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瑞宁得（乳腺癌，雌激素，）
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成人(包括老年人)：口服,每日1次,每次1片(1mg).儿童：本药不推荐儿童服用.肾功能损害：轻度至中度肾功能损害患者不用调整剂量.肝功能损害：轻度肝功能损害患者不用调整剂量.对于早期乳腺癌,推荐的疗程为5年.
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适用于绝经后妇女的晚期乳腺癌的治疗.对雌激素受体阴性的病人,若其对他莫昔芬呈现阳性的临床反应,可考虑使用本品.适用于绝经后妇女激素受体阳性的早期乳腺癌的辅助治疗.
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【medical-news】【资讯翻译】瑞宁得是预防乳腺癌的首选药物吗？
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这个帖子发布于3年零121天前，其中的信息可能已发生改变或有所发展。
【认 领 须 知】1、认领翻译的战友请跟帖注明“认领本文翻译，48小时内未完成，请其他战友认领！”2、请根据自己专业背景选择认领，如使用翻译软件翻译，被发现者扣分1-2分3、经常认领而不能及时提供优质稿件者将被列入黑名单，取消认领资格，请大家注意！4、翻译时请参照版规：
5、在首位认领战友未超过规定时间的其他任何认领属违规认领，将不会给予丁当或加分！6、翻译完成后加分（或丁当）的时限为三日，请耐心等待，若超过时限未加者可进行申诉：7、本文题目仅供译者参考，篇幅较长者可申请适当延时8、翻译前请查一下有无重复帖9、为保证翻译质量，每人每天最多只能认领两篇原文链接：Arimidex: Top Drug for Breast Ca Prevention? Should anastrozole (Arimidex) be the top choice in pharmacologic primary prevention of breast cancer, based on presented here? No, said most experts.The aromatase inhibitor cut risk of developing a first primary breast cancer by 53% (2% incidence over 5 years versus 4% on placebo, P&0.0001) in that trial.&We believe these results provide strong support for the use of anastrozole in high-risk postmenopausal women and that it should be the treatment of first choice for such patients,& , of Queen Mary University of London, told attendees in presenting the results at the
(SABCS).Others disagreed.&That's difficult to understand given that we have
that have been shown to be effective, and you're comparison arm was a placebo and neither of those two other agents,& , of the University of Toronto, countered from the audience at the session.Cuzick then backpedaled and said the aromatase inhibitors as a class should be the first choice.Even that was &quite a strong statement,& commented session moderator Fabrice Andre, MD, PhD, of Institut Gustave Roussy in Villejuif, France.&I think it was a little bit of an overstatement,& conference co-chair , toldMedPage Today.&I don't entirely agree [with Cuzick],& added another co-chair, , of the University of Texas Health Science Center at San Antonio. &There should be some community discussion about the drug because there were some things that were kind of glossed over that are pretty well established [such as] side effects.&Comparing ResultsThere's no reason to expect any difference in effect among aromatase inhibitors based on comparisons done in women who already had a first breast cancer, said Osborne, of Baylor College of Medicine in Houston.And in primary prevention specifically, the risk reduction with anastrozole was on par with what was seen with fellow aromatase inhibitor , the researchers acknowledged in reporting the IBIS-II results online in .Those results with those aromatase inhibitors have been stronger than reported with the selective estrogen receptor modulators (SERMs) tamoxifen and , but there are other factors to consider, namely side effect profiles, Osborne pointed out.