u1ec1u tr\u1ecb vi\u00eam gan C m\u1ea1n t\u00ednh \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh v\u00e0 nh\u1eefng ng\u01b0\u1eddi n\u00e0y c\u00f3 HCV-RNA huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh, bao g\u1ed3m c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan c\u00f2n b\u00f9.<\/p>\n<p>Tham kh\u1ea3o h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a \u0111\u1ec3 bi\u1ebft th\u00eam th\u00f4ng tin.<\/p>\n<p><strong>4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<\/strong><\/p>\n<p><strong><em>C\u00e1ch d\u00f9ng<\/em><\/strong> :<\/p>\n<p>D\u00f9ng theo \u0111\u01b0\u1eddng u\u1ed1ng: U\u1ed1ng ng\u00e0y 2 l\u1ea7n, kh\u00f4ng c\u1ea7n \u0111\u1ec3 \u00fd \u0111\u1ebfn b\u1eefa \u0103n, nh\u01b0ng thu\u1ed1c \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ed1t h\u01a1n n\u1ebfu u\u1ed1ng thu\u1ed1c sau b\u1eefa \u0103n nhi\u1ec1u ch\u1ea5t b\u00e9o.<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p>Copegus \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a. Li\u1ec1u ch\u00ednh x\u00e1c v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb ph\u1ee5 thu\u1ed9c v\u00e0o thu\u1ed1c interferon d\u00f9ng c\u00f9ng.<\/p>\n<p>Xin tham kh\u1ea3o ph\u1ea7n h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng c\u1ee7a peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a \u0111\u1ec3 bi\u1ebft th\u00eam th\u00f4ng tin v\u1ec1 li\u1ec1u v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb khi Copegus \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t trong hai thu\u1ed1c n\u00e0y.<\/p>\n<p><em>Ph\u1ed1i h\u1ee3p v\u1edbi Pegasys (peginterferon \u03b1-2a)<\/em><\/p>\n<p>Li\u1ec1u h\u00e0ng ng\u00e0y v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb c\u1ee7a Copegus ph\u1ed1i h\u1ee3p v\u1edbi Pegasys thay \u0111\u1ed5i t\u00f9y t\u1eebng c\u00e1 nh\u00e2n d\u1ef1a v\u00e0o ki\u1ec3u gen vi r\u00fat v\u00e0 c\u00e2n n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u00e2n (xem B\u1ea3ng 1). Li\u1ec1u h\u00e0ng ng\u00e0y c\u1ee7a Copegus \u0111\u01b0\u1ee3c chia l\u00e0m hai l\u1ea7n (s\u00e1ng v\u00e0 t\u1ed1i) u\u1ed1ng trong khi \u0103n.<\/p>\n<p><em>Vi\u00eam gan C m\u1ea1n<\/em><\/p>\n<p>B\u1ea3ng 1 Li\u1ec1u khuy\u1ebfn c\u00e1o c\u1ee7a Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a cho nh\u1eefng b\u1ec7nh nh\u00e2n HCV<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Ki\u1ec3u gen<\/strong><\/td>\n<td><strong>Li\u1ec1u Copegus d\u00f9ng h\u00e0ng ng\u00e0y<\/strong><\/td>\n<td><strong>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<td><strong>S\u1ed1 vi\u00ean 200mg<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 1, 4*<\/td>\n<td>&lt; 75 kg = 1000 mg<\/p>\n<p>\u2265 75 kg = 1200 mg<\/td>\n<td>48 tu\u1ea7n<\/p>\n<p>48 tu\u1ea7n<\/td>\n<td>5 (2 vi\u00ean bu\u1ed5i s\u00e1ng: 3 vi\u00ean bu\u1ed5i t\u1ed1i)<\/p>\n<p>6 (3 vi\u00ean bu\u1ed3i s\u00e1ng; 3 vi\u00ean bu\u1ed5i t\u1ed1i<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 2, 3<\/td>\n<td>800 mg (kh\u00f4ng t\u00ednh \u0111\u1ebfn c\u00e2n n\u1eb7ng)<\/td>\n<td>24 tu\u1ea7n<\/td>\n<td>4 (2 vi\u00ean bu\u1ed5i s\u00e1ng; 2 vi\u00ean bu\u1ed5i t\u1ed1i)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>*Nh\u00ecn chung, b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m ki\u1ec3u gen 4 \u0111\u01b0\u1ee3c xem l\u00e0 kh\u00f3 \u0111i\u1ec1u tr\u1ecb v\u00e0 s\u1ed1 li\u1ec7u nghi\u00ean c\u1ee9u h\u1ea1n ch\u1ebf (N=49) th\u00edch h\u1ee3p v\u1edbi li\u1ec1u l\u01b0\u1ee3ng nh\u01b0 nh\u00f3m ki\u1ec3u gen 1.<\/p>\n<p><em>\u0110\u1ed3ng Nhi\u1ec5m HIV &#8211; HCV<\/em><\/p>\n<p>Li\u1ec1u khuy\u1ebfn c\u00e1o c\u1ee7a Copegus, ph\u1ed1i h\u1ee3p v\u1edbi 180 mcg peginterferon \u03b1-2a l\u00e0 800 mg ribavirin d\u00f9ng h\u00e0ng ng\u00e0y trong 48 tu\u1ea7n, kh\u00f4ng t\u00ednh \u0111\u1ebfn ki\u1ec3u gen. T\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi Copegus li\u1ec1u l\u1edbn h\u01a1n 800 mg d\u00f9ng h\u00e0ng ng\u00e0y ho\u1eb7c th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi 48 tu\u1ea7n ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u.<\/p>\n<p>C\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc t\u00ednh \u0111\u00e1p \u1ee9ng v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/p>\n<p>\u0110\u00e1p \u1ee9ng vi r\u00fat s\u1edbm v\u00e0o kho\u1ea3ng tu\u1ea7n 12, x\u00e1c \u0111\u1ecbnh b\u1eb1ng l\u01b0\u1ee3ng vi r\u00fat gi\u1ea3m 2log ho\u1eb7c l\u01b0\u1ee3ng HCV RNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u00e3 cho th\u1ea5y c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng b\u1ec1n v\u1eefng (xem B\u1ea3ng 2)<\/p>\n<p>B\u1ea3ng 2. Gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n \u0111\u00e1p \u1ee9ng vi r\u00fat v\u00e0o tu\u1ea7n 12 t\u1ea1i li\u1ec1u khuy\u1ebfn c\u00e1o khi Copegus d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi Pegasys \u1edf b\u1ec7nh nh\u00e2n HCV<\/p>\n<table>\n<tbody>\n<tr>\n<td rowspan=\"2\"><strong>Ki\u1ec3u gen<\/strong><\/td>\n<td colspan=\"3\"><strong>\u00c2m t\u00ednh<\/strong><\/td>\n<td colspan=\"3\"><strong>D\u01b0\u01a1ng t\u00ednh<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u00e0o tu\u1ea7n 12<\/strong><\/td>\n<td><strong>\u0110\u00e1p \u1ee9ng kh\u00f4ng b\u1ec1n v\u1eefng<\/strong><\/td>\n<td><strong>Gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc<\/strong><\/td>\n<td><strong>\u0110\u00e1p \u1ee9ng v\u00e0o tu\u1ea7n 12<\/strong><\/td>\n<td><strong>\u0110\u00e1p \u1ee9ng b\u1ebfn v\u1eefng<\/strong><\/td>\n<td><strong>Gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 1 (N=569)<\/td>\n<td>102<\/td>\n<td>97<\/td>\n<td>95% (97\/102)<\/td>\n<td>467<\/td>\n<td>271<\/td>\n<td>58% (271\/467)<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 2 v\u00e0 3<\/p>\n<p>(N=96)<\/td>\n<td>3<\/td>\n<td>3<\/td>\n<td>100% (3\/3)<\/td>\n<td>93<\/td>\n<td>81<\/td>\n<td>87% (81\/93)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n \u00e2m t\u00ednh t\u01b0\u01a1ng t\u1ef1 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f9ng nhi\u1ec5m HIV-HCV \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi \u0111\u01a1n tr\u1ecb li\u1ec7u peginterferon \u03b1-2a ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi Copegus l\u00e0 (100% (130\/130) ho\u1eb7c 98% (83\/85), theo th\u1ee9 t\u1ef1. Gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n d\u01b0\u01a1ng t\u00ednh l\u00e0 45% (50\/110) v\u00e0 70% (59\/84) \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV ki\u1ec3u gen 1 v\u00e0 ki\u1ec3u gen 2\/3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p.<\/p>\n<p><em>Ph\u1ed1i h\u1ee3p v\u1edbi Roferon-4 (lmterferon \u03b1-2a)<\/em><\/p>\n<p>Li\u1ec1u khuy\u1ebfn c\u00e1o c\u1ee7a Copegus ph\u1ed1i h\u1ee3p v\u1edbi dung d\u1ecbch ti\u00eam interferon \u03b1-2a ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n (xem b\u1ea3ng 3).<\/p>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p v\u1edbi interferon \u03b1-2a trong \u00edt nh\u1ea5t 6 th\u00e1ng. B\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m HCV ki\u1ec3u gen n\u00ean d\u00f9ng li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p trong 48 tu\u1ea7n, B\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m HCV c\u1ee7a ki\u1ec3u gen kh\u00e1c, quy\u1ebft \u0111\u1ecbnh k\u00e9o d\u00e0i li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1edbi 48 tu\u1ea7n n\u00ean d\u1ef1a v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng kh\u00e1c (nh\u01b0 l\u01b0\u1ee3ng vi r\u00fat cao t\u1ea1i th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u, nam gi\u1edbi, tu\u1ed5i &gt; 40 v\u00e0 b\u1eb1ng ch\u1ee9ng c\u1ee7a s\u1ef1 x\u01a1 h\u00f3a c\u1ea7u n\u1ed1i).<\/p>\n<p>B\u1ea3ng 3. Li\u1ec1u khuy\u1ebfn c\u00e1o Copegus d\u00f9ng ph\u1ed1i h\u1ee3p v\u00e9i interferon \u03b1-2a \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HCV<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>C\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n (kg)<\/strong><\/td>\n<td><strong>Li\u1ec1u h\u00e0ng ng\u00e0y Copegus<\/strong><\/td>\n<td><strong>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<td><strong>S\u1ed1 vi\u00ean 200mg<\/strong><\/td>\n<\/tr>\n<tr>\n<td>&lt;75<\/td>\n<td>1000 mg<\/td>\n<td>24 ho\u1eb7c 48 tu\u1ea7n<\/td>\n<td>5 (2 vi\u00e9n bu\u1ed5i s\u1ea3ng, 3 vi\u00ean bu\u1ed5i t\u1ed1i)<\/td>\n<\/tr>\n<tr>\n<td>\u226575<\/td>\n<td>1200 mg<\/td>\n<td>24 ho\u1eb7c 48 tu\u1ea7n<\/td>\n<td>6 (3 vi\u00ean bu\u1ed5i s\u1ea3ng, 3 vi\u00ean bu\u1ed5i t\u1ed1i)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>C\u00c1C H\u01af\u1edaNG D\u1eaaN LI\u1ec0U D\u00d9NG \u0110\u1eb6C BI\u1ec6T<\/p>\n<p><em>\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u khi g\u1eb7p c\u00e1c ph\u1ea3n \u1ee9ng ngo\u1ea1i \u00fd<\/em><\/p>\n<p>Tham kh\u1ea3o t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c c\u1ee7a peginterferon \u03b1-2a hoac interferon \u03b1-2a \u0111\u1ec3 bi\u1ebft th\u00eam th\u00f4ng tin v\u1ec1 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u v\u00e0 vi\u1ec7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb c\u1ee7a hai thu\u1ed1c n\u00e0y.<\/p>\n<p>N\u1ebfu xu\u1ea5t hi\u1ec7n c\u00e1c ph\u1ea3n \u1ee9ng ngo\u1ea1i \u00fd n\u1eb7ng ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi Copegus v\u00e0 peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u c\u1ee7a t\u1eebng s\u1ea3n ph\u1ea9m cho \u0111\u1ebfn khi kh\u00f4ng c\u00f2n c\u00e1c ph\u1ea3n \u1ee9ng ngo\u1ea1i \u00fd. N\u1ebfu v\u1eabn c\u00f2n t\u00ecnh tr\u1ea1ng kh\u00f4ng dung n\u1ea1p sau khi \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u c\u1ee7a Copegus, vi\u1ec7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 c\u1ea7n thi\u1ebft.<\/p>\n<p>\u0110\u1ec3 ki\u1ec3m so\u00e1t hi\u1ec7n t\u01b0\u1ee3ng thi\u1ebfu m\u00e1u do \u0111i\u1ec1u tr\u1ecb, c\u00e1c h\u01b0\u1edfng d\u1eabn sau \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (xem b\u1ea3ng 4).<\/p>\n<p>B\u1ea3ng 4. H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u Copegus trong vi\u1ec7c ki\u1ec3m so\u00e1t hi\u1ec7n t\u01b0\u1ee3ng thi\u1ebfu m\u00e1u do \u0111i\u1ec1u tr\u1ecb<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>C\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m<\/strong><\/td>\n<td><strong>Gi\u1ea3m li\u1ec1u Copegus xu\u1ed1ng c\u00f2n 600mg\/ng\u00e0y* ch\u1ec9 n\u1ebfu nh\u01b0:<\/strong><\/td>\n<td><strong>Ng\u1eebng \u0111i\u1ec1u tr\u1ecb Copegus n\u1ebfu nh\u01b0**<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Hemoglobin: B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh tim m\u1ea1ch<\/td>\n<td>&lt; 10 g\/dl<\/td>\n<td>&lt; 8,5 g\/dl<\/td>\n<\/tr>\n<tr>\n<td>Hemoglobin: B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch \u1ed5n \u0111\u1ecbnh<\/td>\n<td>&gt;2 g\/dl hemoglobin gi\u1ea3m trong b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o k\u00e9o d\u00e0i 4 tu\u1ea7n trong khi \u0111i\u1ec1u tr\u1ecb (gi\u1ea3m li\u1ec1u th\u01b0\u1eddng xuy\u00ean)<\/td>\n<td>&lt; 12 g\/dl sau 4 tu\u1ea7n gi\u1ea3m li\u1ec1u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>* Li\u1ec1u Copegus c\u1ee7a b\u1ec7nh nh\u00e2n gi\u1ea3m xu\u1ed1ng c\u00f2n 600 mg d\u00f9ng h\u00e0ng ng\u00e0y, u\u1ed1ng m\u1ed9t vi\u00ean 200 mg v\u00e0o bu\u1ed5i s\u00e1ng v\u00e0 hai vi\u00ean 200 mg v\u00e0o bu\u1ed5i t\u1ed1i.<\/p>\n<p>* * N\u1ebfu c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m xu\u1ea5t hi\u1ec7n tr\u1edf l\u1ea1i, Copegus c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u l\u1ea1i v\u1edbi 600 mg m\u1ed7i ng\u00e0y, v\u00e0 t\u0103ng t\u1edbi 800 mg m\u1ed7i ng\u00e0y v\u1edbi s\u1ef1 th\u1eadn tr\u1ecdng c\u1ee7a b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, kh\u00f4ng khuy\u1ebfn c\u00e1o tr\u1edf l\u1ea1i li\u1ec1u cao h\u01a1n.<\/p>\n<p>Tham kh\u1ea3o h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng c\u1ee7a peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a \u0111\u1ec3 bi\u1ebft th\u00eam th\u00f4ng tin.<\/p>\n<p><strong>4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng Copegus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n qu\u00e1 m\u1eabn c\u1ea3m v\u1edbi ribavirin ho\u1eb7c v\u1edbi b\u1ea5t k\u1ef3 t\u00e1 d\u01b0\u1ee3c n\u00e0o.<\/p>\n<p>Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng Copegus \u1edf nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c nam gi\u1edbi c\u00f3 b\u1ea1n t\u00ecnh \u0111ang mang thai.<\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng Copegus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh hemoglobin (v\u00ed d\u1ee5 b\u1ec7nh thalassemia, b\u1ec7nh thi\u1ebfu m\u00e1u h\u00ecnh li\u1ec1m).<\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Pegasys v\u00e0 Copegus \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh gan m\u1ea5t b\u00f9.<\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh Pegasys \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV b\u1ecb x\u01a1 gan c\u00f3 \u0111i\u1ec3m Child-Pugh \u2265 6 ngo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p t\u0103ng bilirubin gi\u00e1n ti\u1ebfp huy\u1ebft thanh do thu\u1ed1c nh\u01b0 atazanavir v\u00e0 indinavir (Tham kh\u1ea3o th\u00f4ng tin s\u1ea3n ph\u1ea9m c\u1ee7a Pegasys \u0111\u1ec3 bi\u1ebft thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 Child-Pugh).<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.4 Th\u1eadn tr\u1ecdng:<\/strong><\/p>\n<p><em>Th\u1eadn tr\u1ecdng chung<\/em><\/p>\n<p>D\u1ef1a v\u00e0o k\u1ebft qu\u1ea3 t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, d\u00f9ng ribavirin \u0111\u01a1n \u0111\u1ed9c kh\u00f4ng hi\u1ec7u qu\u1ea3 v\u00e0 do \u0111\u00f3 Copegus kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb li\u1ec7u.