µ²ºc¦¡ |
|
Ryzodeg(insulin degludec»Pinsulin aspart°w¾¯)¬O¤@ºØ§t70% insulin degludec¤Î30% insulin aspartªº¤HÃþ¯Ø®q¯ÀÃþ¦üª«·»²G¡A¥Î©ó¥Ö¤Uª`®g¡CInsulin degludec (ÄÝ©óªø®Ä«¬¯Ø®q¯À)©Minsulin aspart (ÄÝ©ó³t®Ä«¬¯Ø®q¯À)ªº§@¥Î§¡¬°«D¤fªA°¦å¿}ÃĪ«¡C
Insulin degludec»P¤HÃþ¯Ø®q¯Àªº¤£¦P³B¦b©ó¯Ê¤ÖB30¦ì¸mªºÓi°ò»ÄĬÓi»Ä(threonine)¡A¨Ã±µ¤W§t¾¢Ói»Ä(glutamic acid)¤ÎC16¯×ªÕ»Äªº°¼Ãì(¤Æ¾Ç¦W¡GLysB29 (N£`-hexadecandioyl-£^-Glu) des (B30)¤HÃþ¯Ø®q¯À)¡A¬O¦bSaccharomyces cerevisiae¤¤¥H«²ÕDNA§Þ³N»s¦¨¡C
Insulin degludecªº¤À¤l¦¡¬°C274H411N65O81S6¡A¤À¤l¶q¬°6103.97¡C Insulin aspart»P±`³W¤HÃþ¯Ø®q¯À¦P·½¡A¥u¦³¦bB28¦ì¸m¤§Ói°ò»Ä¥Ñ²ãÓi»Ä(proline)¸m´«¦¨¤Ñªù¥VÓi»Ä(aspartic acid)¡A¬O¦bSaccharomyces cerevisiae¤¤¥H«²ÕDNA§Þ³N»s¦¨¡CInsulin aspartªº¤À¤l¦¡¬°C256H381N65O79S6¡A¤À¤l¶q¬°5825.8¡C
|
UpToDate |
UpToDate ³sµ²
|
ÃIJz§@¥Î |
|
¯Ø®q¯À(¥]¬ARyzodeg)ªº¥Dn¬¡©Ê¬°½Õ¸`¸²µå¿}¥NÁ¡C¯Ø®q¯À¤Î¨äÃþ¦üª«·|¨ë¿E©PÃ串µå¿}§l¦¬(¤×¨ä¬O°©Àf¦Ù¤Î¯×ªÕ)¤Î§í¨î¨xŦ¸²µå¿}¥Í¦¨¦Ó°§C¦å¿}¡C¯Ø®q¯À¤]·|§í¨î¯×ªÕ¤ô¸Ñ©M³J¥Õ½è¤ô¸Ñ¡A¨Ã«P¶i³J¥Õ½è¦X¦¨¡CRyzodeg¤¤ªºinsulin degludec¦¨¤Àª`®g¨ì¥Ö¤U²Õ´«á·|§Î¦¨¦h¤»»EÅé¡A²£¥Í¥Ö¤Uinsulin degludec¹Î¡CRyzodeg«ù¤[ªº®É¶¡§@¥Î¯S©Ê¡A¥Dn¬O¥Ñ©óinsulin degludec±q¥Ö¤U²Õ´§l¦¬¶i¤J¥þ¨´`Àôªº®É¶¡¦³©µ¿ð¡A¸û¤Ö¤@³¡¤À¬O¥Ñ©óinsulin degludec·|»P´`Àô¥Õ³J¥Õµ²¦X¡CInsulin aspart³æÅé·|¨³³tÄÀ©ñ¶i¤J´`Àô¤¤¡C
|
¾AÀ³¯g |
|
¾A¥Î©ó¤@·³¥H¤W¿©±w¿}§¿¯f¯f¤H¡A¥H§ïµ½¦å¿}±±¨î¡C
|
¥Îªk¥Î¶q |
|