&I think there's a choice there,& he said in an interview. &I think it's going to depend a lot on the patient, their characteristics, what is their bone health, do they have any pre-existing conditions that would suggest they would have more side effects on an aromatase inhibitor than on tamoxifen ... there are a whole bunch of factors.&The side effects of endometrial cancer and thromboembolism associated with tamoxifen weren't seen with either aromatase inhibitor.Other side effects have been a concern with this class, particularly joint pain, , and vaginal symptoms.&Side effects have always been the major barrier,& Ravdin told MedPage Today.The anastrozole findings suggested those might not be so bad as people think, Cuzick argued.With a strategy of baseline bone density scans and bisphosphonates for at-risk women, IBIS-II showed only a tiny, nonsignificant elevation in fractures compared with placebo (9% versus 8%).Vasomotor symptoms rates were &high& in both groups and not that much worse with anastrozole -- 57% versus 49% -- Cuzick pointed out.He called it striking that musculoskeletal joint pain overall differed by so little, with a rate of 64% with anastrozole overall compared with 58% on placebo overall and just 4% and 2% absolute increases in moderate and severe arthralgia, respectively.&So there's a very general perception that these drugs are very toxic and cause a lot of aches and pains,& he told reporters at an SABCS press conference. But &most of these in uncontrolled situations are attributed to the drug. It's clear now that most of these aches and pains have nothing to do with aromatase inhibitors.&Cuzick suggested that this may help clinicians sell patients on primary prevention drugs, for which uptake has been low.Moreover, there was a 40% relative reduction in nonbreast cancers in the anastrozole arm, driven by fewer skin and colorectal cancers. While this result was unexplained and in some ways contrary to expectations from other trials, it was highly significant and &merits further investigation.&Mixed InterpretationsHowever, experts questioned the low toxicity found in the trial and how well it might go over telling women the symptoms they're reporting are just aging.The blinded comparison of anastrozole and tamoxifen in the landmark did show extra arthralgia events, Ravdin pointed out. &I don't think you can dismiss it.&&Of course it's real,& argued , a breast surgeon and director of the Breast Care Center at the University of California San Francisco.When patients stop the drugs in the treatment setting they feel a lot better, and that's exactly what they're going to do despite being told what they're experiencing isn't a side effect, she pointed out in an interview.&People will vote with their feet,& she said. &Even if they think they're having a side effect they're not going stay on it, so the net effect is the same.