<\/p>\n<p>Copegus trong ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng theo h\u01b0\u1edbng d\u1eabn c\u1ee7a b\u00e1c s\u0129 \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n chuy\u00ean m\u00f4n v\u00e0 c\u00f3 kinh nghi\u1ec7m trong vi\u1ec7c gi\u1ea3m li\u1ec1u do ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng, ng\u1eebng thu\u1ed1c t\u1ea1m th\u1eddi ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 chuy\u1ec3n sang ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb kh\u00e1c.<\/p>\n<p><em>Nguy c\u01a1 sinh qu\u00e1i thai:<\/em> Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi Copegus, b\u00e1c s\u0129 ph\u1ea3i th\u00f4ng tin m\u1ed9t c\u00e1ch \u0111\u1ea7y \u0111\u1ee7 cho b\u1ec7nh nh\u00e2n nguy c\u01a1 g\u00e2y qu\u00e1i thai c\u1ee7a ribavirin, s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a bi\u1ec7n ph\u00e1p ng\u1eeba thai li\u00ean t\u1ee5c v\u00e0 hi\u1ec7u qu\u1ea3, kh\u1ea3 n\u0103ng c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p ch\u1ed1ng thai c\u00f3 th\u1ec3 th\u1ea5t b\u1ea1i v\u00e0 h\u1eadu qu\u1ea3 c\u00f3 thai c\u00f3 th\u1ec3 x\u1ea3y ra trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi ribavirin (xem ph\u1ea7n 2.5.1).<\/p>\n<p><em>Qu\u00e1 m\u1eabn c\u1ea3m c\u1ea5p:<\/em> N\u1ebfu x\u1ea3y ra ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn c\u1ea5p (v\u00ed d\u1ee5 m\u1ec1 \u0111ay, ph\u00f9 m\u1ea1ch, co th\u1eaft ph\u1ebf qu\u1ea3n, ph\u1ea3n v\u1ec7), ph\u1ea3i d\u1eebng Copegus ngay l\u1eadp t\u1ee9c v\u00e0 c\u00f3 nh\u1eefng bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ph\u00e1t ban tho\u00e1ng qua kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><em>H\u1ec7 tim m\u1ea1ch v\u00e0 m\u00e1u:<\/em> N\u1ebfu nh\u01b0 c\u00f3 b\u1ea5t k\u00ec s\u1ef1 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 hemoglobin m\u00e1u, n\u00ean t\u1ea1m ng\u1eebng ho\u1eb7c ng\u1eebng d\u00f9ng Copegus (xem B\u1ea3ng 1). M\u1eb7c d\u00f9 ribavirin kh\u00f4ng t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp l\u00ean h\u1ec7 tim m\u1ea1ch, thi\u1ebfu m\u00e1u do Copegus c\u00f3 th\u1ec3 g\u00e2y ra gi\u1ea3m ch\u1ee9c n\u0103ng tim, ho\u1eb7c l\u00e0m n\u1eb7ng th\u00eam tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh m\u1ea1ch v\u00e0nh, ho\u1eb7c c\u1ea3 hai. V\u00ec v\u1eady, n\u00ean d\u00f9ng Copegus th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c b\u1ec7nh n\u1eb7ng \u0111\u00e3 c\u00f3 t\u1eeb tr\u01b0\u1edbc. C\u1ea7n \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng tim m\u1ea1ch tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i l\u00e2m s\u00e0ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. N\u1ebfu tim m\u1ea1ch x\u1ea5u \u0111i, c\u1ea7n ng\u1eebng \u0111i\u1ec1u tr\u1ecb ribavirin. Khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ea5t th\u01b0\u1eddng tim m\u1ea1ch n\u00ean \u0111\u01b0\u1ee3c l\u00e0m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 tr\u01b0\u1edbc v\u00e0 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p Copegus v\u00e0 peginterferon \u03b1-2a cho b\u1ec7nh nh\u00e2n vi\u00eam gan si\u00eau vi C m\u1ea1n \u0111\u00e3 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3, kh\u00f4ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u00ec c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i v\u1ec1 huy\u1ebft h\u1ecdc. B\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c nh\u1eafc c\u1ea9n th\u1eadn c\u00e1c nguy c\u01a1 so v\u1edbi l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng l\u1ea1i thu\u1ed1c.<\/p>\n<p>Thi\u1ebfu m\u00e1u do suy t\u1ee7y (gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u1ea3 3 d\u00f2ng h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u) v\u00e0 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng x\u1ea3y ra trong kho\u1ea3ng 3 \u0111\u1ebfn 7 tu\u1ea7n sau khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ribavirin v\u00e0 azathioprine \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong y v\u0103n. T\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c t\u1ee7y x\u01b0\u01a1ng h\u1ed3i ph\u1ee5c trong kho\u1ea3ng 4 \u0111\u1ebfn 6 tu\u1ea7n khi ng\u1eebng \u0111\u1ed3ng th\u1eddi li\u1ec7u ph\u00e1p kh\u00e1ng virut HCV v\u00e0 azathioprine v\u00e0 kh\u00f4ng l\u1eb7p l\u1ea1i khi s\u1eed d\u1ee5ng l\u1ea1i 1 trong 2 \u0111i\u1ec1u tr\u1ecb n\u00f3i tr\u00ean.<\/p>\n<p><em>Ng\u01b0\u1eddi nh\u1eadn t\u1ea1ng gh\u00e9p:<\/em> T\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb Pegasys v\u00e0 Copegus ch\u01b0a \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p gan hay c\u00e1c t\u1ea1ng kh\u00e1c. T\u01b0\u01a1ng t\u1ef1 c\u00e1c interferon alpha kh\u00e1c, s\u1ef1 lo\u1ea1i b\u1ecf m\u1ea3nh gh\u00e9p gan v\u00e0 th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi \u0111i\u1ec1u tr\u1ecb Pegasys \u0111\u01a1n tr\u1ecb hay ph\u1ed1i h\u1ee3p v\u1edbi Copegus.<\/p>\n<p><em>Ch\u1ee9c n\u0103ng gan<\/em>: Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1eb1ng ch\u1ee9ng gan m\u00e1t b\u00f9 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a.<\/p>\n<p><em>Suy th\u1eadn<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin b\u1ecb thay \u0111\u1ed5i \u1edf b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn do gi\u1ea3m thanh th\u1ea3i thu\u1ed1c tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. Khuy\u1ebfn c\u00e1o \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng Copegus. D\u1ef1a tr\u00ean m\u00f4 h\u00ecnh d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 m\u00f4 ph\u1ecfng, khuy\u1ebfn c\u00e1o hi\u1ec7u ch\u1ec9nh li\u1ec1u tr\u00ean b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn r\u00f5 r\u1ec7t.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 thanh th\u1ea3i creatinin nh\u1ecf h\u01a1n ho\u1eb7c b\u1eb1ng 50 mL\/ph\u00fat n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd khi d\u00f9ng Copegus.<\/p>\n<p><em>C\u00e1c x\u00e9t nghi\u1ec7m<\/em><\/p>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft h\u1ecdc chu\u1ea9n v\u00e0 sinh h\u00f3a m\u00e1u (c\u00f4ng th\u1ee9c m\u00e1u to\u00e0n b\u1ed9 [CBC] v\u00e0 bi\u1ec7t h\u00f3a s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u, \u0111i\u1ec7n gi\u1ea3i, creatinin huy\u1ebft thanh, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan, acid uric) c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb Copegus. n\u00ean l\u00e0m l\u1ea1i c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 sau 2 ho\u1eb7c 4 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ecbnh k\u1ef3 sau \u0111\u00f3 t\u00f9y theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng. C\u00e1c gi\u00e1 tr\u1ecb x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u ch\u1ea5p nh\u1eadn bao g\u1ed3m tr\u01b0\u1edbc khi d\u00f9ng Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a bao g\u1ed3m:<\/p>\n<p>Hemoglobin \u2265 12 g\/dl (n\u1eef); 2 13 g\/dl (nam).<\/p>\n<p>Ti\u1ec3u c\u1ea7u \u2265 90 000\/mm3.<\/p>\n<p>L\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh \u2265 1 500\/mm3.<\/p>\n<p>V\u1edbi b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV: CD4+ \u2265 200\/1 ho\u1eb7c CD4+ \u2265 100\/ul &#8211; &lt; 200\/ul v\u00e0 HIV-1 RNA &lt; 5000 phi\u00ean b\u1ea3n \/ml s\u1eed d\u1ee5ng th\u1eed nghi\u1ec7m theo d\u00f5i HIV-1 Amplicor, v 1.5.<\/p>\n<p><em>Cho nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 kh\u1ea3 n\u0103ng mang thai<\/em>: B\u1ec7nh nh\u00e2n n\u1eef ph\u1ea3i l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m th\u1eed thai \u0111\u1ec1u \u0111\u1eb7n h\u00e0ng th\u00e1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 trong 6 th\u00e1ng sau \u0111\u00f3. B\u1ea1n t\u00ecnh c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n nam ph\u1ea3i l\u00e0m th\u1eed nghi\u1ec7m th\u1eed thai h\u00e0ng th\u00e1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 6 th\u00e1ng sau \u0111\u00f3.<\/p>\n<p><em>T\u0103ng tr\u01b0\u1edfng v\u00e0 ph\u00e1t tri\u1ec3n (b\u1ec7nh nhi)<\/em><\/p>\n<p>Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Pegasysk\u1ebft h\u1ee3p v\u1edbi ribavirin k\u00e9o d\u00e0i \u0111\u1ebfn 48 tu\u1ea7n tr\u00ean b\u1ec7nh nh\u00e2n t\u1eeb 5 \u0111\u1ebfn 17 tu\u1ed5i, th\u01b0\u1eddng g\u1eb7p hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m c\u00e2n v\u00e0 \u1ee9c ch\u1ebf t\u0103ng tr\u01b0\u1edfng.<\/p>\n<p>T\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb, 16% b\u1ec7nh nhi c\u00f3 c\u00e2n n\u1eb7ng th\u1ea5p h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb so v\u1edbi \u0111\u01b0\u1eddng cong t\u0103ng tr\u01b0\u1edfng ban \u0111\u1ea7u, 11% b\u1ec7nh nhi c\u00f3 chi\u1ec1u cao th\u1ea5p h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb so v\u1edbi \u0111\u01b0\u1eddng cong chi\u1ec1u cao ban \u0111\u1ea7u.<\/p>\n<p>T\u1ea1i th\u1eddi \u0111i\u1ec3m 5 \u0111\u1ebfn 6 n\u0103m sau \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nhi c\u00f3 b\u00e1ch ph\u00e2n v\u1ecb gi\u1ea3m 15% so v\u1edbi ban \u0111\u1ea7u t\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 h\u1ed3i ph\u1ee5c v\u1ec1 m\u1ee9c b\u00e1ch ph\u00e2n v\u1ecb chi\u1ec1u cao nh\u01b0 ban \u0111\u1ea7u ho\u1eb7c m\u1ed9t y\u1ebfu t\u1ed1 g\u00e2y \u1ea3nh h\u01b0\u1edfng kh\u00e1c kh\u00f4ng li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. D\u1eef li\u1ec7u theo d\u00f5i d\u00e0i h\u1ea1n cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Pegasys v\u1edbi ribavirin d\u01b0\u1eddng nh\u01b0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn s\u1ef1 \u1ee9c ch\u1ebf l\u00e2u d\u00e0i s\u1ef1 t\u0103ng tr\u01b0\u1edfng \u1edf tr\u1ebb em. Trong t\u1eebng tr\u01b0\u1eddng h\u1ee3p, c\u00e1c l\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb d\u1ef1 ki\u1ebfn n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc th\u1eadn tr\u1ecdng so v\u1edbi t\u00ednh an to\u00e0n d\u1ef1a tr\u00ean d\u1eef li\u1ec7u \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/p>\n<p>\u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n c\u00e2n nh\u1eafc l\u00e0 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p c\u00f3 g\u00e2y ra s\u1ef1 \u1ee9c ch\u1ebf t\u0103ng tr\u01b0\u1edfng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Nguy c\u01a1 n\u00e0y n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc, v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh c\u1ee7a tr\u1ebb, nh\u01b0 b\u1eb1ng ch\u1ee9ngv\u1ec1 su ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh (\u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh l\u00fd x\u01a1 h\u00f3a), c\u00e1c b\u1ec7nh l\u00fd m\u1eafc k\u00e8m theo c\u00f3 \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn ti\u1ebfn tri\u1ec3n b\u1ec7nh c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng dapimg (genotype HCV v\u00e0 t\u1ea3i l\u01b0\u1ee3ng virus).<\/p>\n<p><em>L\u1ea1m d\u1ee5ng v\u00e0 ph\u1ee5 thu\u1ed9c thu\u1ed1c<\/em><\/p>\n<p>Kh\u00f4ng c\u00f3 th\u00f4ng tin.<\/p>\n<p><em>X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/em><\/p>\n<p>Tham kh\u1ea3o m\u1ee5c (C\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng, Th\u1eadn tr\u1ecdng chung).<\/p>\n<p>D\u00d9NG THU\u1ed0C \u1ede NH\u1eeeNG \u0110\u1ed0I T\u01af\u1ee2NG \u0110\u1eb6C BI\u1ec6T<\/p>\n<p><em>D\u00f9ng thu\u1ed1c \u1edf tr\u1ebb em<\/em><\/p>\n<p>T\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a ribavirin khi d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a v\u00e0 interferon \u03b1-2a \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1. \u0110i\u1ec1u tr\u1ecb v\u1edbi Copegus kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho d\u00f9ng \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean d\u01b0\u1edbi 18 tu\u1ed5i.<\/p>\n<p><em>D\u00f9ng thu\u1ed1c \u1edf ng\u01b0\u1eddi gi\u00e0<\/em><\/p>\n<p>Tu\u1ed5i t\u00e1c d\u01b0\u1eddng nh\u01b0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin. Tuy nhi\u00ean, t\u01b0\u01a1ng t\u1ef1 nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb h\u01a1n, n\u00ean ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn cho b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi d\u00f9ng Copegus.<\/p>\n<p><em>\u1ede b\u1ec7nh nh\u00e2n suy th\u1eadn<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin thay \u0111\u1ed5i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn do gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i r\u00f5 r\u00e0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. Do \u0111\u00f3, khuy\u1ebfn c\u00e1o \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng Copegus, t\u1ed1t nh\u1ea5t l\u00e0 \u0111\u00e1nh gi\u00e1 th\u00f4ng qua \u0111\u1ed9 thanh th\u1ea3i creatinin c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>B\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ee9c \u0111\u1ed9 trung b\u00ecnh ho\u1eb7c n\u1eb7ng (\u0111\u1ed9 thanh th\u1ea3i creatinin &lt;50 mL\/ph\u00fat) kh\u00f4ng l\u1ecdc m\u00e1u \u0111\u1ecbnh k\u1ef3 kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c m\u1ee9c li\u1ec1u h\u00e0ng ng\u00e0y t\u01b0\u01a1ng \u1ee9ng l\u00e0 600 mg v\u00e0 400 mg c\u1ee7a Copegus v\u00e0 c\u00f3 n\u1ed3ng \u0111\u1ed9 ribavirin trong huy\u1ebft t\u01b0\u01a1ng cao h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng (\u0111\u1ed9 thanh th\u1ea3i creatinin &gt;80 mL\/ph\u00fat) sau khi d\u00f9ng li\u1ec1u chu\u1ea9n c\u1ee7a Copegus.<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i (ESRD) ph\u1ea3i l\u1ecdc m\u00e1u \u0111\u1ecbnh k\u1ef3, h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y ph\u1ea3i d\u00f9ng c\u00e1c y\u1ebfu t\u1ed1 k\u00edch th\u00edch h\u1ec7 t\u1ea1o m\u00e1u, Copegus \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n \u1edf m\u1ee9c li\u1ec1u 200 mg h\u00e0ng ng\u00e0y.