(1) ª`®gRyzodeg¨ì¤j»L¡B¤WÁu©Î¸¡³¡ªº¥Ö¤U¡C (2) ¹ï©ó¦¨¤H¯f¤H¡A¨C¤Ñ1¦¸©Î2¦¸©ó¥ô¦ó¥¿À\®É¥Ö¤Uª`®g¥»«~¡F¹ï©ó¨àµ£¤Î«C¤Ö¦~¯f¤H¡A¨C¤Ñ1¦¸©ó¥ô¦ó¥¿À\®É¡C (3) ¦b¨ä¥L¥¿À\®Éµø»Ýn§ë¤©³t®Ä«¬©Îµu®Ä«¬¯Ø®q¯À¡C (4) ®Ú¾Ú¯f¤HÓ¤Hªº¥NÁ»ݨD¡B¦å¿}ºÊ´úµ²ªG¤Î¦å¿}±±¨î¥Ø¼Ð³]p¨Ã½Õ¾ãRyzodegªº¾¯¶q¡C (5) ®Ú¾Ú¦À\«e(ªÅ¸¡)¦å¿}´ú¶qȽվãRyzodeg¾¯¶q¡C (6) «Øij¨C¦¸¼W¥[¾¯¶qÀ³¶¡¹j3¦Ü4¤Ñªº®É¶¡¡C (7) ¥i¯à»ÝnÀHµÛÅé¯à¬¡°Ê§ïÅÜ¡B¥ÎÀ\«¬ºA§ïÅÜ(¥ç§Y¥¨¶qÀç¾i¯À§t¶q©Î¹ª«Äá¨úªº®É¶¡)¡BµÇŦ©Î¨xŦ¥\¯à§ïÅܩΦb«æ©Ê¯e¯f´Á¶¡½Õ¾ã¾¯¶q¡A¥H°§C§C¦å¿}©Î°ª¦å¿}ªº·ÀI¡C ¥Î©ó¤£´¿±µ¨ü¯Ø®q¯ÀªvÀø¯f¤Hªº°_©l¾¯¶q ²Ä1«¬¿}§¿¯f ¦b¤£´¿±µ¨ü¯Ø®q¯ÀªvÀøªº²Ä1«¬¿}§¿¯f¤HªÌ¡A«ØijªºRyzodeg°_©l¾¯¶q¬ù¬°¨C¤é¯Ø®q¯ÀÁ`¾¯¶qªº1/3¦Ü1/2¡C¨ä¾lªº¨C¤é¯Ø®q¯ÀÁ`¾¯¶q«hÀ³§ë¤©µu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¡A¨Ã©ó¨C¤é¤TÀ\¤À¦¸§ë¤©¡C¤@¯ë±¡ªp¤U¡A¦b¤£´¿±µ¨ü¯Ø®q¯ÀªvÀøªº²Ä1«¬¿}§¿¯f¤HªÌ¡A¥i¨Ï¥Î¨C¤½¤çÅé«0.2¦Ü0.4³æ¦ì¯Ø®q¯À¨Ópºâªì©lªvÀøªº¨C¤é¯Ø®q¯ÀÁ`¾¯¶q¡C ²Ä2«¬¿}§¿¯f ¦b¤£´¿±µ¨ü¯Ø®q¯ÀªvÀøªº²Ä2«¬¿}§¿¯f¤HªÌ¡A«ØijªºRyzodeg°_©l¾¯¶q¬°10³æ¦ì¨C¤Ñ1¦¸¡C ¥Î©ó¤w±µ¨ü¹w²V(premix)©Î¦Û²V(self-mix)¯Ø®q¯À¨C¤Ñ1¦¸©Î2¦¸(³æ¿WªvÀø©Î¨C¤é¦h¦¸ª`®g¤§Àøµ{ªº¤@³¡¤À)¤§²Ä1«¬©Î²Ä2«¬¿}§¿¯f¤HªÌªº°_©l¾¯¶q ²Ä1«¬¿}§¿¯f»P²Ä2«¬¿}§¿¯fªº¦¨¤H¯f¤H¡G ¨Ï¥Î»P¹w²V©Î¦Û²V¯Ø®q¯À¬Û¦Pªº¾¯¶q³æ¦ì¼Æ©Mª`®g®Éµ{¶}©lRyzodegªvÀø¡C¦P®É©óÀ\®É¨Ï¥Îµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯Àªº¯f¤H¡A¦b¤£ª`®gRyzodegªº¥¿À\®ÉÄ~Äò¨Ï¥Î¬Û¦P¾¯¶qªºµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¡C ²Ä1«¬¿}§¿¯f©Î²Ä2«¬¿}§¿¯fªº¨àµ£¯f¤H(¤@·³¥H¤W)¡G ¥H²V¦X«¬¯Ø®q¯À¨C¤éÁ`¾¯¶q80%ªº¾¯¶q³æ¦ì¼Æ¶}©lRyzodegªvÀø¡A¥HÁקK§C¦å¿}·ÀI¡C¨C¤Ñ1¦¸¨Ö¥¿À\¨Ï¥Î¡C¦P®É©óÀ\®É¨Ï¥Îµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯Àªº¯f¤H¡A¦b¤£ª`®gRyzodegªº¥¿À\®ÉÄ~Äò¨Ï¥Î¬Û¦P¾¯¶qªºµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¡C ¥Î©ó¤w±µ¨ü¨Ï¥Î°ò¦¯Ø®q¯À¨C¤Ñ1¦¸©Î2¦¸(³æ¿WªvÀø©Î¨C¤é¦h¦¸ª`®g¤§Àøµ{ªº¤@³¡¤À)¤§²Ä1«¬©Î²Ä2«¬¿}§¿¯f¤HªÌªº°_©l¾¯¶q ²Ä1«¬¿}§¿¯f»P²Ä2«¬¿}§¿¯fªº¦¨¤H¯f¤H¡G ±q¶È§t°ò¦¯Ø®q¯À¨C¤Ñ1¦¸©Î2¦¸³æ¿WªvÀøÀøµ{Âà´«ªvÀøªº²Ä2«¬¿}§¿¯f¤HªÌ¡A¥H¬Û¦P¾¯¶q³æ¦ì¼Æ©Mª`®g®Éµ{¶}©lRyzodegªvÀø¡C¹ï©ó±q°ò¦¯Ø®q¯À¨C¤Ñ1¦¸Âà´«¬°Ryzodeg¨C¤Ñ1¦¸ªº¯f¤H¡A¥Ñ©óRyzodeg§t³t®Ä«¬¯Ø®q¯À¦¨¤À¡AÀ³©ó¶}©lªvÀø«áºÊ´ú¦å¿}¡C ±q§t°ò¦¯Ø®q¯À¤ÎÀ\®É¨Ï¥Îµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¤§¨C¤Ñ¦h¦¸ª`®gÀøµ{Âà´«ªvÀøªº¯f¤H¡A©ó¥¿À\®É¨Ï¥Î»P°ò¦¯Ø®q¯À¬Û¦Pªº¾¯¶q³æ¦ì¼Æ¶}©lRyzodegªvÀø¡C¦b¤£ª`®gRyzodegªº¥¿À\®É¡AÄ~Äò¨Ï¥Î¬Û¦P¾¯¶qªºµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¡C ²Ä1«¬¿}§¿¯f©Î²Ä2«¬¿}§¿¯fªº¨àµ£¯f¤H(¤@·³¥H¤W)¡G ¥Hªø®Ä«¬©Î¤¤®Ä«¬¯Ø®q¯À¨C¤éÁ`¾¯¶q80%ªº¾¯¶q³æ¦ì¼Æ¶}©lRyzodegªvÀø¡A¥HÁקK§C¦å¿}·ÀI¡C¨C¤Ñ1¦¸¨Ö¥¿À\¨Ï¥Î¡C¦P®É©óÀ\®É¨Ï¥Îµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯Àªº¯f¤H¡A¦b¤£ª`®gRyzodegªº¥¿À\®ÉÄ~Äò¨Ï¥Î¬Û¦P¾¯¶qªºµu®Ä«¬©Î³t®Ä«¬¯Ø®q¯À¡C
|
ÃİʤO¾Ç |
|
ÃĮľǷ§ªp¤D¬O³t®Ä«¬insulin aspart©Mªø®Ä«¬insulin degludecªº§@¥Î·§ªp¡C
§l¦¬ ¬°²Ä1«¬¿}§¿¯f¤Î²Ä2«¬¿}§¿¯f¤HªÌ§ë¤©0.4¡B0.6¤Î0.8 units/kg Ryzodeg¤§³æ¾¯¥Ö¤U¾¯¶q«á¡A¿@«×¡Ð®É¶¡·§ªpÅã¥ÜRyzodegªº¨âºØ¦¨¤À(insulin degludec¤Îinsulin aspart)¾¯¶q¼W¥[®É¼ÉÅS¶q¥ç¤É°ª¡C ¬°²Ä1«¬¿}§¿¯f¤Î²Ä2«¬¿}§¿¯f¤HªÌ§ë¤©Ryzodegªº³æ¾¯¥Ö¤U¾¯¶q«á¡AInsulin