Nhóm thuốc mới chống đái tháo đường: thuốc ức chế dipeptidyl peptidase-4

Tt/VAN

NHOM THUOC MQI CHONG OAI THAO Ol/QNG:

THUOC LTC CH E DIPEPTIDY L PEPTIDASE- 4

Dao Van Phan*

D e dieu trj dai thao duong typ 2. ngoai viec

'kiem soat che do an uong va tap the due,

cac nhom thuoc sau day dang dugc sir dung:

- Insulin va cac thuoc lam tang tiet insulin nhu sul￾fonylure (glipizid, gliclazid, gliburid), glitinid (repa￾glinid, nateglinid).

- Thuoc lam tang nhay cam vdi insulin nhu: thiazo￾lidinedion (pioglitazon, rosiglitazon), biguanid (met￾formin).

- Thuoc lam giam hap thu glucose tir ruot vao mau

nhu thuoc iic che alpha- glucosidase.

May nam gan day. mgt so thuoc moi thuoc nhom

thuoc ii'c che dipeptidyl peptidase - 4 dugc phep dua

ra thj truong la sitagliptin (Januvia ciia Hang Merck

& Co. dugc Ca quan quan ly thirc pham - thuoc cua

My FDA cho phep vao thang 10 nam 2006), sau do la

vildagliptin (Galvus ciia Novartis dugc phep luu hanh

6 Chau Au vao thang 2 nam 2008), roi saxagliptin

(Onglyza. FDA cho phep nam 2009) va nhieu thuoc

dang con o giai doan thir nghiem.

Theo Cochrane Library (2010). eho toi nay da co

12.864 ngudi tham gia trong 25 nghien ciru danh gia 2

che pham thuoc mdi sitagliptin va vildagliptin. Phan

Ion dugc theo doi sau 24 tuan diing thuoc, nghien ciru

dai nhat la sau 52 tuan. Cac ket qua cho thay 2 thuoc

da cai thien dugc mirc duong huyet, thuoc dugc dung

nap tot va khong gay ra ha duong huyet nang.

Co' che tac dung ciia thuoc iic che dipeptidyl pepti￾dase - 4 (DPP-4 inhibitor)

Duoi tac dung ciia thirc an trong khi an, niem mac

ruot non tiet vao he mach mgt nh6in hormon hudng in￾sulin dugc ggi la cac incretin, trong do chu yeu la 2 hor￾mon: peptid gidng glucagon 1 (glucagon - like peptide

I - GLP-1) va polypeptid hudng insulin phu thudc

vdo glucose (glucose-dependent insulinotropic poly￾peptide - GIP). Hai hormon nay dieu hoa bai tiet in￾sulin phu thuoc vao glucose. GLP-1 la hormon manh

nhat trong so cac incretin, co nhieu vai tro sinh ly:

kich thich sinh tong hgp va bai tiet insulin, iic che bai

tiet glucagon, lam cham thao rong da day (giu' thirc

an trong da day lau hon binh thudng), lam giam cam

giac them an va kich thich tai tao te bao beta ciia dao

tuy. GIF thiic day giai phong insulin, nhung trai vai

GLP-1, GIP con CO the kich thich giai phong gluca￾gon. Tac dung chung ciia 2 hormon nay la lam giam

glucose huyet, nhung boat tinh lai phu thuoc vao glu￾cose huyet: chimg bj mat hoat tinh khi mii'c glucose

huyet ha xuong duoi 65 ing/dL. Trong co the, GLP-1

va GIF CO thdi gian ban thai cyc ngan, nghTa la bj mat

hoat tinh chi sau vai phiit bdi enzym dipeptidyl pep￾tidase- 4 (DFF-4) CO sin trong nhieu mo: tuy ngoai

tiet, luyen mo hoi, tuyen nuac bgt, tuyen sua, hach

bach huyet, gan, mat, than, rau thai, tii' eung, tuyen

tien liet. da va he mao mach ciia niem mac ruot. Cac

thuoc ire che DFF-4 se lam virng ben GIF va GLF-1

ngi sinh. do do co the cai thien dugc benh dai thao

duang typ 2.

DFF-4 con co mat trong cac djch ciia co the nhu

huyet tuong, djch nao tiiy dudi dang hoa tan, co tac

Trudng Dgi hge Y Hd Ndi

S6 51 (Thang 04/2010) Y HOC LAM SANG I 59