<\/p>\n<p>Trong nghi\u00ean c\u1ee9u n\u00e0y, b\u1ec7nh nh\u00e2n ESRD \u0111\u01b0\u1ee3c l\u1ecdc m\u00e1u \u0111\u1ecbnh k\u1ef3 d\u00f9ng ribavirin v\u1edbi li\u1ec1u h\u00e0ng ng\u00e0y 200 mg c\u00f3 n\u1ed3ng \u0111\u1ed9 ribavirin trong huy\u1ebft t\u01b0\u01a1ng th\u1ea5p h\u01a1n kho\u1ea3ng 20% so v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng sau khi d\u00f9ng Copegus h\u00e0ng ng\u00e0y v\u1edbi li\u1ec1u chu\u1ea9n 1000\/1200 mg.<\/p>\n<p><em>\u1ede b\u1ec7nh nh\u00e2n suy gan<\/em><\/p>\n<p>Kh\u00f4ng c\u00f3 t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc gi\u1eefa ribavirin v\u00e0 ch\u1ee9c n\u0103ng gan. V\u00ec v\u1eady, kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u Copegus \u1edf b\u1ec7nh nh\u00e2n b\u1ecb suy gan. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan m\u1ea5t b\u00f9.<\/p>\n<p><strong>T\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c tr\u00ean ng\u01b0\u1eddi l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/strong><\/p>\n<p>Copegus kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 \u1ea3nh h\u01b0\u1edfng kh\u00f4ng \u0111\u00e1ng k\u1ec3 l\u00ean kh\u1ea3 n\u0103ng l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c; tuy nhi\u00ean, interferon \u03b1-2a ho\u1eb7c peginterferon \u03b1-2a s\u1eed d\u1ee5ng k\u00eat h\u1ee3p c\u00f3 th\u00ea c\u00f3 t\u00e1c \u0111\u1ed9ng n\u00e0y. Do \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 m\u1ec7t, bu\u1ed3n ng\u1ee7, ho\u1eb7c l\u1eabn l\u1ed9n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea7n ch\u00fa \u00fd tr\u00e1nh l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/p>\n<p><strong>4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/strong><\/p>\n<p><em>X\u1ebfp h\u1ea1ng c\u1ea3nh b\u00e1o<\/em><\/p>\n<p>AU TGA pregnancy category: X<\/p>\n<p>US FDA pregnancy category: X<\/p>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>Copegus kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng m\u00e0 b\u1ea1n t\u00ecnh c\u1ee7a h\u1ecd \u0111ang mang thai.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u \u0111\u1ed9ng v\u1eadt tr\u00ean th\u1ef1c nghi\u1ec7m cho th\u1ea5y \u0111\u1ed9c t\u00ednh tr\u00ean sinh s\u1ea3n. Nguy c\u01a1 cho ph\u00f4i v\u00e0\/ho\u1eb7c g\u00e2y qu\u00e1i thai \u0111\u01b0\u1ee3c ch\u1ee9ng minh cho ribavirin \u1edf t\u1ea5t c\u1ea3 c\u00e1c lo\u00e0i \u0111\u1ed9ng v\u1eadt trong nh\u1eefng nghi\u00ean c\u1ee9u th\u00edch h\u1ee3p, x\u1ea3y ra \u1edf li\u1ec1u th\u1ea5p h\u01a1n li\u1ec1u d\u00f9ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf ng\u01b0\u1eddi. Nh\u1eefng b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u01b0\u01a1ng s\u1ecd, v\u00f2m mi\u1ec7ng, m\u1eaft, h\u00e0m, ch\u00e2n tay, khung x\u01b0\u01a1ng, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn. T\u1ec9 l\u1ec7 v\u00e0 \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a nh\u1eefng t\u00e1c \u0111\u1ed9ng g\u00e2y qu\u00e1i thai t\u0103ng c\u00f9ng v\u1edbi s\u1ef1 t\u0103ng li\u1ec1u c\u1ee7a ribavirin. S\u1ef1 s\u1ed1ng c\u1ee7a ph\u00f4i v\u00e0 thai gi\u1ea3m.<\/p>\n<p>C\u1ea7n ph\u1ea3i quan t\u00e2m \u0111\u1ec3 tr\u00e1nh mang thai \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eef. Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng Copegus cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m th\u1eed thai \u00e2m t\u00ednh tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Do b\u1ea5t c\u1ee9 bi\u1ec7n ph\u00e1p ph\u00f2ng tr\u00e1nh thai n\u00e0o c\u0169ng c\u00f3 th\u1ec3 th\u1ea5t b\u1ea1i n\u00ean r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 kh\u1ea3 n\u0103ng mang thai v\u00e0 nh\u1eefng b\u1ea1n t\u00ecnh c\u1ee7a h\u1ecd ph\u1ea3i s\u1eed d\u1ee5ng c\u00f9ng m\u1ed9t l\u00fac hai h\u00ecnh th\u1ee9c tr\u00e1nh thai c\u00f3 hi\u1ec7u qu\u1ea3, trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 trong 6 th\u00e1ng sau \u0111i\u1ec1u tr\u1ecb; c\u00e1c x\u00e9t nghi\u1ec7m th\u1eed thai ph\u1ea3i l\u00e0m \u0111\u1ec1u \u0111\u1eb7n h\u00e0ng th\u00e1ng trong th\u1eddi gian n\u00e0y.<\/p>\n<p>N\u1ebfu mang thai trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ho\u1eb7c trong v\u00f2ng 6 th\u00e1ng sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u1ec1 nguy c\u01a1 cao c\u1ee7a ribavirin g\u00e2y qu\u00e1i thai cho ph\u00f4i.<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n nam v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ea1n t\u00ecnh c\u1ee7a h\u1ecd: C\u1ea7n l\u01b0u \u00fd \u0111\u1ec3 tr\u00e1nh mang thai cho nh\u1eefng b\u1ea1n t\u00ecnh c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n nam \u0111ang d\u00f9ng Copegus. Ribavirin t\u00edch l\u0169y trong t\u1ebf b\u00e0o v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i kh\u1ecfi c\u01a1 th\u1ec3 r\u1ea5t ch\u1eadm.<\/p>\n<p>Trong nh\u1eefng nghi\u00ean c\u1ee9u \u1edf \u0111\u1ed9ng v\u1eadt, ribavirin l\u00e0m thay \u0111\u1ed5i tinh d\u1ecbch t\u1ea1i li\u1ec1u th\u1ea5p h\u01a1n li\u1ec1u l\u00e2m s\u00e0ng. Hi\u1ec7n kh\u00f4ng r\u00f5 li\u1ec7u ribavirin c\u00f3 trong tinh d\u1ecbch s\u1ebd g\u00e2y nh\u1eefng t\u00e1c \u0111\u1ed9ng qu\u00e1i thai \u0111\u00e3 bi\u1ebft sau khi th\u1ee5 tinh v\u1edbi tr\u1ee9ng. V\u00ec v\u1eady, ph\u1ea3i h\u01b0\u1edbng d\u1eabn cho nh\u1eefng b\u1ec7nh nh\u00e2n nam s\u1eed d\u1ee5ng bao cao su \u0111\u1ec3 truy\u1ec1n t\u1ed1i thi\u1ec3u ribavirin cho ng\u01b0\u1eddi b\u1ea1n t\u00ecnh c\u1ee7a h\u1ecd.<\/p>\n<p>B\u1ec7nh nh\u00e2n nam v\u00e0 b\u1ea1n t\u00ecnh c\u1ee7a h\u1ecd \u1edf l\u1ee9a tu\u1ed5i sinh s\u1ea3n c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n s\u1eed d\u1ee5ng hai bi\u1ec7n ph\u00e1p tr\u00e1nh thai trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi Copegus v\u00e0 trong v\u00f2ng 6 th\u00e1ng sau khi \u0111i\u1ec1u tr\u1ecb. Ng\u01b0\u1eddi ph\u1ee5 n\u1eef ph\u1ea3i c\u00f3 x\u00e9t nghi\u1ec7m th\u1eed thai \u00e2m t\u00ednh tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Ng\u01b0\u1eddi ta v\u1eabn ch\u01b0a bi\u1ebft li\u1ec7u Copegus c\u00f3 ti\u1ebft qua s\u1eefa m\u1eb9 kh\u00f4ng. Do \u0111\u00f3 c\u00f3 th\u1ec3 c\u00f3 c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i \u1edf tr\u1ebb b\u00fa m\u1eb9, n\u00ean quy\u1ebft \u0111\u1ecbnh ng\u1eebng cho b\u00fa ho\u1eb7c kh\u00f4ng d\u00f9ng thu\u1ed1c.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<\/strong><\/p>\n<p>Th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 b\u1ea5t k\u00ec t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o li\u00ean quan \u0111\u1ebfn vi\u1ec7c d\u00f9ng thu\u1ed1c.<\/p>\n<p><em>C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/em><\/p>\n<p>Lo\u1ea1i v\u00e0 t\u1ea7n su\u1ea5t c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 trong ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p ph\u00f9 h\u1ee3p v\u1edbi t\u00e0i li\u1ec7u v\u1ec1 \u0111\u1ed9 an to\u00e0n \u0111\u01b0\u1ee3c bi\u1ebft c\u1ee7a interferon \u03b1-2a ho\u1eb7c peginterferon \u03b1-2a v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111i k\u00e8m v\u1edbi ribavirin.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn b\u1ecb vi\u00eam gan C m\u1ea1n t\u00ednh<\/em><\/p>\n<p>So s\u00e1nh \u0111i\u1ec1u tr\u1ecb v\u1edbi Copegus 1000\/1200 mg v\u00e0 peginterferon \u03b1-2a 180mcg v\u1edbi th\u1eddi gian k\u00e9o d\u00e0i t\u1edbi 48 tu\u1ea7n, li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb gi\u1ea3m xu\u1ed1ng c\u00f2n 24 tu\u1ea7n v\u00e0 li\u1ec1u Copegus xu\u00f4ng c\u00f2n 800 mg \u0111\u00e3 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng (11% so v\u1edbi 3%), t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n m\u1eafc ph\u1ea3i ng\u1eebng thu\u1ed1c s\u1edbm v\u00ec l\u00fd do an to\u00e0n(13% so v\u1edbi 5%), v\u00e0 t\u1ef7 l\u1ec7 ph\u1ea3i thay \u0111\u1ed5i li\u1ec1u c\u1ee7a Copegus (39% so v\u1edbi 19%).<\/p>\n<p><em>B\u1ec7nh nh\u00e2n tr\u1ebb em b\u1ec9 vi\u00eam gan C m\u1ea1n t\u00ednh<\/em><\/p>\n<p>Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean 114 b\u1ec7nh nhi (t\u1eeb 5 \u0111\u1ebfn 17 tu\u1ed5i) \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Pegasys \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi ribavirin, kho\u1ea3ng 1\/3 b\u1ec7nh nhi \u0111\u00e3 c\u1ea7n ph\u1ea3i thay \u0111\u1ed5i li\u1ec1u, ch\u1ee7 y\u1ebfu do gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 thi\u1ebfu m\u00e1u.<\/p>\n<p>Nh\u00ecn chung, d\u1eef li\u1ec7u v\u1ec1 \u0111\u1ed9 an to\u00e0n c\u1ee7a thu\u1ed1c ghi nh\u1eadn tr\u00ean b\u1ec7nh nhi t\u01b0\u01a1ng t\u1ef1 tr\u00ean b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn. Trong nghi\u00ean c\u1ee9u nhi khoa, c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i th\u01b0\u1eddng g\u1eb7p nh\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ribavirin v\u00e0 Pegasys trong th\u1eddi gian l\u00ean t\u1edbi 48 tu\u1ea7n bao g\u1ed3m h\u1ed9i ch\u1ee9ng gi\u1ea3 c\u00fam (91%), nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean (60%), \u0111au \u0111\u1ea7u (64%), r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a (56%), r\u1ed1i lo\u1ea1n da (47%) v\u00e0 ph\u1ea3n \u1ee9ng t\u1ea1i v\u1ecb tr\u00ed ti\u00eam (45%). B\u1ea3y b\u1ec7nh nh\u00e2n d\u00f9ng k\u1ebft h\u1ee3p ribavirin v\u00e0 Pegasys trong 48 tu\u1ea7n ph\u1ea3i d\u1eebng \u0111i\u1ec1u tr\u1ecb v\u00ec l\u00fd do an to\u00e0n (tr\u1ea7m c\u1ea3m, \u0111\u00e1nh gi\u00e1 t\u00e2m th\u1ea7n kh\u00f4ng b\u00ecnh th\u01b0\u1eddng, m\u00f9 tho\u00e1ng qua, xu\u1ea5t ti\u1ebft v\u00f5ng m\u1ea1c, t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tip 1 v\u00e0 thi\u1ebfu m\u00e1u). H\u1ea7u h\u1ebft c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c ghi nh\u1eadn trong nghi\u00ean c\u1ee9u n\u00e0y \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh. C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng \u0111\u01b0\u1ee3c ghi nh\u1eadn tr\u00ean 2 b\u1ec7nh nh\u00e2n trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ribavirin v\u00e0 Pegasys (t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u1eaft b\u1ecf t\u00fai m\u1eadt).<\/p>\n<p><em>\u1ee8c ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y tr\u00ean b\u1ec7nh nhi (xem m\u1ee5c c\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng).<\/em><\/p>\n<p>B\u1ec7nh nhi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Pegasys k\u1ebft h\u1ee3p ribavirin cho th\u1ea5y ch\u1eadm t\u0103ng tr\u01b0\u1edfng v\u1ec1 th\u1ec3 tr\u1ecdng v\u00e0 chi\u1ec1u cao so v\u1edbi ban \u0111\u1ea7u sau 48 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. Ch\u1ec9 s\u1ed1 z-scores v\u1ec1 th\u1ec3 tr\u1ecdng v\u00e0 chi\u1ec1u cao theo tu\u1ed5i c\u0169ng nh\u01b0 b\u00e1ch ph\u1eadn v\u1ecb th\u1ec3 tr\u1ecdng v\u00e0 chi\u1ec1u cao c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec1u gi\u1ea3m so v\u1edbi chu\u1ea9n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. T\u1ea1i th\u1eddi \u0111i\u1ec3m k\u1ebft th\u00fac 2 n\u0103m theo d\u00f5i sau \u0111i\u1ec1u tr\u1ecb, h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 b\u00e1ch ph\u00e2n v\u1ecb tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng nh\u01b0 ban \u0111\u1ea7u \u0111\u1ed1i v\u1edbi c\u00e2n n\u1eb7ng (trung b\u00ecnh 64 b\u00e1ch ph\u00e2n v\u1ecb t\u1ea1i th\u1eddi \u0111i\u1ec3m ban d\u1ea7u, trung b\u00ecnh 60 b\u00e1ch ph\u00e2n v\u1ecb t\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb) v\u00e0 chi\u1ec1u cao (trung b\u00ecnh 54 b\u00e1ch ph\u00e2n v\u1ecb t\u1ea1i th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u, trung b\u00ecnh 56 b\u00e1ch ph\u00e2n v\u1ecb t\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb). Khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb , 43% (23 trong t\u1ed5ng s\u1ed1 53 b\u1ec7nh nh\u00e2n) gi\u1ea3m h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb th\u1ec3 tr\u1ecdng v\u00e0 25% (13 trong t\u1ed5ng s\u1ed1 53 b\u1ec7nh nh\u00e2n) gi\u1ea3m h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb chi\u1ec1u cao so v\u1edbi \u0111\u01b0\u1eddng cong t\u0103ng tr\u01b0\u1edfng b\u00ecnh th\u01b0\u1eddng. T\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb, 16% (6 tr\u00ean 38 b\u1ec7nh nh\u00e2n) c\u00f3 b\u00e1ch ph\u00e2n v\u1ecb c\u00e2n n\u1eb7ng gi\u1ea3m h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb so v\u1edbi \u0111\u01b0\u1eddng cong th\u1ec3 tr\u1ecdng ban \u0111\u1ea7u v\u00e0 11% (4 tr\u00ean 38 b\u1ec7nh nh\u00e2n) c\u00f3 chi\u1ec1u cao gi\u1ea3m h\u01a1n 15 b\u00e1ch ph\u00e2n v\u1ecb so v\u1edbi \u0111\u01b0\u1eddng cong chi\u1ec1u cao ban \u0111\u1ea7u.<\/p>\n<p>55% (21 tr\u00ean 38 b\u1ec7nh nh\u00e2n) \u0111\u00e3 ho\u00e0n th\u00e0nh nghi\u00ean c\u1ee9u ban \u0111\u1ea7u tham gia v\u00e0o qu\u00e1 tr\u00ecnh theo d\u00f5i d\u00e0i h\u1ea1n k\u00e9o d\u00e0i t\u1edbi 6 n\u0103m sau \u0111i\u1ec1u tr\u1ecb. Nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y s\u1ef1 ph\u1ee5c h\u1ed3i t\u0103ng tr\u01b0\u1edfng t\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec cho \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m sau 6 n\u0103m. M\u1ed9t s\u1ed1 it b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 gi\u1ea3m d\u01b0\u1edbi 15 b\u00e1ch ph\u00e2n v\u1ecb chi\u1ec1u cao so v\u1edbi ban \u0111\u1ea7u t\u1ea1i th\u1eddi \u0111i\u1ec3m 2 n\u0103m sau \u0111i\u1ec1u tr\u1ecb, \u0111\u00e3 h\u1ed3i ph\u1ee5c b\u00e1ch ph\u00e2n v\u1ecb chi\u1ec1u cao t\u01b0\u01a1ng \u0111\u01b0\u01a1ng ban \u0111\u1ea7u \u1edf giai \u0111o\u1ea1n 6 n\u0103m sau \u0111i\u1ec1u tr\u1ecb ho\u1eb7c m\u1ed9t y\u1ebfu t\u1ed1 g\u00e2y anh h\u01b0\u1edfng kh\u00e1c kh\u00f4ng li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. Nh\u00ecn chung, \u0111\u1eef li\u1ec7u theo d\u00f5i d\u00e0i h\u1ea1n cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Pegasys k\u1ebft h\u1ee3p v\u1edbi ribavirin d\u01b0\u1eddng nh\u01b0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u1ee9c ch\u1ebf l\u00e2u d\u00e0i t\u0103ng tr\u01b0\u1edfng \u1edf tr\u1ebb em.