&Cuzick, a statistician, acknowledged that it could be a dicey proposition for physicians.&A major issue is how one actually conv that most of these aches and pains are not treatment related and are simply a function of age,& he told attendees at the trial presentation.Another concern raised by Osborne and Ravdin was the quality of adverse event reporting.&Clinicians, as good as they are, are underreporters of toxicity,& Ravdin explained. &Like sexuality issues: If you ask any gynecologist about aromatase inhibitors, he'll damn them. Yet clinicians will go, 'What are you talking about?' and that's because they neither ask nor does the patient volunteer.&How to Choose?Anastrozole is a good option, and possibly even the best of the current options on average, Ravdin concluded.&The whole story isn't quite in, but the idea that this is the best drug for everybody is ... probably not correct,& he said.The difference in side effect profiles between SERMs and aromatase inhibitors calls for individualization, he suggested. &For instance, a woman who is sexually active probably doesn't want to take anastrozole but would rather take raloxifene or tamoxifen.&Osborne agreed that no one strategy can be universally adopted.&Maybe you would select an aromatase inhibitor prevention for certain patients and not in others, or try them on an aromatase inhibitor and if they don't tolerate it then switch them to tamoxifen or raloxifene,& he proposed. &It's nice that we have a choice.&Just having another option isn't necessarily going to help women that much, Esserman argued.What's really needed is a biomarker to demonstrate that a given woman is benefiting from endocrine treatment, similar to blood pressure in heart disease prevention, she told MedPage Today.&Let's find the intermediate endpoint to show that these drugs are working before we put someone on it for 5 years, because that's what's going to motivate people: 'A) I'm truly at risk and B) I'm going to benefit and here's my demonstration that I am particularly going to benefit',& Esserman said. &That's the right paradigm for prevention.&
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Arimidex: Top Drug for Breast Ca Prevention?瑞宁得是预防乳腺癌的最佳药物吗？ Should anastrozole (Arimidex) be the top choice in pharmacologic primary prevention of breast cancer, based on IBIS-II trial results presented here? No, said most experts.根据在此发表的IBIS-II试验结果，能否认为阿那曲唑（瑞宁得）就是乳腺癌一级预防药物的最佳选择吗？不，大多数专家如是说。 The aromatase inhibitor cut risk of developing a first primary breast cancer by 53% (2% incidence over 5 years versus 4% on placebo, P&0.0001) in that trial.研究结果显示这种芳香化酶抑制剂可以将原发性乳腺癌的首次发病风险减少53%（药物组与安慰剂组5年发病率为2% vs 4%，P＜0.0001）。 &We believe these results provide strong support for the use of anastrozole in high-risk postmenopausal women and that it should be the treatment of first choice for such patients,& Jack Cuzick, PhD, of Queen Mary University of London, told attendees in presenting the results at the San Antonio Breast Cancer Symposium (SABCS).