aspartªº³Ì¤j¿@«×(Cmax)«ö¾¯¶q¤ñ¨Ò¼W¥[¡A¾ãÅé¼ÉÅS¶qAUC0-12h«h²¤·L°ª©ó¾¯¶q¤ñ¨Ò¼W¥[¡C ¬°²Ä1«¬¿}§¿¯f¤Î²Ä2«¬¿}§¿¯f¤HªÌ§ë¤©Ryzodeg®ªº³æ¾¯¥Ö¤U¾¯¶q«á¡AInsulin degludecªºCmax©MAUC0-120h§¡«ö¾¯¶q¤ñ¨Ò¼W¥[¡C Insulin aspart¦¨¤À¶}©l¥X²{ªº®É¶¡¤¤¦ì¼Æ¬°ª`®g«á14¤ÀÄÁ¡A72¤ÀÄÁ«á¹F¨ì³Ì°ª¿@«×¡CRyzodeg ªºinsulin degludec¦¨¤À¦b§ë¤©¾¯¶q«á3¦Ü4¤Ñ¹F¨ìéwª¬ºA¦å²M¿@«×¡C ¤À§G ¦b¤HÅé¦å¼ß¤¤¡AInsulin degludec¹ï¦å²M¥Õ³J¥Õªº¿Ë¦X¤O¹F¨ì> 99%ªº¦å¼ß³J¥Õ½èµ²¦X²v¡CInsulin aspart»P±`³W¤HÃþ¯Ø®q¯ÀÃþ¦ü¡A¹ï¦å¼ß³J¥Õ½èªºµ²¦X²v«Ü§C¡A< 10%¡C ²M°£ ¥Ö¤U§ëÃī᪺¥b°I´Á¥Dn¬O³z¹L±q¥Ö¤U²Õ´§l¦¬ªº³t²v§P©w¡Céwª¬ºA¤U°ò¦¦¨¤À(insulin degludec)ªº¥b°I´Á¬ù¬°25¤p®É¡A»P¾¯¶qµLÃö¡CInsulin degludecªº¤À¸Ñ»P¤HÃþ¯Ø®q¯Àªº¤À¸ÑÃþ¦ü¡F§Î¦¨ªº©Ò¦³¥NÁ²£ª«§¡µL¬¡©Ê¡C
|
°Æ§@¥Î |
|
§C¦å¿}¡B¹L±Ó¤ÏÀ³¡Bª`®g³¡¦ì¤ÏÀ³¡C
|
¥æ¤¬§@¥Î |
|
¥i¯à¼W¥[§C¦å¿}·ÀIªºÃĪ«: §Ü¿}§¿¯fÃĪ«¡B¦åºÞ¦¬ÁY¯ÀÂà¤Æ酶§í¨î¾¯(ACE Inhibitor)¡B¦åºÞ¦¬ÁY¯ÀII¨üÅéªýÂ_¾¯(angiotensin II receptor blocking agents)¡Bdisopyramide¡Bfibrates¡Bfluoxetine¡B³æÓi®ñ¤Æ酶§í¨î¾¯(monoamine oxidase inhibitors)¡Bpentoxifylline¡Bpramlintide¡Bpropoxyphene¡B¤ô·¨»ÄÆQ¡BÅé§í¯À(somatostatin)Ãþ¦üª«(¦poctreotide)¤ÎÁDÓiÃþ§Ü¥Í¯À¡BÃþ¤É¿}¯ÀÐ`肽1 (GLP-1)¨üÅé«P¶i¾¯¡BDPP-4§í¨î¾¯¡B¶u¡Ð¸²µå¿}¦@¦PÂà¹B³J¥Õ2 (SGLT-2)§í¨î¾¯¡C Ryzodeg»P³o¨ÇÃĪ«¨Ö¥Î®É¡A¥i¯à»Ýn°§C¾¯¶q¨Ã´£°ª¦å¿}ºÊ´úÀW²v¡C
|
¸T§Ò |
|
¸T¥Î©ó¡G §C¦å¿}µo§@®É¡C „H ¹ïRyzodeg©Î¨ä¥ô¤@ºØ½á§Î¾¯¹L±Óªº¯f¤H¡C
¨Ï¥Î¨î: ¤£«Øij¥Î©óªvÀø¿}§¿¯f଻Ĥ¤¬r¡C ¤£«Øij¥Î©ó»Ýn¤p©ó5Ó³æ¦ìRyzodegªº¨àµ£¯f¤H¡C
|
µ¹¥I³W©w |
|