<\/p>\n<p>B\u1ea3ng 5 Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i v\u1edbi t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n \u2265 5% tr\u00ean b\u1ec7nh nhi.<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>H\u1ec7 c\u01a1 quan<\/strong><\/td>\n<td><strong>PEG-IFN \u03b1-2a 180 mcg x BSA\/1.73m<sup>2<\/sup><\/strong><\/p>\n<p><strong>+ ribavirin 15 mg\/kg<\/strong><\/p>\n<p><strong>48 tu\u1ea7n (NV17424)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><strong>N=55<\/strong><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><strong>%<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u1ea1i v\u1ecb tr\u00ed ti\u00eam thu\u1ed1c<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>H\u1ed9i ch\u1ee9ng gi\u1ea3 c\u00fam<\/td>\n<td>91<\/td>\n<\/tr>\n<tr>\n<td>Ph\u1ea3n \u1ee9ng t\u1ea1i v\u1ecb tr\u00ed vi\u00eam<\/td>\n<td>45<\/td>\n<\/tr>\n<tr>\n<td>Kh\u00f3 ch\u1ecbu<\/td>\n<td>33<\/td>\n<\/tr>\n<tr>\n<td>M\u1ec7t m\u1ecfi<\/td>\n<td>29<\/td>\n<\/tr>\n<tr>\n<td>Bi\u1ebfn ch\u1ee9ng do thi\u1ebft b\u1ecb y t\u1ebf<\/td>\n<td>20<\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1t<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td>T\u1ee5 m\u00e1u t\u1ea1i v\u00f9ng l\u1ea5y ven<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u0110au \u0111\u1ea7u<\/td>\n<td>64<\/td>\n<\/tr>\n<tr>\n<td>Ch\u00f3ng m\u1eb7t<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td><strong>Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/td>\n<td>60<\/td>\n<\/tr>\n<tr>\n<td>Nhi\u1ec5m tr\u00f9ng tai<\/td>\n<td>18<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam xoang<\/td>\n<td>18<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u<\/td>\n<td>9<\/td>\n<\/tr>\n<tr>\n<td>\u00c1p &#8211; xe r\u0103ng<\/td>\n<td>7<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam d\u1ea1 d\u00e0y ru\u1ed9t do vi r\u00fat<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/td>\n<td>56<\/td>\n<\/tr>\n<tr>\n<td>\u0110au th\u01b0\u1ee3ng v\u1ecb<\/td>\n<td>7<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1o b\u00f3n<\/td>\n<td>7<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam d\u1ea1 d\u00e0y<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td>N\u00f4n<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>R\u1ed1i lo\u1ea1n da<\/td>\n<td>47<\/td>\n<\/tr>\n<tr>\n<td>Ban \u0111\u1ecf<\/td>\n<td>20<\/td>\n<\/tr>\n<tr>\n<td>Ng\u1ee9a<\/td>\n<td>15<\/td>\n<\/tr>\n<tr>\n<td>R\u1ee5ng t\u00f3c<\/td>\n<td>11<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n x\u01b0\u01a1ng, c\u01a1 x\u01b0\u01a1ng v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u0110au c\u01a1 x\u01b0\u01a1ng<\/td>\n<td>36<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, l\u1ed3ng ng\u1ef1c v\u00e0 trung trung th\u1ea5t<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Ch\u1ea3y m\u00e1u cam<\/td>\n<td>15<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 dinh d\u01b0\u1ee1ng<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m c\u1ea3m gi\u00e1c ngon mi\u1ec7ng<\/td>\n<td>13<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>M\u1ea5t ng\u1ee7<\/td>\n<td>13<\/td>\n<\/tr>\n<tr>\n<td>Tr\u1ea7m c\u1ea3m<\/td>\n<td>7<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n v\u00e0 tuy\u1ebfn v\u00fa<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u0110au b\u1ee5ng kinh<\/td>\n<td>7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>K\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 v\u1ec1 \u0111\u1ed9 an to\u00e0n \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn tr\u00ean b\u1ec7nh nhi \u0111i\u1ec1u tr\u1ecb trong 48 tu\u1ea7n v\u1edbi Pegasys \u0111\u01a1n tr\u1ecb li\u1ec7u ho\u1eb7c Pegasys \u0111\u01a1n tr\u1ecb li\u1ec7u tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng virus h\u1ecdc \u1edf m\u1ee9c \u0111\u1ed9 kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c vi r\u00fat trong m\u00e1u sau 24 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00eam 48 tu\u1ea7n b\u1eb1ng ribavirin k\u1ebft h\u1ee3p v\u1edbi Pegasys.<\/p>\n<p>Hi\u1ec7n kh\u00f4ng c\u00f3 c\u00e1c d\u1eef li\u1ec7u tr\u00ean b\u1ec7nh nhi c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb vi\u00eam gan C m\u1ea1n t\u00ednh tr\u00ean b\u00eanh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u00ed tr\u01b0\u1edbc \u0111\u00f3.<\/em><\/p>\n<p>Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng interferon \u03b1-2b pegylat h\u00f3a\/ribavirin trong v\u00f2ng 72 v\u00e0 48 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3, t\u1ef7 l\u1ec7 ph\u1ea3i d\u1eebng \u0111i\u1ec1u tri b\u1eb1ng peginterferon \u03b1-2a l\u00e0 12% v\u00e0 Copegus l\u00e0 13% do c\u00e1c bi\u1ebfn c\u00f3 b\u1ea5t l\u1ee3i ho\u1eb7c c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb trong 72 tu\u1ea7n. \u1ede nh\u00f3m \u0111i\u1ec1u tr\u1ecb trong 48 tu\u1ea7n t\u1ef7 l\u1ec7 ph\u1ea3i ng\u1eebng \u0111i\u1ec1u tr\u1ecb peginterferon \u03b1-2a ho\u1eb7c Copegus t\u01b0\u01a1ng \u1ee9ng l\u00e0 6% v\u00e0 7%. K\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c t\u01b0\u01a1ng t\u1ef1 tr\u00ean b\u1ec7nh nh\u00e2n x\u01a1 gan v\u1edbi t\u1ef7 l\u1ec7 ng\u1eebng \u0111i\u1ec1u tr\u1ecb peginterferon \u03b1-2a v\u00e0 Copegus cao h\u01a1n \u1edf nh\u00f3m \u0111i\u1ec1u tr\u1ecb trong th\u1eddi gian 72 tu\u1ea7n 324 v\u00e0 15%) so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb 48 tu\u1ea7n (6% v\u00e0 6%). B\u1ec7nh nh\u00e2n ph\u1ea3i d\u1eebng \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 do \u0111\u1ed9c t\u00ednh tr\u00ean huy\u1ebft h\u1ecdc \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb kh\u00f4ng tham gia th\u1eed nghi\u1ec7m n\u00e0y.<\/p>\n<p>Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng kh\u00e1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n x\u01a1 gan ho\u1eb7c x\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n (\u0111i\u1ec3m Ishak t\u1eeb 3 \u0111\u1ebfn 6) kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3, c\u00f3 s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u ban \u0111\u1ea7u d\u01b0\u1edbi 50,000\/mm3 v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong 48 tu\u1ea7n. Do t\u1ef7 l\u1ec7 cao c\u00f3 x\u01a1 gan\/x\u01a1 h\u00f3a ti\u1ebfn tri\u1ec3n v\u00e0 s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u ban \u0111\u1ea7u th\u1ea5p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n trong nghi\u00ean c\u1ee9u n\u00e0y, t\u1ef7 l\u1ec7 x\u00e9t nghi\u1ec7m m\u00e1u b\u1ea5t th\u01b0\u1eddng trong 20 tu\u1ea7n \u0111\u1ea7u c\u1ee7a th\u1eed nghi\u1ec7m nh\u01b0 sau: hemoglobin &lt;10 g\/dL, 26,3%; b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh &lt;750\/ mm3,30%; v\u00e0 ti\u1ec3u c\u1ea7u &lt;50,000\/mm3, 13% (xem m\u1ee5c 2.4 C\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng).<\/p>\n<p><em>\u0110\u1ed3ng nhi\u1ec5m HIV-HCV.<\/em><\/p>\n<p>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV, c\u00e1c bi\u1ebfn c\u1ed1 l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o li\u00ean quan \u0111\u1ebfn peginterferon \u03b1-2a, \u0111\u01a1n thu\u1ea7n ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi Copegus, t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c bi\u1ebfn c\u00f3 l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ec9 nhi\u1ec5m HCV. S\u1ed1 li\u1ec7u v\u1ec1 \u0111\u1ed9 an to\u00e0n c\u00f2n \u00edt \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o CD4+ &lt; 200\/\u00b5l (N=51). Trong nghi\u00ean c\u1ee9u NR 15961, t\u1ec9 l\u1ec7 ng\u1eebng \u0111i\u1ec1u tr\u1ecb v\u00ec c\u00e1c bi\u1ebfn c\u1ed1 l\u00e2m s\u00e0ng b\u1ea5t l\u1ee3i, k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 AIDS l\u00e0 16% khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng peginterferon \u03b1-2a \u0111\u01a1n thu\u1ea7n, v\u00e0 15% khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng peginterferon \u03b1-2a k\u1ebft h\u1ee3p v\u1edbi Copegus 800mg, trong 48 tu\u1ea7n. T\u01b0\u01a1ng \u1ee9ng 4% ho\u1eb7c 3% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u ng\u1eebng peginterferon \u03b1-2a ho\u1eb7c peginterferon \u03b1-2a\/ Copegus do c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng. \u1ede ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p, s\u1ef1 thay \u0111\u1ed5i li\u1ec1u peginterferon \u03b1-2a x\u1ea3y ra \u1edf 39%, thay \u0111\u1ed5i li\u1ec1u<\/p>\n<p>Copegus x\u1ea3y ra \u1edf 37% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m. C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 21% v\u00e0 17% s\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u01a1n tr\u1ecb li\u1ec7u peginterferon \u03b1-2a ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi Copegus.<\/p>\n<p>Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9a peginterferon \u03b1-2a g\u00e2y gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i t\u1ebf b\u00e0o CD4+ trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb m\u00e0 kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 ph\u1ea7n tr\u0103m t\u1ebf b\u00e0o CD4+. L\u01b0\u1ee3ng t\u1ebf b\u00e0o CD4+ \u0111\u00e3 tr\u1edf v\u1ec1 gi\u00e1 tr\u1ecb ban \u0111\u1ea7u trong giai \u0111o\u1ea1n sau c\u1ee7a nghi\u00ean c\u1ee9u. Ph\u00e1c \u0111\u1ed3 ch\u00ednh peginterferon \u03b1 &#8211; 2a kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i r\u00f5 r\u1ec7t l\u00ean s\u1ef1 ki\u1ec3m so\u00e1t t\u1ea3i l\u01b0\u1ee3ng vi r\u00fat HIV trong m\u00e1u trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ho\u1eb7c sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>B\u1ea3ng 6 cho th\u1ea5y nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0y x\u1ea3y ra \u2265 10% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HCV, c\u0169ng nh\u01b0 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV, \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb Copegus k\u1ebft h\u1ee3p v\u1edbi peginterferon \u03b1-2a \u1edf c\u00e1c li\u1ec1u kh\u00e1c nhau.<\/p>\n<p>Nh\u1eefng bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng ribavirin ph\u1ed1i h\u1ee3p v\u1edbi interferon alpha ch\u1ee7 y\u1ebfu gi\u1ed1ng nh\u01b0 c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o cho tr\u01b0\u1eddng h\u1ee3p Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a.<\/p>\n<p>B\u1ea3ng 6: C\u00e1c ph\u1ea3n \u1ee9ng ngo\u1ea1i \u00fd (T\u1ec9 l\u1ec7 \u2265 10%).<\/p>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td colspan=\"3\"><strong><br \/>\nHCV<\/strong><\/td>\n<td colspan=\"2\"><strong>HIV-HCV<\/strong><\/td>\n<td><strong>HCV Peginterferon \u03b1-2B<\/strong><\/p>\n<p><strong>Kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>\u00a0<\/strong><\/td>\n<td><strong>Copegus 800 mg + Peginterferon \u03b1-2a 180 mcg (NV15492) 24 tu\u1ea7n N= 207<\/strong><\/td>\n<td><strong>Copegus 1000 mg ho\u1eb7c 1200 mg + Peginterferon \u03b1-2a 180 mcg<\/strong><\/p>\n<p><strong>(NV15801 + NV15942) 48 tu\u1ea7n N=887<\/strong><\/td>\n<td colspan=\"2\"><strong>Copegus 800 mg + Peginterferon \u03b1-2a 180 mcg (NR15961) 48 tu\u1ea7n N=288<\/strong><\/td>\n<td colspan=\"2\"><strong>Copegus 1000 mg ho\u1eb7c 1200 mg + Peginterferon \u03b1-2a 180 mcg (NV17150) 72 tu\u1ea7n N= 156<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>H\u1ec7 th\u1ed1ng c\u01a1 th\u1ec3<\/strong><\/td>\n<td><strong>%<\/strong><\/td>\n<td><strong>%<\/strong><\/td>\n<td colspan=\"2\"><strong>%<\/strong><\/td>\n<td colspan=\"2\"><strong>%<\/strong><\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng v\u00e0 chuy\u00ean h\u00f3a<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>Ch\u00e1n \u0103n<\/td>\n<td>20%<\/td>\n<td>27%<\/td>\n<td colspan=\"2\">23%<\/td>\n<td colspan=\"2\">15%<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m c\u00e2n<\/td>\n<td>2%<\/td>\n<td>7%<\/td>\n<td colspan=\"2\">16%<\/td>\n<td colspan=\"2\">9%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 t\u00e2m th\u1ea7n<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>M\u1ea5t ng\u1ee7<\/td>\n<td>30%<\/td>\n<td>32%<\/td>\n<td colspan=\"2\">19%<\/td>\n<td colspan=\"2\">29%<\/td>\n<\/tr>\n<tr>\n<td>D\u1ec5 b\u1ecb k\u00edch th\u00edch<\/td>\n<td>28%<\/td>\n<td>24%<\/td>\n<td colspan=\"2\">15%<\/td>\n<td colspan=\"2\">17%<\/td>\n<\/tr>\n<tr>\n<td>Tr\u1ea7m c\u1ea3m<\/td>\n<td>17%<\/td>\n<td>21%<\/td>\n<td colspan=\"2\">22%<\/td>\n<td colspan=\"2\">16%<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m \u0111\u1ed9 t\u1eadp trung<\/td>\n<td>8%<\/td>\n<td>10%<\/td>\n<td colspan=\"2\">2%<\/td>\n<td colspan=\"2\">5%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>\u0110au \u0111\u1ea7u<\/td>\n<td>48%<\/td>\n<td>47%<\/td>\n<td colspan=\"2\">35%<\/td>\n<td colspan=\"2\">32%<\/td>\n<\/tr>\n<tr>\n<td>Ch\u00f3ng m\u1eb7t<\/td>\n<td>13%<\/td>\n<td>15%<\/td>\n<td colspan=\"2\">7%<\/td>\n<td colspan=\"2\">10%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>Kh\u00f3 th\u1edf<\/td>\n<td>11%<\/td>\n<td>13%<\/td>\n<td colspan=\"2\">7%<\/td>\n<td colspan=\"2\">11%<\/td>\n<\/tr>\n<tr>\n<td>Ho<\/td>\n<td>8%<\/td>\n<td>13%<\/td>\n<td colspan=\"2\">3%<\/td>\n<td colspan=\"2\">17%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>Bu\u1ed3n n\u00f4n<\/td>\n<td>29%<\/td>\n<td>28%<\/td>\n<td colspan=\"2\">24%<\/td>\n<td colspan=\"2\">24%<\/td>\n<\/tr>\n<tr>\n<td>\u1ec8a ch\u1ea3y<\/td>\n<td>15%<\/td>\n<td>14%<\/td>\n<td colspan=\"2\">16%<\/td>\n<td colspan=\"2\">13%<\/td>\n<\/tr>\n<tr>\n<td>\u0110au b\u1ee5ng<\/td>\n<td>9%<\/td>\n<td>10%<\/td>\n<td colspan=\"2\">7%<\/td>\n<td