在圣安东尼奥乳腺癌研讨会（SABCS）上伦敦大学玛丽皇后学院的杰克库兹克博士就上述结果对与会者说，“我们认为这些结果为绝经后的高危妇女应用阿那曲唑提供强有力的证据支持，并应成为这类患者治疗的首选用药”。 Others disagreed.也有人不同意此说法。 &That's difficult to understand given that we have two other agents that have been shown to be effective, and you're comparison arm was a placebo and neither of those two other agents,& Pamela Goodwin, MD, MSc, of the University of Toronto, countered from the audience at the session.来自大会观众席的多伦多大学的帕梅拉古德温博士对此反驳道，“这种说法让人费解，因为另外两个治疗乳腺癌的药物也是有效的，而你只是和安慰剂进行比较，而未与另外这两种药物进行比较”。 Cuzick then backpedaled and said the aromatase inhibitors as a class should be the first choice.随后库济克改变了措辞，说芳香化酶抑制剂这一类药应成为首选。 Even that was &quite a strong statement,& commented session moderator Fabrice Andre, MD, PhD, of Institut Gustave Roussy in Villejuif, France.法国维勒瑞夫Gustave Roussy研究所的会议主持人法布里斯安德烈博士对此评论，即使如此措辞也是“过于强硬的说法”。 &I think it was a little bit of an overstatement,& conference co-chair C. Kent Osborne, MD, toldMedPage Today.同为大会主席的C.肯特奥斯本博士对《medpage today》说“我认为这种说法有些夸张”。 &I don't entirely agree [with Cuzick],& added another co-chair, Peter Ravdin, MD, PhD, of the University of Texas Health Science Center at San Antonio. &There should be some community discussion about the drug because there were some things that were kind of glossed over that are pretty well established [such as] side effects.&另一位大会共同主席-来自圣安东尼奥德克萨斯大学健康科学中心的Peter Ravdin博士补充说，”我并不完全同意库兹克的说法”。”应该就这一药物进行一些社区讨论，因为有些事情会掩饰大家公认的一些事实，比如副作用。” Comparing Results结果的比较 There's no reason to expect any difference in effect among aromatase inhibitors based on comparisons done in women who already had a first breast cancer, said Osborne, of Baylor College of Medicine in Houston.休斯敦贝勒医学院的奥斯本说，对于首次患乳腺癌的女性而言，指望基于上述比较发现不同芳香化酶抑制剂存在疗效差异，这一做法是没有道理的。 And in primary prevention specifically, the risk reduction with anastrozole was on par with what was seen with fellow aromatase inhibitor exemestane (Aromasin) in the MAP.3 trial, the researchers acknowledged in reporting the IBIS-II results online in The Lancet.这些研究者在柳叶刀在线报道IBIS-II结果时也承认，MAP.3研究显示，阿那曲唑与另一种芳香化酶抑制剂依西美坦（Aromasin）等效，特别是在一级预防中。 Those results with those aromatase inhibitors have been stronger than reported with the selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene (Evista), but there are other factors to consider, namely side effect profiles, Osborne pointed out.奥斯本指出，那些芳香化酶抑制剂的治疗结果强于已报道的选择性雌激素受体调节剂（SERMs）他莫昔芬和雷洛昔芬（Evista），但还有一些其他因素需要考虑，比如副作用。 &I think there's a choice there,& he said in an interview. &I think it's going to depend a lot on the patient, their characteristics, what is their bone health, do they have any pre-existing conditions that would suggest they would have more side effects on an aromatase inhibitor than on tamoxifen ... there are a whole bunch of factors.&他在接受采访时说。“我认为对此是有选择余地的，这在在很大程度上取决于病人及其自身特点，还有他们的骨骼健康状况如何、他们是否存在一些状况提示芳香化酶抑制剂较他莫昔芬发生更多的副作用。