¨Ï¥Î±ø¥ó¡G(105/5/1) (1) ì«h¤W²Ä¤G«¬¿}§¿¯fªvÀøÀ³Àu¥ý¨Ï¥Îmetformin¡A©Î¦Ò¼{¦´Á¶}©l¨Ï¥Î¯Ø®q¯À¡C°£¦³¹L±Ó¡B¸T§Ò¯g¡B¤£¯à@¨ü©Î¤´µLªk²z·Q±±¨î¦å¿}ªº±¡§Î¤U¡A¥i¨Ï¥Î¨ä¥LÃþ¤fªA°¦å¿}ÃĪ«¡C (2) TZD»s¾¯¡BDPP-4§í¨î¾¯¡BSGLT-2§í¨î¾¯¡B¥H¤Î§t¸Ó3Ãþ¦¨¤À¤§½Æ¤è»s¾¯¡A¥Î©ó¤w±µ¨ü¹L³Ì¤j@¨ü¾¯¶qªºmetformin¤´µLªk²z·Q±±¨î¦å¿}¤§²Ä¤G«¬¿}§¿¯f¯f¤H¡A¥BSGLT-2§í¨î¾¯»PDPP-4§í¨î¾¯¤Î¨ä½Æ¤è»s¾¯©y¤GºØ¾Ü¤@ºØ¨Ï¥Î¡C (3) ²Ä¤G«¬¿}§¿¯f¯f¤HÕ©ó¨Ï¥Î¤TºØ¤fªA°¦å¿}ÃĪ«ªvÀø¤´µLªk²z·Q±±¨î¦å¿}ªÌ¡A©y¦Ò¼{µ¹¤©¯Ø®q¯ÀªvÀø¡C (4) ¯S¬ùÂåÀø°|©ÒÀ³¥[±j½Ã±Ð²Ä¤G«¬¿}§¿¯f¯f¤H¡A¹ªÀy°·±d¥Í¬¡«¬ºAªº¶¼¹©M¹B°Ê¡A¦p±±¨îªÎD¡B¨î¼ö¶qÄá¨úµ¥±¹¬I¡C (5) ²Ä¤G«¬¿}§¿¯f¯f¤H¨Ï¥Î¤§¤fªA°¦å¿}ÃĪ«¦¨¤À¡A¥H³Ì¦h¥|ºØ(§t¥|ºØ)¬°¡C ³Æµù¡G¥»³W©w¥Í®Ä«e¤w¨Ï¥Î¶W¹L¥|ºØ¤fªA°¦å¿}ÃĪ«¦¨¤À¤§¯f¤H¡A±oÄ~Äò¨Ï¥ÎìÃĪ«¦ÜÂå®v§ó·s¨ä³B¤è¤º®e¡C
|
ª`·N¨Æ¶µ |
|
¦P¤@°Ï°ì¤º¨C¦¸³£½ü¬yª`®g©ó¤£¦P³¡¦ì¡A¥H°§C¯×ªÕ¥NÁ»Ùê©M§½³¡¥Ö½§Ãþ¾ý¯»¨I¿n¯gªº·ÀI¡C½Ð¤Åª`®g¦Ü¯×ªÕ¥NÁ»Ùê©Î§½³¡¥Ö½§Ãþ¾ý¯»¨I¿n¯gªº³¡¦ì¡C
|
¹L¶q³B²z |
|
¬Û¹ï©ó¹ª«Äá¨ú¡B¯à¶q®ø¯Ó©Î¨âªÌ¦Ó¨Ï¥Î¹L¶q¯Ø®q¯À®É¡A¥i¯à¾ÉP««×¨Ã¥B¦³®É¬°ªø´Á¥B¦M¤Î¥Í©Rªº§C¦å¿}©M§C¦å¹[¯g¡C»´«×§C¦å¿}µo§@³q±`¥i¥H¤fªA¸²µå¿}ªvÀø¡C¥i¯à»Ýn½Õ¾ãÃĪ«¾¯¶q¡B¥ÎÀ\«¬ºA©Î¹B°Ê²ßºD¡C¸û¬°««×ªº§C¦å¿}µo§@¨Öµo©ü°g¡BÅöíw©Î¯«¸g·l¶Ë®É¡A¥i¥H¦Ù¦×/¥Ö¤Uª`®g¤É¿}¯À©ÎÀR¯ß¿éª`¸²µå¿}¿@ÁY²GªvÀø¡C§C¦å¿}¹F¨ìÅãµÛÁ{§É«ì´_«á¡A¥i¯à»ÝnÄ~ÄòÆ[¹î¡A¥H¤ÎÃB¥~Äá¨úºÒ¤ô¤Æ¦Xª«ÁקK§C¦å¿}´_µo¡C§C¦å¹[¯g¥²¶·§´µ½ÁBªv¡C
|
ÃÄ«~«O¦s¤è¦¡ |
|
1. ¥¼¨Ï¥ÎªºÃÄ«~À³§NÂÃ(2-8¢XC)¡A½Ð¤Å§Ná¡C 2. ¨Ï¥Î¤¤ªºÃÄ«~À³§NÂÃ(2-8¢XC)©Î«O¦s©ó«Ç·Å¤U(§C©ó30¢XC)¡A¨ÃÁקKª½±µ¥ú·Ó¤Î¨ü¼ö¡A¶}«Ê«á¥i¨Ï¥Îªø¹F28¤Ñ(4¶g)¡C
|