colspan=\"2\">9%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>R\u1ee5ng t\u00f3c<\/td>\n<td>25%<\/td>\n<td>24%<\/td>\n<td colspan=\"2\">10%<\/td>\n<td colspan=\"2\">18%<\/td>\n<\/tr>\n<tr>\n<td>Ng\u1ee9a<\/td>\n<td>25%<\/td>\n<td>21%<\/td>\n<td colspan=\"2\">5%<\/td>\n<td colspan=\"2\">22%<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam da<\/td>\n<td>15%<\/td>\n<td>16%<\/td>\n<td colspan=\"2\">1%<\/td>\n<td colspan=\"2\">1%<\/td>\n<\/tr>\n<tr>\n<td>Da kh\u00f4<\/td>\n<td>13%<\/td>\n<td>12%<\/td>\n<td colspan=\"2\">4%<\/td>\n<td colspan=\"2\">17%<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 c\u01a1 x\u01b0\u01a1ng kh\u1edbp, m\u00f4 li\u00ean k\u1ebft v\u00e0 x\u01b0\u01a1ng<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td>M\u1ec7t m\u1ecfi<\/td>\n<td>45%<\/td>\n<td>49%<\/td>\n<td colspan=\"2\">40%<\/td>\n<td colspan=\"2\">36%<\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1t<\/td>\n<td>37%<\/td>\n<td>39%<\/td>\n<td colspan=\"2\">41%<\/td>\n<td colspan=\"2\">20%<\/td>\n<\/tr>\n<tr>\n<td>R\u00e9t run<\/td>\n<td>30%<\/td>\n<td>25%<\/td>\n<td colspan=\"2\">16%<\/td>\n<td colspan=\"2\">12%<\/td>\n<\/tr>\n<tr>\n<td>Ph\u1ea3n \u1ee9ng n\u01a1i ti\u00eam<\/td>\n<td>28%<\/td>\n<td>21%<\/td>\n<td colspan=\"2\">10%<\/td>\n<td colspan=\"2\">12%<\/td>\n<\/tr>\n<tr>\n<td>Suy nh\u01b0\u1ee3c<\/td>\n<td>18%<\/td>\n<td>15%<\/td>\n<td colspan=\"2\">26%<\/td>\n<td colspan=\"2\">30%<\/td>\n<\/tr>\n<tr>\n<td>\u0110au<\/td>\n<td>9%<\/td>\n<td>10%<\/td>\n<td colspan=\"2\">6%<\/td>\n<td colspan=\"2\">6%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u2265 1% nh\u01b0ng &lt; 10% khi \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Pegasys\/Copegus 6% ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Pegasys \u0111\u01a1n thu\u1ea7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HCV v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV- HCV bao g\u1ed3m:<\/p>\n<p>Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng: nhi\u1ec5m herpes simplex, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, vi\u00eam ph\u1ebf qu\u1ea3n, nhi\u1ec5m n\u1ea5m candida mi\u1ec7ng.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 m\u00e1u v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft: b\u1ec7nh b\u1ea1ch huy\u1ebft, thi\u1ebfu m\u00e1u, gi\u1ea3m ti\u1ec3u c\u1ea7u<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft: nh\u01b0\u1ee3c gi\u00e1p, c\u01b0\u1eddng gi\u00e1p<\/p>\n<p>T\u00e2m th\u1ea7n kinh: gi\u1ea3m tr\u00ed nh\u1edb, r\u1ed1i lo\u1ea1n v\u1ecb gi\u00e1c, d\u1ecb c\u1ea3m, gi\u1ea3m c\u1ea3m gi\u00e1c, run, y\u1ebfu, c\u00e1c r\u1ed1i lo\u1ea1n c\u1ea3m x\u00fac, thay \u0111\u1ed5i t\u00ecnh c\u1ea3m, c\u0103ng th\u1eb3ng, g\u00e2y g\u1ed5, gi\u1ea3m, \u0111au n\u1eeda \u0111\u1ea7u, bu\u1ed3n ng\u1ee7, t\u0103ng c\u1ea3m gi\u00e1c, \u00e1c m\u1ed9ng, ng\u1ea5t, lo l\u1eafng.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n m\u1eaft: nh\u00ecn m\u1edd, kh\u00f4 m\u1eaft, nhi\u1ec5m tr\u00f9ng m\u1eaft, \u0111au m\u1eaft.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 tai v\u00e0 tai trong: ch\u00f3ng m\u1eb7t, \u0111au tai.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n tim m\u1ea1ch: \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ph\u00f9 ngo\u1ea1i bi\u00ean, m\u1ea1ch nhanh.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n m\u1ea1ch m\u00e1u: ch\u1ee9ng \u0111\u1ecf b\u1eebng.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t: \u0111au h\u1ecdng, vi\u00eam m\u0169i, vi\u00eam m\u0169i h\u1ecdng, xung huy\u1ebft xoang, kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, ch\u1ea3y m\u00e1u cam.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: n\u00f4n, kh\u00f3 ti\u00eau, \u0111\u1ea7y h\u01a1i, kh\u00f4 mi\u1ec7ng, lo\u00e9t mi\u1ec7ng, ch\u1ea3y m\u00e1u l\u1ee3i, vi\u00eam d\u1ea1 d\u00e0y, kh\u00f3 nu\u1ed1t, vi\u00eam l\u01b0\u1ee1i.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da: c\u00e1c r\u1ed1i lo\u1ea1n da, s\u1ea9n ng\u1ee9a, eczema, v\u1ea9y n\u1ebfn, m\u1ec1 \u0111ay, ph\u1ea3n \u1ee9ng nh\u1ea1y c\u1ea3m \u00e1nh s\u00e1ng, t\u0103ng ti\u1ec7t m\u00f4 h\u00f4i, ra m\u00f4 h\u00f4i \u0111\u00eam.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 c\u01a1 x\u01b0\u01a1ng kh\u1edbp, m\u00f4 li\u00ean k\u1ebft v\u00e0 x\u01b0\u01a1ng: \u0111au x\u01b0\u01a1ng, \u0111au l\u01b0ng, \u0111au c\u1ed5, chu\u1ed9t r\u00fat, y\u1ebfu c\u01a1, \u0111au c\u01a1 x\u01b0\u01a1ng, vi\u00eam kh\u1edbp.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n v\u00e0 v\u00fa: b\u1ea5t l\u1ef1c<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u00ecnh tr\u1ea1ng n\u01a1i d\u00f9ng thu\u1ed1c: \u1ed1m gi\u1ea3 c\u00fam, kh\u00f3 ch\u1ecbu, ng\u1ee7 l\u1ecbm, n\u00f3ng b\u1eebng, \u0111au ng\u1ef1c, kh\u00e1t.<\/p>\n<p>C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i kh\u00e1c \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ef7 l\u1ec7 \u2265 1% \u0111\u1ebfn \u2264 2% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV-HCV \u0111ang \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Pegasys\/ Copegus bao g\u1ed3m: t\u0103ng acid lactic m\u00e1u\/ nhi\u1ec5m acid lactic, c\u00fam, vi\u00eam ph\u1ed5i, t\u00ednh t\u00ecnh kh\u00f4ng \u1ed5n \u0111\u1ecbnh, l\u00e3nh \u0111\u1ea1m, \u00f9 tai, \u0111au h\u1ea7u h\u1ecdng, vi\u00eam m\u00f4i, lo\u1ea1n d\u01b0\u1ee1ng m\u1ee1 v\u00e0 s\u1eafc t\u1ed1 ni\u1ec7u.<\/p>\n<p>T\u01b0\u01a1ng t\u1ef1 c\u00e1c ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb v\u1edbi interferon alpha kh\u00e1c, c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng v\u1edbi t\u1ea7n su\u1ea5t t\u1eeb kh\u00f4ng th\u01b0\u1eddng g\u1eb7p \u0111\u1ebfn hi\u1ebfm sau \u0111\u00e2y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng ph\u1ed1i h\u1ee3p Pegasys\/Copegus ho\u1eb7c d\u00f9ng Pegasys \u0111\u01a1n thu\u1ea7n trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng: nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u00e2p d\u01b0\u1edbi, nhi\u1ec5m tr\u00f9ng da, vi\u00eam tai ngo\u00e0i, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, t\u1ef1 t\u1eed, qu\u00e1 li\u1ec1u, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, gan nhi\u1ec5m m\u1ee1, vi\u00eam \u0111\u01b0\u1eddng m\u1eadt, kh\u1ed1i u gan \u00e1c t\u00ednh, lo\u00e9t d\u1ea1 d\u00e0y,xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, vi\u00eam tu\u1ef5, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, rung nh\u0129, vi\u00eam m\u00e0ng ngo\u00e0i tim, b\u1ec7nh t\u1ef1 mi\u1ec5n (v\u00ed d\u1ee5: ITP, vi\u00eam tuy\u1ebfn gi\u00e1p, v\u1ea9y n\u1ebfn, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, SLE), vi\u00eam c\u01a1, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean, b\u1ec7nh sarcoit, vi\u00eam ph\u1ed5i k\u1ebd c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong, t\u1eafc m\u1ea1ch ph\u1ed5i, lo\u00e9t gi\u00e1c m\u1ea1c, h\u00f4n m\u00ea v\u00e0 ch\u1ea3y m\u00e1u n\u00e3o, TTP, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, v\u00e0 \u1ea3o gi\u00e1c.<\/p>\n<p>R\u1ea5t hi\u1ebfm g\u1eb7p, alpha interferon bao g\u1ed3m Pegasys, d\u00f9ng \u0111\u01a1n thu\u1ea7n ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi ribavirin, c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea7u bao g\u1ed3m thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n.<\/p>\n<p>C\u00e1c ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m: Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a, ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ec9 s\u1ed1 x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng vi\u1ec7c hi\u1ec7u ch\u1ec9nh li\u1ec1u (xem ph\u1ea7n 2.2.1, C\u00e1c h\u01b0\u1edbng d\u1eabn li\u1ec1u d\u00f9ng \u0111\u1eb7c bi\u1ec7t).<\/p>\n<p>Tan m\u00e1u l\u00e0 \u0111\u1ed9c t\u00ednh h\u1ea1n ch\u1ebf c\u1ee7a li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ribavirin. \u0110\u00e3 ghi nh\u1eadn \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng hemoglobin gi\u1ea3m xu\u1ed1ng m\u1ee9c &lt;10 g\/dl \u1edf 15% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong 48 tu\u1ea7n v\u1edbi Copegus 1000\/1200 mg ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b12a v\u00e0 l\u00ean t\u1edbi 19% b\u1ec7nh nh\u00e2n ph\u1ed1i h\u1ee3p v\u1edbi interferon \u03b1-2a. Khi d\u00f9ng Copegus 800 mg ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a trong 24 tu\u1ea7n, 3% s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c hemoglobin gi\u1ea3m xu\u1ed1ng m\u1ee9c &lt; 10 g\/dl. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n ng\u1eebng \u0111i\u1ec1u tr\u1ecb n\u00eau ch\u1ec9 gi\u1ea3m l\u01b0\u1ee3ng hemoglobin \u0111\u01a1n thu\u1ea7n. Trong \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, gi\u1ea3m hemoglobin x\u1ea3y ra s\u1edbm trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 \u1ed5n \u0111\u1ecbnh \u0111\u1ed3ng th\u1eddi v\u1edbi s\u1ef1 t\u0103ng b\u00f9 tr\u1eeb c\u1ee7a s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi.<\/p>\n<p><em>C\u00e1c gi\u00e1 tr\u1ecb x\u00e9t nghi\u00eam \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV \u2013 HCV.<\/em><\/p>\n<p>M\u1eb7c d\u00f9 \u0111\u1ed9c t\u00ednh huy\u1ebft h\u1ecdc nh\u01b0 gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 thi\u1ebfu m\u00e1u x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV-HCV, ph\u1ea7n l\u1edbn \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng s\u1ef1 thay \u0111\u1ed5i li\u1ec1u v\u00e0 d\u00f9ng c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng, hi\u1ec3m khi ph\u1ea3i ng\u1eebng \u0111i\u1ec1u tr\u1ecb s\u1edbm. Gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u (ANC) d\u01b0\u1edbi 500 t\u1ebf b\u00e0o\/mm \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 13% v\u00e0 11% s\u1ed1 b\u1ec7nh nh\u00e2n t\u01b0\u01a1ng \u1ee9ng \u0111ang \u0111i\u1ec1u tr\u1ecb peginterferon \u03b1-2a \u0111\u01a1n thu\u1ea7n v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p.<\/p>\n<p>Thi\u1ebfu m\u00e1u (hemoglobin &lt; 10 g\/dl) \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u01b0\u01a1ng \u1ee9ng \u1edf 7% v\u00e0 14% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi peginterferon \u03b1-2a \u0111\u01a1n thu\u1ea7n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p.<\/p>\n<p><em>X\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng<\/em><\/p>\n<p>B\u1ec7nh nhi: gi\u1ea3m hemoglobin, b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 \u0111\u00f2i h\u1ecfi ph\u1ea3i gi\u1ea3m li\u1ec1u ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb v\u0129nh vi\u1ec5n. H\u1ea7u h\u1ebft c\u00e1c x\u00e9t nghi\u1ec7m b\u1ea5t th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u1edf l\u1ea1i m\u1ee9c ban \u0111\u1ea7u ngay sau khi d\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><em>B\u00e1o c\u00e1o l\u01b0u h\u00e0nh thu\u1ed1c<\/em><\/p>\n<p>Trong giai \u0111o\u1ea1n sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng, h\u1ed3ng ban \u0111a d\u1ea1ng, h\u1ed9i ch\u1ee9ng Steven Johnson, ho\u1ea1i t\u1eed bi\u1ec3u b\u00ec nhi\u1ec5m \u0111\u1ed9c, b\u1ea5t s\u1ea3n nguy\u00ean h\u1ed3ng c\u1ea7u (PRCA) v\u00e0 \u00fd \u0111\u1ecbnh gi\u1ebft ng\u01b0\u1eddi \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn r\u1ea5t hi\u1ebfm g\u1eb7p khi \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Pegasys v\u00e0 ribavirin.<\/p>\n<p>M\u1ea5t n\u01b0\u1edbc \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn hi\u1ebfm g\u1eb7p khi \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Copegus v\u00e0 alpha interferons.<\/p>\n<p>T\u01b0\u01a1ng t\u1ef1 c\u00e1c interferons alpha kh\u00e1c, bong thanh d\u1ecbch v\u00f5ng m\u1ea1c \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p Pegasys v\u00e0 Copegus.<\/p>\n<p>T\u01b0\u01a1ng t\u1ef1 c\u00e1c interferons alpha kh\u00e1c, th\u1ea3i tr\u1eeb sau gh\u00e9p t\u1ea1ng gan v\u00e0 th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi d\u00f9ng Pegasys, \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi Copegus.<\/p>\n<p><em>Th\u00f4ng b\u00e1o cho B\u00e1c s\u0129 nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c.<\/em><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<\/strong><\/p>\n<p>Khi d\u00f9ng thu\u1ed1c h\u00edt, \u0111\u1ec3 tr\u00e1nh l\u00e0m suy h\u00f4 h\u1ea5p n\u1eb7ng l\u00ean, th\u1ea7y thu\u1ed1c ph\u1ea3i th\u00e0nh th\u1ea1o trong h\u1ed3i s\u1ee9c \u0111\u1ec3 ph\u00e1t hi\u1ec7n khi m\u00e1y th\u1edf b\u1ecb t\u1eafc do thu\u1ed1c l\u1eafng \u0111\u1ecdng trong m\u00e1y, \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n&#8230; Tr\u00e1nh d\u00f9ng thu\u1ed1c d\u1ea1ng h\u00edt k\u00e9o d\u00e0i, v\u00ec thu\u1ed1c c\u00f3 th\u1ec3 t\u00e1c \u0111\u1ed9ng x\u1ea5u \u0111\u1ebfn m\u00e0ng h\u00f4 h\u1ea5p. Ribavirin u\u1ed1ng c\u0169ng c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 th\u1edf, th\u00e2m nhi\u1ec5m ph\u1ed5i, vi\u00eam ph\u1ed5i.<\/p>\n<p>Khi d\u00f9ng ribavirin d\u1ea1ng h\u00edt cho ng\u01b0\u1eddi m\u1eafc b\u1ec7nh tim b\u1ea5m sinh, c\u1ea7n ch\u00fa \u00fd \u0111\u1ec1 ph\u00f2ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n<p>Hemoglobin c\u00f3 th\u1ec3 tr\u1edf l\u1ea1i tr\u1ecb s\u1ed1 ban \u0111\u1ea7u trong v\u00f2ng 4 &#8211; 8 tu\u1ea7n sau khi ng\u1eebng d\u00f9ng ribavirin. N\u1ebfu b\u1ecb thi\u1ebfu m\u00e1u n\u1eb7ng, c\u00f3 th\u1ec3 ph\u1ea3i truy\u1ec1n m\u00e1u.<\/p>\n<p>V\u1edbi tr\u01b0\u1eddng h\u1ee3p b\u1ecb r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n khi \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n th\u1ea7n kinh v\u00e0 ph\u1ea3i ng\u1eebng ribavirin v\u00e0 interferon alpha-2b, n\u1ebfu th\u1ea5y c\u1ea7n thi\u1ebft.