…还有很多其他的因素要考虑。” The side effects of endometrial cancer and thromboembolism associated with tamoxifen weren't seen with either aromatase inhibitor.他莫昔芬相关的子宫内膜癌和血栓栓塞的副作用在任何一种芳香化酶抑制剂中都未曾见到。 Other side effects have been a concern with this class, particularly joint pain, bone loss, and vaginal symptoms.其他特别需要关注的副作用还包括关节疼痛，骨丢失和阴道症状。 &Side effects have always been the major barrier,& Ravdin told MedPage Today.Ravdin告诉《MedPage Today》 “副作用一直是主要的障碍，”。 The anastrozole findings suggested those might not be so bad as people think, Cuzick argued.库济克说，阿那曲唑的研究结果提示它可能并非如人们所想的那样糟糕。 With a strategy of baseline bone density scans and bisphosphonates for at-risk women, IBIS-II showed only a tiny, nonsignificant elevation in fractures compared with placebo (9% versus 8%).IBIS-II研究显示通过对高危女性采用基线骨密度扫描和双膦酸盐治疗后，与安慰剂组相比骨折发生率仅有并不显著的微小增加（9% vs 8%）。 Vasomotor symptoms rates were &high& in both groups and not that much worse with anastrozole -- 57% versus 49% -- Cuzick pointed out.库兹克指出，血管舒缩症状的发生率在两组均较高，但阿那曲唑并未过于糟糕（57% vs 49%）。 He called it striking that musculoskeletal joint pain overall differed by so little, with a rate of 64% with anastrozole overall compared with 58% on placebo overall and just 4% and 2% absolute increases in moderate and severe arthralgia, respectively.他说，阿那曲唑与安慰剂的肌肉骨骼关节疼痛的总体发生率差别如此之小令人惊讶（64% vs 58%），而中度和重度关节疼痛的绝对增加值也分别只有4%和2%。 &So there's a very general perception that these drugs are very toxic and cause a lot of aches and pains,& he told reporters at an SABCS press conference. But &most of these in uncontrolled situations are attributed to the drug. It's clear now that most of these aches and pains have nothing to do with aromatase inhibitors.&他在SABCS的新闻发布会上告诉记者，“这些药物毒性大并且会造成大量痛苦的看法非常普遍”。但”多数情况下只在失去控制的情况下这些药物才会导致疼痛。现在我们应该明确的是这些疼痛大多与芳香化酶抑制剂无关。” Cuzick suggested that this may help clinicians sell patients on primary prevention drugs, for which uptake has been low.库济克认为这可能有助于临床医生对患者出售初级预防类药物，这些药物的使用率一直很低。 Moreover, there was a 40% relative reduction in nonbreast cancers in the anastrozole arm, driven by fewer skin and colorectal cancers. While this result was unexplained and in some ways contrary to expectations from other trials, it was highly significant and &merits further investigation.&此外，阿那曲唑这一组的非乳腺癌发病率也相对减少了40%，其中皮肤癌和大肠癌的贡献较少。虽然这个结果无法解释，而且在某些方面与其他实验的预期相反，但却非常重要，”值得进一步研究”。 Mixed Interpretations综合解释 However, experts questioned the low toxicity found in the trial and how well it might go over telling women the symptoms they're reporting are just aging.然而，专家质疑该研究得出的低毒性结论，而且应该如何告诉女性她们提到的症状只是衰老的表现。 The blinded comparison of anastrozole and tamoxifen in the landmark ATAC early breast cancer treatment trial did show extra arthralgia events, Ravdin pointed out. &I don't think you can dismiss it.&ATAC早期乳腺癌治疗试验具有里程碑式的意义，它对阿那曲唑与他莫昔芬进行了盲法比较。研究结果表明（阿那曲唑）存在额外的关节疼痛事件。Ravdin指出，”我认为不能对此置之不理。” &Of course it's real,& argued Laura Esserman, MD, MBA, a breast surgeon and director of the Breast Care Center at the University of California San Francisco.旧金山加利福尼亚大学的乳腺保健中心Laura Esserman博士/MBA/乳腺外科医生说，“的确如此”。 