<\/p>\n<p><strong>4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<\/strong><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh v\u1edbi ribavirin k\u1ebft h\u1ee3p v\u1edbi peginterferon \u03b1-2a, interferon \u03b1-2b v\u00e0 thu\u1ed9c kh\u00e1ng acid. N\u1ed3ng \u0111\u1ed9 ribavirin l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c Interferon \u03b1-2b.<\/p>\n<p>B\u1ea5t c\u1ee9 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c n\u00e0o c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1edbi 2 th\u00e1ng (t\u01b0\u01a1ng \u1ee9ng v\u1edbi 5 l\u1ea7n th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a ribavirin) sau khi ng\u1eebng Copegus do th\u1eddi gian b\u00e1n h\u1ee7y c\u1ee7a thu\u1ed1c d\u00e0i.<\/p>\n<p>K\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u in-vitro s\u1eed d\u1ee5ng c\u1ea3 ti th\u1ec3 gan chu\u1ed9t v\u00e0 ng\u01b0\u1eddi ch\u1ec9 ra r\u1eb1ng chuy\u1ec3n h\u00f3a c\u1ee7a ribavirin kh\u00f4ng qua men trung gian cytochrome P450. Ribavirin kh\u00f4ng \u1ee9c ch\u1ebf cytochrome P450. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed9c t\u00ednh cho r\u1eb1ng ribavirin k\u00edch ho\u1ea1t men gan. V\u00ec v\u1eady, nguy c\u01a1 l\u00e0 t\u1ed1i thi\u1ec3u \u0111\u1ed1i v\u1edbi t\u01b0\u01a1ng t\u00e1c qua enzyme P450.<\/p>\n<p>Thu\u1ed1c kh\u00e1ng acid: Sinh kh\u1ea3 d\u1ee5ng c\u1ee7a ribavirin 600mg gi\u1ea3m khi d\u00f9ng c\u00f9ng v\u1edbi thu\u1ed1c kh\u00e1ng acid c\u00f3 ch\u1ee9a magi\u00ea, nh\u00f4m v\u00e0 methicone; AUCtf to\u00e0n ph\u1ea7n gi\u1ea3m 14%. C\u00f3 th\u1ec3 gi\u1ea3 thuy\u1ebft \u0111\u1ed9 kh\u1ea3 d\u1ee5ng sinh h\u1ecdc gi\u1ea3m trong nghi\u00ean c\u1ee9u n\u00e0y do thu\u1ed1c di chuy\u1ec3n ch\u1eadm trong \u1ed1ng ti\u00eau h\u00f3a ho\u1eb7c do thay \u0111\u1ed5i pH. T\u01b0\u01a1ng t\u00e1c n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng.<\/p>\n<p>C\u00e1c thu\u1ed1c t\u01b0\u01a1ng t\u1ef1 nucleoside: K\u1ebft qu\u1ea3 in-vitro cho th\u1ea5y ribavirin \u1ee9c ch\u1ebf s\u1ef1 phosphoryl h\u00f3a cua zidovudine v\u00e0 stavudine. \u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c s\u00e1ng t\u1ecf. Tuy nhi\u00ean, nh\u1eefng nghi\u00ean c\u1ee9u in-vitro n\u00e0y \u0111\u01b0a ra kh\u1ea3 n\u0103ng d\u00f9ng \u0111\u1ed3ng th\u1eddi Copegus v\u1edbi zidovudine ho\u1eb7c stavudine c\u00f3 th\u1ebb d\u1eabn \u0111\u1ebfn t\u0103ng t\u1ea3i l\u01b0\u1ee3ng vi r\u00fat HIV trong huy\u1ebft t\u01b0\u01a1ng. V\u00ec v\u1eady, khuy\u1ebfn c\u00e1o theo d\u00f5i ch\u1eb7t ch\u1ebd s\u1ed1 phi\u00ean b\u1ea3n RNA HIV huy\u1ebft t\u01b0\u01a1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Copegus c\u00f9ng v\u1edbi m\u1ed9t trong hai thu\u1ed1c tr\u00ean. N\u1ebfu m\u1ee9c RNA HIV t\u0103ng, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc l\u1ea1i vi\u1ec7c d\u00f9ng \u0111\u1ed3ng th\u1eddi Copegus v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf sao ch\u00e9p ng\u01b0\u1ee3c.<\/p>\n<p>T\u1eeb m\u1ed9t ngh\u00ean c\u1ee9u ph\u1ee5 12 tu\u1ea7n v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a ribavirin tr\u00ean s\u1ef1 phosphoryl ho\u00e1 trong t\u1ebf b\u00e0o c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c \u1ee9c ch\u1ebf sao ch\u00e9p ng\u01b0\u1ee3c nucleoside (lamivudine, zidovudine ho\u1eb7c stavudine), kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 47 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV. T\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a ribavirin d\u01b0\u1eddng nh\u01b0 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi s\u1ef1 d\u00f9ng c\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf sao ch\u00e9p ng\u01b0\u1ee3c nucleoside (NRTIs).<\/p>\n<p>Didanosine (ddl): Ribavirin l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng kh\u00e1ng vi r\u00fat c\u1ee7a didanosine (ddI) in-vitro v\u00e0 tr\u00ean \u0111\u1ed9ng v\u1eadt b\u1eb1ng c\u00e1ch t\u0103ng t\u1ea1o ch\u1ea5t \u0111\u1ed3ng h\u00f3a triphosphate c\u00f3 ho\u1ea1t t\u00ednh (ddATP). Quan s\u00e1t n\u00e0y c\u0169ng cho th\u1ea5y kh\u1ea3 n\u0103ng m\u00e0 d\u00f9ng \u0111\u1ed3ng th\u1eddi ribavirin v\u00e0 ddI c\u0169ng l\u00e0m t\u0103ng nguy c\u01a1 c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i c\u00f3 li\u00ean quan \u0111\u1ebfn ddI (nh\u01b0 b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean, vi\u00eam t\u1ee5y c\u1ea5p, v\u00e0 ch\u1ee9ng gan nhi\u1ec5m m\u1ee1 gan k\u00e8m theo toan chuy\u1ec3n h\u00f3a acid lactic). Trong khi \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c s\u00e1ng t\u1ecf, m\u1ed9t nghi\u00ean c\u1ee9u d\u00f9ng ribavirin c\u00f9ng v\u1edbi ddI \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m HIV \u0111\u00e3 kh\u00f4ng l\u00e0m gi\u1ea3m th\u00eam t\u1ea3i l\u01b0\u1ee3ng vi r\u00fat m\u00e1u ho\u1eb7c kh\u00f4ng \u00e0m t\u0103ng c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc huy\u1ebft t\u01b0\u01a1ng c\u1ee7a ddI kh\u00f4ng \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u khi d\u00f9ng c\u00f9ng v\u1edbi ribavirin, tuy nhi\u00ean l\u01b0\u1ee3ng ddATP trong t\u1ebf b\u00e0o \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111o l\u01b0\u1eddng.<\/p>\n<p>Kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng ribavirin c\u00f9ng v\u1edbi didanosine. N\u1ed3ng \u0111\u1ed9 c\u1ee7a didanosine ho\u1eb7c ch\u1ea5t chuy\u1ec3n ho\u00e1 c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a ch\u00fang (dideoxyadenosine 5 -triphosphate) t\u0103ng khi didanosine \u0111\u01b0\u1ee3c d\u00f9ng c\u00f9ng v\u1edbi ribavirin. C\u00e1c b\u00e1o c\u00e1o v\u1ec1 s\u1ef1 suy gan n\u1eb7ng c\u0169ng nh\u01b0 b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean, vi\u00eam tu\u1ef5 c\u1ea5p, v\u00e0 t\u0103ng acid lactic huy\u1ebft thanh\/ nhi\u1ec5m toan acid lactic \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi d\u00f9ng ribavirin.<\/p>\n<p>Azathioprine: Ribavirin, th\u00f4ng qua t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf inosine monophosphate dehydrogenase, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn chuy\u1ec3n h\u00f3a c\u1ee7a azathioprine v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00edch t\u1ee5 6-methylthioinosine monophosphate (6-MTIMP), \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 li\u00ean quan v\u1edbi nhi\u1ec5m \u0111\u1ed9c t\u1ee7y x\u01b0\u01a1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng azathioprine.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p khi l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ribavirin v\u1edbi azathioprine \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn c\u00f3 nguy c\u01a1 ti\u1ec1m \u1ea9n, khuy\u1ebfn c\u00e1o theo d\u00f5i s\u00e1t c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 huy\u1ebft h\u1ecdc trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi azathioprine \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u nhi\u1ec5m \u0111\u1ed9c t\u1ee7y x\u01b0\u01a1ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><strong>4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<\/strong><\/p>\n<p>Kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p qu\u00e1 li\u1ec1u Copegus \u0111\u01b0\u1ee3c ghi nh\u1eadn trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng. Gi\u1ea3m calci m\u00e1u v\u00e0 gi\u1ea3m magi\u00ea m\u00e1u \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u1eefng ng\u01b0\u1eddi d\u00f9ng li\u1ec1u l\u1edbn h\u01a1n b\u1ed1n l\u1ea7n li\u1ec1u t\u1ed1i \u0111a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y, ribavirin \u0111\u01b0\u1ee3c d\u00f9ng b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Ribavirin kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf m\u1ed9t c\u00e1ch h\u1eefu hi\u1ec7u b\u1eb1ng th\u1ea9m ph\u00e2n m\u00e1u.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<\/strong><\/p>\n<p><strong>5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/strong><\/p>\n<p><em>C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng<\/em><\/p>\n<p>Ribavirin l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed3ng d\u1ea1ng nucleoside t\u1ed5ng h\u1ee3p cho th\u1ea5y c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean in-vitro ch\u1ed1ng l\u1ea1i m\u1ed9t v\u00e0i RNA v\u00e0 DNA c\u1ee7a vi r\u00fat. C\u01a1 ch\u1ebf m\u00e0 ribavirin ph\u1ed1i h\u1ee3p v\u1edbi alpha interferon ho\u1eb7c peginterferon \u03b1-2a c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ea1i HCV ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft.<\/p>\n<p>D\u1ea1ng u\u1ed1ng c\u1ee7a ribavirin trong \u0111\u01a1n tr\u1ecb li\u1ec7u \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nh\u01b0 l\u00e0 li\u1ec7u ph\u00e1p cho \u0111i\u1ec1u tr\u1ecb vi\u00eam gan C m\u1ea1n t\u00ednh trong m\u1ed9t v\u00e0i th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. K\u00eat qu\u1ea3 c\u1ee7a nh\u1eefng th\u1eed nghi\u1ec7m n\u00e0y cho th\u00e2y ribavirin \u0111\u01a1n tr\u1ecb li\u1ec7u kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng lo\u1ea1i tr\u1eeb v\u1ecb r\u00fat vi\u00eam gan (HCV RNA) ho\u1eb7c c\u1ea3i thi\u1ec7n m\u00f4 gan sau li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb 6 \u0111\u1ebfn 12 th\u00e1ng v\u00e0 6 th\u00e1ng sau \u0111\u00f3.<\/p>\n<p>C\u00c1C NGHI\u00caN C\u1ee8U L\u00c2M S\u00c0NG\/HI\u1ec6U QU\u1ea2<\/p>\n<p>Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a.<\/p>\n<p><em>Vi\u00eam gan C m\u1ea1n t\u00ednh<\/em><\/p>\n<p>K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u<\/p>\n<p>T\u00ednh hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a vi\u1ec7c k\u1ebft h\u1ee3p Copegus v\u00e0 peginterferon \u03b1-2a \u0111\u01b0\u1ee3c x\u00e1c l\u1eadp trong hai nghi\u00ean c\u1ee9u then ch\u1ed1t (NV15801+ NV15942), bao g\u1ed3m 2405 b\u1ec7nh nh\u00e2n. Nh\u1eefng b\u1ec7nh nh\u00e2n trong nghi\u00ean c\u1ee9u bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam gan C m\u1ea1n (CHC) ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng interferon bao gi\u1edd \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng l\u01b0\u1ee3ng HCV RNA trong huy\u1ebft thanh, n\u1ed3ng \u0111\u1ed9 ALT t\u0103ng, v\u00e0 sinh thi\u1ebft gan ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng vi\u00eam gan C m\u1ea1n t\u00ednh.<\/p>\n<p>Nghi\u00ean c\u1ee9u NV15801 (1121 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb) so s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a 48 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u1edbi peginterferon \u03b12a (180 mcg tu\u1ea7n m\u1ed9t l\u1ea7n) v\u00e0 Copegus (1000\/1200 mg d\u00f9ng h\u00e0ng ng\u00e0y) v\u1edbi ho\u1eb7c \u0111\u01a1n tr\u1ecb li\u1ec7u peginterferon \u03b1-2a ho\u1eb7c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p interferon \u03b1-2b v\u00e0 ribavirin. S\u1ef1 k\u1ebft h\u1ee3p peginterferon \u03b1-2a v\u00e0 Copegus c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n nhi\u1ec1u so v\u1edbi s\u1ef1 k\u1ebft h\u1ee3p v\u1edbi interferon \u03b1-2b v\u00e0 ribavirin ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng peginterferon \u03b1-2a \u0111\u01a1n thu\u1ea7n (xem B\u1ea3ng 7).<\/p>\n<p>Nghi\u00ean c\u1ee9u NV 15942 (1284 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb) so s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a hai li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb (24 tu\u1ea7n v\u1edbi 48 tu\u1ea7n) v\u00e0 hai d\u1ea1ng li\u1ec1u c\u1ee7a Copegus (800 mg v\u1edbi 1000\/1200 mg).<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m ki\u1ec3u gen 1, \u0111\u00e1p \u1ee9ng vi r\u00fat b\u1ec1n v\u1eefng sau 48 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb cao h\u01a1n sau 24 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb (p=0,001) v\u00e0 v\u1edbi li\u1ec1u Copegus cao h\u01a1n (p=0,005). Tuy nhi\u00ean, v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m ki\u1ec3u gen 2\/3 kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t r\u00f5 r\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea gi\u1eefa 48 tu\u1ea7n v\u00e0 24 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1eefa li\u1ec1u cao v\u00e0 th\u1ea5p c\u1ee7a Copegus (xem B\u1ea3ng 8). Nh\u1eefng ki\u1ec3u \u0111\u00e1p \u1ee9ng n\u00e0y kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi l\u01b0\u1ee3ng vi r\u00fat ho\u1eb7c s\u1ef1 c\u00f3 m\u1eb7t ho\u1eb7c kh\u00f4ng c\u00f3 x\u01a1 gan, v\u00ec v\u1eady s\u1ef1 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ban \u0111\u1ea7u n\u00e0y. \u0110\u00e1p \u1ee9ng vi r\u00fat \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng l\u01b0\u1ee3ng HCV RNA kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng th\u1eed nghi\u1ec7m Cobas Amplicor&#x2122; HCV, phi\u00ean b\u1ea3n 2.0 (gi\u1edbi h\u1ea1n ph\u00e1t hi\u1ec7n 100 phi\u00ean b\u1ea3n\/ml t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 50 \u0111\u01a1n v\u1ecb qu\u1ed1c t\u1ebf\/ml) v\u00e0 \u0111\u00e1p \u1ee9ng k\u00e9o d\u00e0i gi\u1ed1ng nh\u01b0 m\u1eabu \u00e2m t\u00ednh kho\u1ea3ng 6 th\u00e1ng sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>B\u1ea3ng 7. \u0110\u00e1p \u1ee9ng vi r\u00fat \u1edf to\u00e0n b\u1ed9 b\u1ec7nh nh\u00e2n (bao g\u1ed3m b\u1ec7nh nh\u00e2n x\u01a1 gan v\u00e0 kh\u00f4ng x\u01a1 gan)<\/p>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td>Nghi\u00ean c\u1ee9u NV15942<\/td>\n<td colspan=\"2\">Nghi\u00ean c\u1ee9u NV159801<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Copegus 1000\/1200mg v\u00e0 Peginterferon \u03b1-2a<\/p>\n<p>180mcg<\/p>\n<p>(N= 436)<\/p>\n<p>48 tu\u1ea7n<\/td>\n<td>Copegus 1000\/1200mg v\u00e0 Peginterferon \u03b1-2a<\/p>\n<p>180mcg<\/p>\n<p>(N= 453)<\/p>\n<p>48 tu\u1ea7n<\/td>\n<td>Copegus 1000\/1200mg v\u00e0 Interferon \u03b1-2b 3MIU<\/p>\n<p>(N= 444)<\/p>\n<p>48 tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td>\u0110\u00e1p \u1ee9ng v\u00e0o cu\u1ed1i qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb<\/td>\n<td>68%<\/td>\n<td>69%<\/td>\n<td>52%<\/td>\n<\/tr>\n<tr>\n<td>\u0110\u00e1p \u1ee9ng b\u1ec1n v\u1eefng to\u00e0n b\u1ed9<\/td>\n<td>63%<\/td>\n<td>54%*<\/td>\n<td>45%*<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>*\u0111\u1ed9 tin c\u1eady 95% cho s\u1ef1 kh\u00e1c bi\u1ec7t; 3% \u0111\u1ebfn 16% gi\u00e1 tr\u1ecb p=0,003 (th\u1eed nghi\u1ec7m ph\u00e2n t\u1ea7ng Cochran &#8211; Mantel &#8211; Haenszel)<\/p>\n<p>B\u1ea3ng 8. \u0110\u00e1p \u1ee9ng vi r\u00fat b\u1ec1n v\u1eefng d\u1ef1a v\u00e0o ki\u1ec3u gen v\u00e0 l\u01b0\u1ee3ng vi r\u00fat sau khi \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Copegus<\/p>\n<table>\n<tbody>\n<tr>\n<td rowspan=\"2\"><\/td>\n<td colspan=\"4\">Nghi\u00ean c\u1ee9u NV 15942<\/td>\n<td colspan=\"2\">Nghi\u00ean c\u1ee9u NV 15801<\/td>\n<\/tr>\n<tr>\n<td>Copegus 800 mg v\u00e0 PEG-IFN \u03b1-2a 180 mcg 24 tu\u1ea7n<\/td>\n<td>Copegus 1000\/1200 mg v\u00e0 PEG-IFN \u03b1-2a180 mcg 24 tu\u1ea7n<\/td>\n<td>Copegus 800 mg v\u00e0 PEG-IFN \u03b1-2a180 mcg 48 tu\u1ea7n<\/td>\n<td>Copegus 1000\/1200 mg v\u00e0 PEG-IFN \u03b1-2a180 mcg 48 tu\u1ea7n<\/td>\n<td>Copegus 1000\/1200 mg v\u00e0 PEG-IFN \u03b1-2a180 mcg 48 tu\u1ea7n<\/td>\n<td>Ribavirin 1000\/1200 mg v\u00e0 Interferon \u03b1-2b 3 MIU 48 tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 1<\/p>\n<p>L\u01b0\u1ee3ng vi r\u00fat th\u1ea5p<\/p>\n<p>L\u01b0\u1ee3ng vi r\u00fat cao<\/td>\n<td>29%(29\/101)<\/p>\n<p>41% (21\/51)<\/p>\n<p>16% (8\/50)<\/td>\n<td>42%(49\/118) \u2020<\/p>\n<p>52% (37\/71)<\/p>\n<p>26% (12\/47)<\/td>\n<td>41%(102\/250)<\/p>\n<p>55% (33\/60)<\/p>\n<p>36% (69\/190)<\/td>\n<td>52%(142\/271)*\u2020<\/p>\n<p>65% (55\/85)<\/p>\n<p>47% (87\/186)<\/td>\n<td>45% (134\/298)<\/p>\n<p>53% (61\/115)<\/p>\n<p>40% (73\/182)<\/td>\n<td>36% (103\/285)<\/p>\n<p>44% (41\/94)<\/p>\n<p>33% (62\/189)<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 2\/3<\/p>\n<p>L\u01b0\u1ee3ng vi r\u00fat th\u1ea5p<\/p>\n<p>L\u01b0\u1ee3ng vi r\u00fat cao<\/td>\n<td>84% (81\/96)<\/p>\n<p>85% (29\/34)<\/p>\n<p>84% (52\/62)<\/td>\n<td>81% (117\/144)<\/p>\n<p>83% (39\/47)<\/p>\n<p>80% (78\/97)<\/td>\n<td>79% (78\/99)<\/p>\n<p>88% (29\/33)<\/p>\n<p>74% (49\/66)<\/td>\n<td>80% (123\/153)<\/p>\n<p>77% (37\/48)<\/p>\n<p>82% (86\/105)<\/td>\n<td>71% (100\/140)<\/p>\n<p>76% (28\/37)<\/p>\n<p>70% (72\/103)<\/td>\n<td>61% (88\/145)<\/p>\n<p>65% (34\/52)<\/p>\n<p>38% (54\/93)<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 4<\/td>\n<td>0% + (0\/5)<\/td>\n<td>67% (8\/12)<\/td>\n<td>63%(5\/8)<\/td>\n<td>82%(9\/11)<\/td>\n<td>77%(10\/3)<\/td>\n<td>45%(5\/11)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>* Copegus 1000\/1200 mg + peginterferon \u03b1-2a 180 mcg, 48 tu\u1ea7n so v\u1edbi Copegus 800mcg + peginterferon \u03b1-2a 180 mcg, 48 tu\u1ea7n: t\u1ec9 l\u1ec7 ch\u00eanh l\u1ec7ch (\u0111\u1ed9 tin c\u1eady 93%) = 1,52 (1,07 \u0111\u1ebfn 2,17) gi\u00e1 tr\u1ecb p = 0,020 (th\u1eed nghi\u1ec7m ph\u00e2n t\u1ea7ng Cochran-Mantel- Haenszel).<\/p>\n<p>\u2020 Copegus 1000\/1200 mg + peginterferon \u03b1-2a 180 meg, 48 tu\u1ea7n so v\u1edbi Copegus 1000\/1200 mg + peginterferon \u03b1-2a 180 meg, 24 tu\u1ea7n: t\u1ec9 l\u1ec7 ch\u00eanh l\u1ec7ch (\u0111\u1ed9 tin c\u1eady 959%)= 2,12 (1,30 \u0111\u1ebfn 3,46) gi\u00e1 tr\u1ecb p = 0,002 (th\u1eed nghi\u1ec7m ph\u00e2n t\u1ea7ng Cochran-Mantel- Haenszel).<\/p>\n<p><em>\u0110\u1ed3ng nhi\u1ec5m HIV-HCV<\/em><\/p>\n<p>\u1ede nghi\u00ean c\u1ee9u NR 15961, 860 b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi peginterferon \u03b1-2a 180 mcg\/tu\u1ea7n v\u00e0 gi\u1ea3 d\u01b0\u1ee3c, peginterferon \u03b1-2a 180 mcg\/tu\u1ea7n v\u00e0 ribavirin 800 mg\/ngay ho\u1eb7c interferon \u03b1-2a 3 MIU ba l\u1ea7n m\u1ed9t tu\u1ea7n v\u00e0 ribavirin 800 mg\/ng\u00e0y trong 48 tu\u1ea7n sau \u0111\u00f3 l\u00e0 24 tu\u1ea7n kh\u00f4ng \u0111i\u1ec1u tr\u1ecb. \u0110\u00e1p \u1ee9ng vi r\u00fat b\u1ec1n v\u1eefng cho c\u1ea3 ba nh\u00f3m \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n v\u00e0 b\u1edfi ki\u1ec3u gen trong b\u1ea3ng 9.<\/p>\n<p>B\u1ea3ng 9. \u0110\u00e1p \u1ee9ng vi r\u00fat b\u1ec1n v\u1eefng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ed3ng nhi\u1ec5m HIV-HCV<\/p>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td>Pegasys 180mcg + gi\u1ea3 d\u01b0\u1ee3c48 tu\u1ea7n<\/td>\n<td>Pegasys 180mcg + Copegus 800mg<\/p>\n<p>48 tu\u1ea7n<\/td>\n<td>Interferon \u03b1-2a 3MIU + Copegus 800mg<\/p>\n<p>48 tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td>T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n<\/td>\n<td>20% (58\/286)*<\/td>\n<td>40% (116\/289)*<\/td>\n<td>12% (33\/285)*<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 1<\/td>\n<td>14% (24\/175)<\/td>\n<td>29% (51\/176)<\/td>\n<td>7%(12\/171)<\/td>\n<\/tr>\n<tr>\n<td>Ki\u1ec3u gen 2\/3<\/td>\n<td>36% (32\/90)<\/td>\n<td>62% (59\/95)<\/td>\n<td>20% (18\/89)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>* Pegasys 180 mcg, Cogegus 800 mg so v\u1edbi Interferon \u03b1-2a 3MIU Copegus 800 mg: T\u1ec9 l\u1ec7 ch\u00eanh l\u1ec7ch (\u0111\u1ed9 tin c\u1eady 95%) = 5,40 (3,42 \u0111\u1ebfn 8,54), gi\u00e1 tr\u1ecb p= &lt; 0,000] (th\u1eed nghi\u1ec7m ph\u00e2n t\u1ea7ng Cochran &#8211; Mantel &#8211; Haenszel).<\/p>\n<p>* Pegasys 180 mcg, Copegus 800 mg so v\u1edbi Pegasys 180 mcg: T\u1ec9 l\u1ec7 ch\u00eanh l\u1ec7ch (\u0111\u1ed9 tin c\u1eady 99%) = 2,89 (1,93 \u0111\u1ebfn 4,32), gi\u00e1 tr\u1ecb p= &lt; 0,0001 (th\u1eed nghi\u1ec7m ph\u00e2n t\u1ea7ng Cochran &#8211; Mantel &#8211; Haenszel).<\/p>\n<p><em>Ribavirin k\u1ebft h\u1ee3p v\u1edbi interferon \u03b1-2a<\/em><\/p>\n<p>Hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a interferon \u03b1-2a \u0111\u01a1n thu\u1ea7n v\u00e0 k\u1ebft h\u1ee3p v\u1edbi ribavirin d\u1ea1ng u\u1ed1ng \u0111\u01b0\u1ee3c so s\u00e1nh trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb bao gi\u1edd (ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00e2y) v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1i ph\u00e1t \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1ec1 m\u1eb7t m\u00f4 h\u1ecdc, sinh h\u00f3a, vi r\u00fat h\u1ecdc l\u00e0 vi\u00eam gan C m\u1ea1n t\u00ednh. S\u00e1u th\u00e1ng sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb \u0111\u00e1p \u1ee9ng vi r\u00fat v\u00e0 sinh h\u00f3a c\u0169ng nh\u01b0 m\u00f4 h\u1ecdc \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 c\u00f3 c\u1ea3i thi\u1ec7n.<\/p>\n<p>\u0110\u00e1p \u1ee9ng sinh h\u00f3a v\u00e0 vi r\u00fat k\u00e9o d\u00e0i t\u0103ng g\u1ea5p 10 l\u1ea7n m\u1ed9t c\u00e1ch c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea (t\u1eeb 4% \u0111\u1ebfn 43%; p &lt; 0,01) \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u00e1i ph\u00e1t (M23136; N=99). C\u00e1c t\u00e0i li\u1ec7u t\u00e1n th\u00e0nh li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p c\u0169ng ph\u1ea3n \u00e1nh t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng c\u00f3 li\u00ean quan \u0111\u1ebfn ki\u00eau gen HCV ho\u1eb7c l\u01b0\u1ee3ng vi r\u00fat ban \u0111\u1ea7u. Trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u00e0 \u0111\u01a1n tr\u1ecb li\u1ec7u interferon, t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng b\u1ec1n v\u1eefng t\u01b0\u01a1ng \u1ee9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HCV c\u00f3 ki\u1ec3u gen 1 l\u00e0 282% so v\u1edbi 0% v\u00e0 v\u1edbi ki\u1ec3u gen kh\u00e1c 1 l\u00e0 58% so v\u1edbi 8%. Ngo\u00e0i ra, s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t m\u00f4 h\u1ecdc \u1ee7ng h\u1ed9 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p. C\u00e1c k\u1ebft qu\u1ea3 c\u00f3 \u00edch h\u1ed7 tr\u1ee3 (\u0111\u01a1n tr\u1ecb li\u1ec7u so v\u1edbi k\u1ebft h\u1ee3p; 6% so v\u1edbi 48%, p &lt; 0,04) t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u nh\u1ecf \u0111\u00e3 \u0111\u01b0\u1ee3c xu\u1ea5t b\u1ea3n g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb (N=40) ghi nh\u1eadn d\u00f9ng interferon \u03b1-2a (3 MIU 3 l\u1ea7n m\u1ed7i tu\u1ea7n) v\u1edbi ribavirin.<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a ribavirin c\u00f2n ch\u01b0a bi\u1ebft \u0111\u1ea7y \u0111\u1ee7. <em>In vitro, <\/em>ribavirin c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean nhi\u1ec1u lo\u1ea1i virus, tuy nhi\u00ean kh\u00f4ng li\u00ean quan t\u1edbi t\u00e1c d\u1ee5ng ch\u1ed1ng virus nhi\u1ec5m \u1edf ng\u01b0\u1eddi. Khi v\u00e0o c\u01a1 th\u1ec3, ribavirin \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n v\u00e0o trong t\u1ebf b\u00e0o v\u00e0 gi\u00e1ng h\u00f3a th\u00e0nh ribavirin deribosylate v\u00e0 phosphoryl h\u00f3a th\u00e0nh ribavirin-5\u2019-monophosphat, -diphosphat v\u00e0 -triphosphat nh\u1edd x\u00fac t\u00e1c c\u1ee7a adenosin kinase v\u00e0 c\u00e1c enzym kh\u00e1c. Qu\u00e1 tr\u00ecnh phosphoryl h\u00f3a c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf c\u1ea3 c\u00e1c t\u1ebf b\u00e0o nhi\u1ec5m v\u00e0 t\u1ebf b\u00e0o kh\u00f4ng nhi\u1ec5m, t\u1ef7 l\u1ec7 c\u00e1c d\u1eabn ch\u1ea5t t\u1ea1o th\u00e0nh kh\u00e1c nhau t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p. Do v\u1eady, hi\u1ec7u qu\u1ea3 ch\u1ed1ng virus c\u1ee7a ribavirin c\u00f3 th\u1ec3 b\u1ecb thay \u0111\u1ed5i tr\u00ean t\u1eebng c\u00e1 th\u1ec3. T\u00e1c d\u1ee5ng ch\u1ed1ng virus ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c cho l\u00e0 b\u1edfi d\u1eabn ch\u1ea5t -mono v\u00e0 -triphosphat. C\u1ea5u tr\u00fac c\u1ee7a c\u00e1c d\u1eabn ch\u1ea5t phosphoryl h\u00f3a t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u1ea5u tr\u00fac c\u1ee7a c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 trong t\u1ebf b\u00e0o nh\u01b0 guanosin nucleotid. S\u1ef1 c\u1ea1nh tranh gi\u1eefa ribavirin-5\u2019-triphosphat v\u1edbi adenosin-5\u2019-triphosphat v\u00e0 guanosin-5\u2019-triphosphat, c\u01a1 ch\u1ea5t c\u1ee7a polymerase virus RNA \u0111\u00e3 g\u00e2y \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p protein c\u1ee7a virus, l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng sao ch\u00e9p v\u00e0 lan truy\u1ec1n virus t\u1edbi c\u00e1c t\u1ebf b\u00e0o kh\u00e1c. B\u00ean c\u1ea1nh \u0111\u00f3, nghi\u00ean c\u1ee9u <em>in vitro<\/em> cho th\u1ea5y t\u00e1c d\u1ee5ng ch\u1ed1ng virus c\u1ee7a ribavirin c\u00f2n c\u00f3 th\u1ec3 do \u1ee9c ch\u1ebf guanyltransferase v\u00e0 methyltransferase, nh\u1eefng enzym c\u1ea7n thi\u1ebft cho s\u1ef1 sao ch\u00e9p c\u1ee7a virus.<\/p>\n<p><strong>[XEM T\u1ea0I \u0110\u00c2Y]<\/strong><\/p>\n<p><strong>5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/strong><\/p>\n<p><em>H\u1ea5p thu<\/em><\/p>\n<p>Ribavirin \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh ch\u00f3ng sau khi u\u1ed1ng Copegus li\u1ec1u \u0111\u01a1n (th\u1eddi gian trung b\u00ecnh \u0111\u1ec3 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong m\u00e1u l\u00e0 1-2 gi\u1edd). Th\u1eddi gian b\u00e1n h\u1ee7y giai \u0111o\u1ea1n cu\u1ed1i trung b\u00ecnh c\u1ee7a ribavirin sau khi d\u00f9ng Copegus li\u1ec1u \u0111\u01a1n trong kho\u1ea3ng t\u1eeb 140 \u0111\u1ebfn 160 gi\u1edd. S\u1ed1 li\u1ec7u c\u1ee7a ribavirin trong c\u00e1c t\u00e0i li\u1ec7u ch\u1ee9ng minh s\u1ef1 h\u1ea5p thu c\u00f3 ph\u1ea1m vi r\u1ed9ng v\u1edbi kho\u1ea3ng 10% li\u1ec1u \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u ph\u00f3ng x\u1ea1 \u0111\u01b0\u1ee3c ti\u1ebft theo ph\u00e2n. Tuy nhi\u00ean, \u0111\u1ed9 kh\u1ea3 d\u1ee5ng sinh h\u1ecdc tuy\u1ec7t \u0111\u1ed1i kho\u1ea3ng 45-65%, c\u00f3 th\u1ec3 do chuy\u1ec3n h\u00f3a b\u01b0\u1edbc \u0111\u1ea7u. C\u00f3 m\u1ed1i quan h\u1ec7 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa li\u1ec1u v\u00e0 AUCtf sau khi d\u00f9ng ribavirin li\u1ec1u \u0111\u01a1n 200-1200 mg. \u0110\u1ed9 thanh th\u1ea3i trung b\u00ecnh c\u1ee7a ribavirin th\u1ea5y r\u00f5 sau khi u\u1ed1ng Copegus li\u1ec1u \u0111\u01a1n 600,mg trong kho\u1ea3ng t\u1eeb 22 \u0111\u1ebfn 29 l\u00edt\/gi\u1edd. Th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 kho\u1ea3ng 4500 l\u00edt sau khi d\u00f9ng Copegus. Ribavirin kh\u00f4ng g\u1eafn k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng.<\/p>\n<p>T\u00e1c \u0111\u1ed9ng c\u1ee7a th\u1ee9c \u0103n<\/p>\n<p>\u0110\u1ed9 kh\u1ea3 d\u1ee5ng sinh h\u1ecdc c\u1ee7a Copegus li\u1ec1u \u0111\u01a1n 600 mg t\u0103ng khi d\u00f9ng trong b\u1eefa \u0103n c\u00f3 nhi\u1ec1u ch\u1ea5t b\u00e9o. C\u00e1c th\u00f4ng s\u1ed1 v\u1ec1 n\u1ed3ng \u0111\u1ed9 c\u1ee7a ribavirin 14 AUC(0-192h) v\u00e0 Cmmax t\u0103ng kho\u1ea3ng 42% v\u00e0 665%, theo th\u1ee9 t\u1ef1, khi Copegus\u0111\u01b0\u1ee3c d\u00f9ng c\u00f9ng v\u1edbi b\u1eefa \u0103n s\u00e1ng nhi\u1ec1u ch\u1ea5t b\u00e9o so v\u1edbi d\u00f9ng c\u00f9ng v\u1edbi b\u1eefa \u0103n chay. S\u1ef1 li\u00ean quan v\u1ec1 l\u00e2m s\u00e0ng gi\u1eefa k\u1ebft qu\u1ea3 v\u00e0 nghi\u00ean c\u1ee9u li\u1ec1u \u0111\u01a1n n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft. N\u1ed3ng \u0111\u1ed9 c\u1ee7a ribavirin sau khi d\u00f9ng \u0111a li\u1ec1u c\u00f9ng v\u1edbi th\u1ee9c \u0103n \u0111\u01b0\u1ee3c so s\u00e1nh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng peginterferon \u03b1-2a v\u00e0 Copegus v\u00e0 interferon \u03b1-2b v\u00e0 ribavirin. \u0110\u1ec1 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 ribavirin huy\u1ebft t\u01b0\u01a1ng t\u1ed1i \u0111a, n\u00ean d\u00f9ng ribavirin c\u00f9ng v\u1edbi th\u1ee9c \u0103n.