When patients stop the drugs in the treatment setting they feel a lot better, and that's exactly what they're going to do despite being told what they're experiencing isn't a side effect, she pointed out in an interview.她在接受记者采访时指出，在治疗过程中病人当停用药物后后她们会感觉舒服很多，所以这就是为什么尽管有人告诉她们经历的并非副作用但她们仍然执意停药。 &People will vote with their feet,& she said. &Even if they think they're having a side effect they're not going stay on it, so the net effect is the same.&“人们会用实际行动表态，”她说。“即使她们认为是药物的副作用，她们也不会继续坚持服用，所以净效果是相同的。” Cuzick, a statistician, acknowledged that it could be a dicey proposition for physicians.库济克作为一名统计学家，承认它对内科医生而言是一个冒险的建议。 &A major issue is how one actually conv that most of these aches and pains are not treatment related and are simply a function of age,& he told attendees at the trial presentation. 他在汇报试验结果时告诉与会者，“一个主要的问题是如何向病人传达这些信息；这些疼痛大多与治疗无关的，而仅仅是年龄的一个函数，”。 Another concern raised by Osborne and Ravdin was the quality of adverse event reporting.奥斯本和Ravdin关注的另一个问题是不良事件报告的质量。 &Clinicians, as good as they are, are underreporters of toxicity,& Ravdin explained. &Like sexuality issues: If you ask any gynecologist about aromatase inhibitors, he'll damn them. Yet clinicians will go, 'What are you talking about?' and that's because they neither ask nor does the patient volunteer.&“临床医生，正如他们优秀的那一面，很少报道各自研究中的毒性问题，“Ravdin解释。”诸如有关性的问题：如果你询问妇科医生有关芳香化酶抑制剂的问题，他会怒斥这些药。然而临床医生会继续问道，“你说什么？”那是因为他们既没有询问也没有研究过这些患者志愿者。” How to Choose?如何选择？ Anastrozole is a good option, and possibly even the best of the current options on average, Ravdin concluded.Ravdin总结说，阿那曲唑是一个很好的选择，甚至平均起来可能是最好的选择。 &The whole story isn't quite in, but the idea that this is the best drug for everybody is ... probably not correct,& he said.“然而整件事情并不完全如此，认为对所有人来说都是最好的药…可能是不正确的，”他说。 The difference in side effect profiles between SERMs and aromatase inhibitors calls for individualization, he suggested. &For instance, a woman who is sexually active probably doesn't want to take anastrozole but would rather take raloxifene or tamoxifen.&由于SERMs和芳香化酶抑制剂在副作用方面存在差异，故要求医生给予个性化治疗。”例如，一位有性生活要求的女人可能不愿服用阿那曲唑而选择雷洛昔芬或他莫昔芬。” Osborne agreed that no one strategy can be universally adopted.奥斯本认为没有一种普适性的策略。 &Maybe you would select an aromatase inhibitor prevention for certain patients and not in others, or try them on an aromatase inhibitor and if they don't tolerate it then switch them to tamoxifen or raloxifene,& he proposed. &It's nice that we have a choice.&他建议或，“也许你会有选择的让某些人使用芳香酶抑制剂作为预防，或者先尝试芳香酶抑制剂，如果不能耐受再换成他莫昔芬或雷洛昔芬，”。”很幸运我们能有选择的机会。” Just having another option isn't necessarily going to help women that much, Esserman argued.埃瑟曼说有，仅仅选择另外一种药物不一定会更多地帮助女性。 What's really needed is a biomarker to demonstrate that a given woman is benefiting from endocrine treatment, similar to blood pressure in heart disease prevention, she told MedPage Today.她告诉《MedPage Today》，我们真正需要的是通过一种生物学标志物来证明某个女性可受益于内分泌治疗，类似于血压在预防冠心病中的作用。 &Let's find the intermediate endpoint to show that these drugs are working before we put someone on it for 5 years, because that's what's going to motivate people: 'A) I'm truly at risk and B) I'm going to benefit and here's my demonstration that I am particularly going to benefit',& Esserman said. &That's the right paradigm for prevention.&“在让患者坚持服用5年的药物之前，我们应该找到这样一个短期终点来表明这些药物是有效的，因为这样可以调动人们的积极性：“A)我的确处于危险之中和B）我将得到效益，我的情况显示我将肯定会效益”，“埃瑟曼说。”这才是预防医学的正确范例。” 编译（2301字）瑞宁得是预防乳腺癌的最佳药物吗？ 根据在此发表的IBIS-II试验结果，能否认为阿那曲唑（瑞宁得）就是乳腺癌一级预防药物的最佳选择吗？不，大多数专家如是说。研究结果显示这种芳香化酶抑制剂可以将原发性乳腺癌的首次发病风险减少53%（药物组与安慰剂组5年发病率为2% vs 4%，P＜0.0001）。在圣安东尼奥乳腺癌研讨会（SABCS）上伦敦大学玛丽皇后学院的杰克库兹克博士就上述结果对与会者说，“我们认为这些结果为绝经后的高危妇女应用阿那曲唑提供强有力的证据支持，并应成为这类患者治疗的首选用药”。也有人不同意此说法。来自大会观众席的多伦多大学的帕梅拉古德温博士对此反驳道，“这种说法让人费解，因为另外两个治疗乳腺癌的药物也是有效的，而你只是和安慰剂进行比较，而未与另外这两种药物进行比较”。随后库济克改变了措辞，说芳香化酶抑制剂这一类药应成为首选。法国维勒瑞夫Gustave Roussy研究所的会议主持人法布里斯安德烈博士对此评论，”即使如此措辞也是“过于强硬的说法”。同为大会主席的C.肯特奥斯本博士对《medpage today》说“我认为这种说法有些夸张”。另一位大会共同主席-来自圣安东尼奥德克萨斯大学健康科学中心的Peter Ravdin博士补充说，”我并不完全同意库兹克的说法”。”应该就这一药物进行一些社区讨论，因为有些事情会掩饰大家公认的一些事实，比如副作用。” 结果的比较休斯敦贝勒医学院的奥斯本说，对于首次患乳腺癌的女性而言，指望基于上述比较发现不同芳香化酶抑制剂存在疗效差异，这一做法是没有道理的。这些研究者在柳叶刀在线报道IBIS-II结果时也承认，MAP.3研究显示，阿那曲唑与另一种芳香化酶抑制剂依西美坦（Aromasin）等效，特别是在一级预防中。奥斯本指出，那些芳香化酶抑制剂的治疗结果强于已报道的选择性雌激素受体调节剂（SERMs）他莫昔芬和雷洛昔芬（Evista），但还有一些其他因素需要考虑，比如副作用。他在接受采访时说。“我认为对此是有选择余地的，这在在很大程度上取决于病人及其自身特点，还有他们的骨骼健康状况如何、他们是否存在一些状况提示芳香化酶抑制剂较他莫昔芬发生更多的副作用。…还有很多其他的因素要考虑。”其他特别需要关注的副作用还包括关节疼痛，骨丢失和阴道症状。Ravdin告诉《MedPage Today》 “副作用一直是主要的障碍，”。库济克说，阿那曲唑的研究结果提示它可能并非如人们所想的那样糟糕。IBIS-II研究显示通过对高危女性采用基线骨密度扫描和双膦酸盐治疗后，与安慰剂组相比骨折发生率仅有并不显著的微小增加（9% vs 8%）。库兹克指出，血管舒缩症状的发生率在两组均较高，但阿那曲唑并未过于糟糕（57% vs 49%）。他说，阿那曲唑与安慰剂的肌肉骨骼关节疼痛的总体发生率差别如此之小令人惊讶（64% vs 58%），而中度和重度关节疼痛的绝对增加值也分别只有4%和2%。他在SABCS的新闻发布会上告诉记者，“这些药物毒性大并且会造成大量痛苦的看法非常普遍”。但”多数情况下只在失去控制的情况下这些药物才会导致疼痛。现在我们应该明确的是这些疼痛大多与芳香化酶抑制剂无关。”库济克认为这可能有助于临床医生对患者出售初级预防类药物，这些药物的使用率一直很低。此外，阿那曲唑这一组的非乳腺癌发病率也相对减少了40%，其中皮肤癌和大肠癌的贡献较少。虽然这个结果无法解释，而且在某些方面与其他实验的预期相反，但却非常重要，”值得进一步研究”。 综合解释然而，专家质疑该研究得出的低毒性结论，而且应该如何告诉女性她们提到的症状只是衰老的表现。ATAC早期乳腺癌治疗试验具有里程碑式的意义，它对阿那曲唑与他莫昔芬进行了盲法比较。研究结果表明（阿那曲唑）存在额外的关节疼痛事件。Ravdin指出，”我认为不能对此置之不理。”旧金山加利福尼亚大学的乳腺保健中心Laura Esserman博士/MBA/乳腺外科医生说，“的确如此”。她在接受记者采访时指出，在治疗过程中病人当停用药物后她们会感觉舒服很多，所以这就是为什么尽管有人告诉她们经历的并非副作用但她们仍然执意停药。 “人们会用实际行动表态，”她说。“即使她们认为是药物的副作用，她们也不会继续坚持服用，所以净效果是相同的。”库济克作为一名统计学家，承认它对内科医生而言是一个冒险的建议。他在汇报试验结果时告诉与会者，“一个主要的问题是如何向病人传达这些信息；这些疼痛大多与治疗无关的，而仅仅是年龄的一个函数，”。奥斯本和Ravdin关注的另一个问题是不良事件报告的质量。 “临床医生，正如他们优秀的那一面，很少报道各自研究中的毒性问题，“Ravdin解释。”诸如有关性的问题：如果你询问妇科医生有关芳香化酶抑制剂的问题，他会怒斥这些药。然而临床医生会继续问道，“你说什么？”那是因为他们既没有询问也没有研究过这些患者志愿者。” 如何选择？Ravdin总结说，阿那曲唑是一个很好的选择，甚至平均起来可能是最好的选择。 “然而整件事情并不完全如此，认为对所有人来说都是最好的药…可能是不正确的，”他说。他建议，由于SERMs和芳香化酶抑制剂在副作用方面存在差异，故要求医生给予个性化治疗。”例如，一位有性生活要求的女人可能不愿服用阿那曲唑而选择雷洛昔芬或他莫昔芬。”奥斯本认为没有一种普适性的策略。他建议或，“也许你会有选择的让某些人使用芳香酶抑制剂作为预防，或者先尝试芳香酶抑制剂，如果不能耐受再换成他莫昔芬或雷洛昔芬，”。”很幸运我们能有选择的机会。”埃瑟曼说有，仅仅选择另外一种药物不一定会更多地帮助女性。她告诉《MedPage Today》，我们真正需要的是通过一种生物学标志物来证明某个女性可受益于内分泌治疗，类似于血压在预防冠心病中的作用。 “在让患者坚持服用5年的药物之前，我们应该找到这样一个短期终点来表明这些药物是有效的，因为这样可以调动人们的积极性：“A）我的确处于危险之中和B）我将得到效益，我的情况显示我将肯定会效益”，“埃瑟曼说。”这才是预防医学的正确范例。”（丁香园）
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