<\/p>\n<p><em>Ph\u00e2n b\u1ed1<\/em><\/p>\n<p>Ribavirin cho th\u1ea5y n\u00f3 c\u00f3 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc thay \u0111\u1ed5i ngay trong m\u1ed9t c\u00e1 th\u1ec3 v\u00e0 gi\u1eefa c\u00e1c c\u00e1 th\u1ec3 sau khi d\u00f9ng Copegus li\u1ec1u \u0111\u01a1n (s\u1ef1 thay \u0111\u1ed5i trong m\u1ed9t c\u00e1 th\u1ec3 \u2264 25% cho c\u1ea3 AUC v\u00e0 Cmmax), \u0111i\u00eau n\u00e0y c\u00f3 th\u1ec3 do s\u1ef1 chuy\u1ec3n h\u00f3a b\u01b0\u1edbc \u0111\u1ea7u \u1edf ph\u1ea1m vi r\u1ed9ng v\u00e0 di chuy\u1ec3n trong v\u00e0 ngo\u00e0i khoang m\u00e1u.<\/p>\n<p>S\u1ef1 v\u1eadn chuy\u1ec3n ribavirin trong c\u00e1c khoang kh\u00f4ng ph\u1ea3i huy\u1ebft t\u01b0\u01a1ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch r\u1ed9ng rai trong c\u00e1c t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u, v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 ch\u1ee7 y\u1ebfu qua c\u00e1c ch\u1ea5t v\u1eadn chuy\u1ec3n nucleoside c\u00f3 t\u00ednh c\u00e2n b\u1eb1ng lo\u1ea1i es. Lo\u1ea1i ch\u1ea5t v\u1eadn chuy\u1ec3n n\u00e0y c\u00f3 m\u1eb7t h\u1ea7u nh\u01b0 \u1edf t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o v\u00e0 c\u00f3 th\u1ec3 chi\u1ebfm th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 l\u1edbn c\u1ee7a ribavirin.T\u1ec9 l\u1ec7 c\u1ee7a m\u00e1u to\u00e0n b\u1ed9: n\u1ed3ng \u0111\u1ed9 ribavirin huy\u1ebft t\u01b0\u01a1ng l\u00e0 kho\u1ea3ng 60: 1; L\u01b0\u1ee3ng th\u1eeba c\u1ee7a ribavirin trong m\u00e1u to\u00e0n b\u1ed9 t\u1ed3n t\u1ea1i d\u01b0\u1edbi d\u1ea1ng nucleotide ribavirin \u1ea9n trong c\u00e1c h\u1ed3ng c\u1ea7u.<\/p>\n<p><em>Chuy\u1ec3n ho\u00e1<\/em><\/p>\n<p>Ribavirin c\u00f3 hai con \u0111\u01b0\u1eddng chuy\u1ec3n h\u00f3a: 1) con \u0111\u01b0\u1eddng phosphoryl h\u00f3a c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c, 2) con \u0111\u01b0\u1eddng tho\u00e1i h\u00f3a bao g\u1ed3m deribosyl h\u00f3a v\u00e0 s\u1ef1 th\u1ee7y ph\u00e2n amit \u0111\u1ec3 sinh ra ch\u1ea5t chuy\u1ec3n h\u00f3a triazole carboxyacid. Ribavirin v\u00e0 hai ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3 l\u00e0 triazole carboxamide v\u00e0 triazole carboxylic acid \u0111\u1ec1u \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i b\u1edfi th\u1eadn.<\/p>\n<p>Sau khi d\u00f9ng \u0111a li\u1ec1u, ribavirin t\u00edch l\u0169y nhi\u1ec1u trong huy\u1ebft t\u01b0\u01a1ng v\u1edbi AUC12 gi\u1edd sau khi d\u00f9ng \u0111a li\u1ec1u g\u1ea5p 6 l\u1ea7n AUC12gi\u1edd sau khi d\u00f9ng li\u1ec1u \u0111\u01a1n d\u1ef1a v\u00e0o c\u00e1c t\u00e0i li\u1ec7u nghi\u00ean c\u1ee9u. Sau khi u\u1ed1ng li\u1ec1u 600 mg hai l\u1ea7n m\u1ed9t ng\u00e0y, n\u1ed3ng \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh \u0111\u1ea1t \u0111\u01b0\u1ee3c sau kho\u1ea3ng 4 tu\u1ea7n, v\u1edbi n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng trung b\u00ecnh \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh v\u00e0o kho\u1ea3ng 2200 ng\/ml.<\/p>\n<p><em>\u0110\u00e0o th\u1ea3i<\/em><\/p>\n<p>Sau khi ng\u1eebng d\u00f9ng thu\u1ed1c, th\u1eddi gian b\u00e1n th\u1ea3i v\u00e0o kho\u1ea3ng 300 gi\u1edd, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 ph\u1ea3n \u00e1nh s\u1ef1 \u0111\u1ea3o th\u1ea3i ch\u1eadm t\u1eeb c\u00e1c khoang kh\u00f4ng ph\u1ea3i huy\u1ebft t\u01b0\u01a1ng.<\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t<\/p>\n<p><em>B\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn:<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin sau khi d\u00f9ng li\u1ec1u \u0111\u01a1n b\u1ecb thay \u0111\u1ed5i (t\u0103ng AUtf v\u00e0 C\u00admax) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n nh\u00f3m ch\u1ee9ng c\u00f3 \u0111\u1ed9 thanh th\u1ea3i cao h\u01a1n 90 ml\/ph\u00fat. \u0110\u1ed9 thanh th\u1ea3i c\u1ee7a ribavirin sau khi u\u1ed1ng gi\u1ea3m nhi\u1ec1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 h\u00e0m l\u01b0\u1ee3ng creatinine huy\u1ebft thanh &gt; 2 mg\/dl ho\u1eb7c \u0111\u1ed9 thanh th\u1ea3i creatinin &lt; 50 ml\/ph\u00fat. Kh\u00f4ng \u0111\u1ee7 s\u1ed1 li\u1ec7u v\u1ec1 \u0111\u1ed9 an to\u00e0n v\u00e0 t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a ribavirin \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y v\u00e0 v\u00ec th\u1ebf, ph\u1ea3i r\u1ea5t th\u1eadn tr\u1ecdng khi d\u00f9ng Copegus v\u00e0 c\u00f3 h\u00e0nh \u0111\u1ed9ng th\u00edch h\u1ee3p bao g\u1ed3m ng\u1eebng thu\u1ed1c ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc n\u1ebfu xu\u1ea5t hi\u1ec7n c\u00e1c ph\u1ea3n \u1ee9ng ngo\u1ea1i \u00fd. N\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a ribavirin v\u1ec1 c\u01a1 b\u1ea3n kh\u00f4ng thay \u0111\u1ed5i b\u1edfi s\u1ef1 l\u1ecdc m\u00e1u.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan:<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin li\u1ec1u \u0111\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan nh\u1eb9, trung b\u00ecnh v\u00e0 n\u1eb7ng l\u00e0 t\u01b0\u01a1ng t\u1ef1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a nh\u1eefng ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p><em>Ng\u01b0\u1eddi gi\u00e0 (\u2265 65 tu\u1ed5i)<\/em><\/p>\n<p>C\u00e1c \u0111\u00e1nh gi\u00e1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc chuy\u00ean bi\u1ec7t cho nh\u1eefng ng\u01b0\u1eddi l\u1edbn tu\u1ed5i ch\u01b0a \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh. Tuy nhi\u00ean, trong phi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c xu\u1ea5t b\u1ea3n v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc d\u00e2n s\u1ed1, tu\u1ed5i kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng trong \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin; ch\u1ee9c n\u0103ng th\u1eadn l\u00e0 y\u1ebfu t\u1ed5 quy\u1ebft \u0111\u1ecbnh.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n d\u01b0\u1edbi 18 tu\u1ed5i:<\/em><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc chuy\u00ean bi\u1ec7t ch\u01b0a \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 18 tu\u1ed5i. Copegus ph\u1ed1i h\u1ee3p v\u1edbi peginterferon \u03b1-2a ho\u1eb7c interferon \u03b1-2a \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho vi\u00eam gan C m\u1ea1n t\u00ednh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eeb 18 tu\u1ed5i tr\u1edf l\u00ean.<\/p>\n<p><em>Ch\u1ee7ng t\u1ed9c:<\/em><\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf 42 ng\u01b0\u1eddi cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng v\u1ec1 \u0111\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ribavirin gi\u1eefa nh\u1eefng ch\u1ee7ng t\u1ed9c ng\u01b0\u1eddi da \u0111en (n=14), ch\u1ee7ng t\u1ed9c ng\u01b0\u1eddi T\u00e2y Ban Nha v\u00e0 B\u1ed3 \u0110\u00e0o Nha (n=13) v\u00e0 ch\u1ee7ng t\u1ed9c ng\u01b0\u1eddi da tr\u1eafng (n=15).<\/p>\n<p><strong>5.3 Gi\u1ea3i th\u00edch: <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong>5.4 Thay th\u1ebf thu\u1ed1c : <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong><em>*L\u01b0u \u00fd:<\/em><\/strong><\/p>\n<p><strong><em>C\u00e1c th\u00f4ng tin v\u1ec1 thu\u1ed1c tr\u00ean Pharmog.com ch\u1ec9 mang t\u00ednh ch\u1ea5t tham kh\u1ea3o &#8211; Khi d\u00f9ng thu\u1ed1c c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tu\u00e2n theo theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u00e1c s\u0129 <\/em><\/strong><\/p>\n<p><strong><em>Ch\u00fang t\u00f4i kh\u00f4ng ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 b\u1ea5t c\u1ee9 h\u1eadu qu\u1ea3 n\u00e0o x\u1ea3y ra do t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c d\u1ef1a theo c\u00e1c th\u00f4ng tin tr\u00ean Pharmog.com<\/em><\/strong><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<\/strong><\/p>\n<p><strong>6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<\/strong><\/p>\n<p>T\u00e1 d\u01b0\u1ee3c vi\u00ean n\u00e9n:<\/p>\n<p>L\u00f5i vi\u00ean thu\u1ed1c:<\/p>\n<p>Pregelatinised starch, sodium starch glycolate, microcrystalline cellulose, maize starch, magnesium stearate.<\/p>\n<p>Bao phim:<\/p>\n<p>Hypromellose, talc, titanium dioxide (E171), yellow iron oxide (E172), red iron oxide (E172), ethylcellulose aqueous dispersion, triacetin.<\/p>\n<p><strong>6.2. T\u01b0\u01a1ng k\u1ef5 :<\/strong><\/p>\n<p>Kh\u00f4ng \u00e1p d\u1ee5ng.<\/p>\n<p><strong>6.3. B\u1ea3o qu\u1ea3n: <\/strong><\/p>\n<p>Copegus \u0111\u01b0\u1ee3c \u0111\u1ef1ng trong l\u1ecd nh\u1ef1a polyethylene t\u1ef7 tr\u1ecdng cao (HDPE) v\u1edbi n\u1eafp xo\u00e1y polypropylene ng\u0103n c\u1ea3n tr\u1ebb em th\u00e1o m\u1edf.<\/p>\n<p>Kh\u00f4ng b\u1ea3o qu\u1ea3n thu\u1ed1c \u1edf tr\u00ean 30\u00b0C.<\/p>\n<p><strong>6.4. Th\u00f4ng tin kh\u00e1c :<\/strong><\/p>\n<p>\u0110\u1ed8 AN TO\u00c0N TI\u1ec0N L\u00c2M S\u00c0NG<\/p>\n<p><em>T\u00ednh g\u00e2y ung th\u01b0<\/em><\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 t\u00ednh g\u00e2y ung th\u01b0 \u1edf chu\u1ed9t nh\u1eaft 53 (+\/-) v\u00e0 m\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 t\u00ednh g\u00e2y ung th\u01b0 2 n\u0103m \u1edf chu\u1ed9t t\u1ea1i li\u1ec1u l\u00ean t\u1edbi li\u1ec1u t\u1ed1i \u0111a \u0111\u01b0\u1ee3c dung n\u1ea1p l\u00e0 100 mg\/kg\/ng\u00e0y v\u00e0 60 mg\/kg\/ng\u00e0y, theo th\u1ee9 t\u1ef1, ribavirin kh\u00f4ng l\u00e0 ch\u1ea5t g\u00e2y ung th\u01b0. D\u1ef1a v\u00e0o di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t c\u01a1 th\u1ec3, nh\u1eefng li\u1ec1u n\u00e0y kho\u1ea3ng b\u1eb1ng 0,5 v\u00e0 0,6 l\u1ea7n li\u1ec1u ribavirin t\u1ed1i \u0111a 24 gi\u1edd \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n<p><em>S\u1ef1 suy gi\u1ea3m kh\u1ea3 n\u0103ng sinh s\u1ea3n<\/em><\/p>\n<p>Trong nh\u1eefng nghi\u00ean c\u1ee9u nh\u1eafc l\u1ea1i li\u1ec1u \u1edf chu\u1ed9t \u0111\u1ec3 ch\u1ee9ng minh t\u00e1c \u0111\u1ed9ng l\u00ean tinh d\u1ecbch v\u00e0 tinh ho\u00e0n g\u00e2y ra b\u1edfi ribavirin, nh\u1eefng b\u1ea5t th\u01b0\u1eddng c\u1ee7a tinh d\u1ecbch x\u1ea3y ra \u1edf \u0111\u1ed9ng v\u1eadt v\u1edbi li\u1ec1u th\u00e1p h\u01a1n li\u1ec1u \u0111i\u1ec1u tr\u1ecb. Sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb, v\u1ec1 c\u01a1 b\u1ea3n to\u00e0n b\u1ed9 s\u1ef1 nhi\u1ec5m \u0111\u1ed9c l\u00ean tinh ho\u00e0n do ribavirin h\u1ed3i ph\u1ee5c trong m\u1ed9t ho\u1eb7c hai chu k\u1ef3 sinh tinh.<\/p>\n<p><em>C\u00e1c t\u00e1c \u0111\u1ed9ng kh\u00e1c<\/em><\/p>\n<p>H\u1ed3ng c\u1ea7u l\u00e0 \u0111\u00edch \u0111\u1ea7u ti\u00ean c\u1ee7a s\u1ef1 nhi\u1ec5m \u0111\u1ed9c ribavirin trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed9ng v\u1eadt. Thi\u1ebfu m\u00e1u x\u1ea3y ra ngay sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c, nh\u01b0ng nhanh ch\u00f3ng h\u1ed3i ph\u1ee5c sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u nhi\u1ec5m \u0111\u1ed9c gen \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng ribavirin c\u00f3 m\u1ed9t v\u00e0i ho\u1ea1t t\u00ednh nhi\u1ec5m \u0111\u1ed9c gen. Ribavirin c\u00f3 ho\u1ea1t t\u00ednh \u1edf in-vitro trong th\u1eed nghi\u1ec7m bi\u1ebfn \u0111\u00f4i. Ho\u1ea1t t\u00ednh nhi\u1ec5m \u0111\u1ed9c gen \u0111\u01b0\u1ee3c quan s\u00e1t \u1edf in-vivo th\u1eed nghi\u1ec7m nh\u00e2n nh\u1ecf chu\u1ed9t. Nghi\u1ec7m ph\u00e1p g\u00e2y ch\u1ebft ph\u00f4i \u1edf chu\u1ed9t l\u00e0 \u00e2m t\u00ednh, ch\u1ec9 ra r\u1eb1ng n\u1ebfu \u0111\u1ed9t bi\u1ebfn gen x\u1ea3y ra \u1edf chu\u1ed9t ch\u00fang kh\u00f4ng truy\u1ec1n qua giao t\u1eed \u0111\u1ef1c. C\u00f3 th\u1ec3 kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng nguy c\u01a1 g\u00e2y ung th\u01b0 cho ng\u01b0\u1eddi.<\/p>\n<p>D\u00f9ng ribavirin k\u1ebft h\u1ee3p v\u1edbi peginterferon \u03b1-2a kh\u00f4ng ph\u00e1t sinh b\u1ea5t c\u1ee9 \u0111\u1ed9c t\u00ednh kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00f4ng ch\u1edd n\u00e0o \u1edf kh\u1ec9. Thay \u0111\u1ed5i ch\u1ee7 y\u1ebfu c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 quay ng\u01b0\u1ee3c l\u1ea1i t\u1eeb thi\u1ebfu m\u00e1u nh\u1eb9 \u0111\u1ebfn thi\u1ebfu m\u00e1u v\u1eeba, m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a thay \u0111\u1ed5i n\u00e0y l\u1edbn h\u01a1n m\u1ee9c \u0111\u1ed9 g\u00e2y b\u1edfi t\u1eebng ch\u1ea5t m\u1ed9t.<\/p>\n<p><strong>6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>Ho\u1eb7c HDSD Thu\u1ed1c.<\/p>\n<p><strong>7. Ng\u01b0\u1eddi \u0111\u0103ng t\u1ea3i \/T\u00e1c gi\u1ea3:<\/strong><\/p>\n<p>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c s\u01b0u t\u1ea7m ho\u1eb7c vi\u1ebft b\u1edfi: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-tac-gia-bac-sy-do-my-linh\/\">B\u00e1c s\u0129 nhi khoa &#8211; \u0110\u1ed7 M\u1ef9 Linh.<\/a><\/p>\n<p>Ki\u1ec3m duy\u1ec7t , hi\u1ec7u \u0111\u00ednh v\u00e0 \u0111\u0103ng t\u1ea3i: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-ve-pharmog-team\/\">PHARMOG TEAM<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c Copegus l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Copegus (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;) 1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: Ho\u1ea1t ch\u1ea5t : Ribavirin Ph\u00e2n lo\u1ea1i: Thu\u1ed1c kh\u00e1ng virus. Nh\u00f3m ph\u00e1p [&hellip;]<\/p>\n","protected":false},"author":8612,"featured_media":29532,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[419],"tags":[1136],"class_list":["post-29531","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-biet-duoc","tag-ribavirin"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/29531","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/8612"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=29531"}],"version-history":[{"count":3,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/29531\/revisions"}],"predecessor-version":[{"id":46277,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/29531\/revisions\/46277"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/29532"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=29531"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=29531"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=29531"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}