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Эксиджад — Exjade (Деферазирокс)

Эксиджад (Деферазирокс)

Эксиджад — Exjade (Деферазирокс)

Препарат Эксиджад — оральный хелатор, с основным действующим веществoм Деферазирокс. Главное свойство деферазирокса состоит в снижении хронической перегрузки железом у лиц, длительно получающих переливание крови (например, для таких условий, как бета-талассемии и других хронических анемий).

Применение деферазирокса в суточной дозе 10 мг/кг в течение 1 года позволяло поддерживать в норме содержание железа в печени, концентрацию ферритина в сыворотке крови и способствовало достижению баланса железа (равновесия между поступлением и выведением железа) у пациентов, редко получающих гемотрансфузии или обменные переливания крови.

Категория:

Описание

Препарат Эксиджад — оральный хелатор, с основным действующим веществoм Деферазирокс. Главное свойство деферазирокса состоит в снижении хронической перегрузки железом у лиц, длительно получающих переливание крови (например, для таких условий, как бета-талассемии и других хронических анемий).

Применение деферазирокса в суточной дозе 10 мг/кг в течение 1 года позволяло поддерживать в норме содержание железа в печени, концентрацию ферритина в сыворотке крови и способствовало достижению баланса железа (равновесия между поступлением и выведением железа) у пациентов, редко получающих гемотрансфузии или обменные переливания крови.

Состав

Одна таблетка содержит:

  • 250 мг или 500 мг деферасирокса;
  • вспомогательные вещества: лактозы моногидрат, кросповидон, целлюлоза микрокристаллическая, повидон (K3O), натрия лаурилсульфат, кремния диоксид коллоидный безводный, магния стеарат.

Показания к применению

  •  хроническая перегрузка железом у взрослых и детей в возрасте 2 лет и старше;

Фармакодинамика

Комплексообразующее средство. Является тройным лигандом, обладающим высоким сродством к железу (III) и связывающим его в соотношении 2:1.

Усиливает экскрецию железа, преимущественно с калом. Деферазирокс обладает низким сродством к цинку и меди и не вызывает стойкого снижения содержания этих металлов в сыворотке.
Применение деферазирокса было изучено у взрослых пациентов и детей в возрасте 2 лет и старше с хронической посттрансфузионной перегрузкой железом. Основные заболевания, требующие регулярных трансфузий, включали β-талассемию, серповидно-клеточную анемию и другие врожденные и приобретенные анемии (миелодиспластические синдромы, врожденная гипопластическая анемия Даймонда-Блэкфена, приобретенная апластическая анемия и другие редкие формы анемий).

Показано, что при ежедневном применении деферазирокса в дозах 20 мг/кг и 30 мг/кг в течение 1 года у взрослых и детей с β-талассемией на фоне продолжающихся гемотрансфузий уменьшались запасы общего железа в организме; содержание железа в печени снижалось в среднем соответственно почти на 0.4 мг Fe/г и 0.9 мг Fe/г сухого вещества печени, концентрация ферритина в сыворотке крови уменьшалась в среднем почти на 36 мкг/л и 926 мкг/л соответственно. При применении в тех же дозах соотношение экскреции железа к поступлению железа в организм составляло 1.02 (что является показателем нормального баланса железа) и 1.67 (что соответствует повышенному выведению железа из организма). Подобный терапевтический ответ наблюдался при применении деферазирокса у пациентов с перегрузкой железа и при других типах анемий.

Применение деферазирокса в суточной дозе 10 мг/кг в течение 1 года позволяло поддерживать в норме содержание железа в печени, концентрацию ферритина в сыворотке крови и способствовало достижению баланса железа (равновесия между поступлением и выведением железа) у пациентов, редко получающих гемотрансфузии или обменные переливания крови. Поскольку уровень ферритина в сыворотке крови, определяемый ежемесячно, отражал изменения содержания железа в печени, динамика концентрации ферритина в сыворотке крови может являться критерием для оценки эффективности терапии. Влияние препарата на содержание ферритина в сыворотке крови и соотношение экскреции железа к поступлению его в организм было дозозависимым в диапазоне доз 5-30 мг/кг/сут.

Фармакокинетика

Всасывание
Деферазирокс хорошо абсорбируется после приема внутрь, среднее Тmax в плазме крови составляет около 1.5-4 ч. Абсолютная биодоступность (по AUC) деферазирокса при приеме внутрь составляет около 70% по сравнению с в/в введением. AUC увеличивалась приблизительно в 2 раза при приеме во время завтрака с высоким содержанием жира (содержание жира обуславливает >50% энергетической ценности) и почти на 50% при приеме во время стандартного завтрака. Биодоступность (по AUC) деферазирокса умеренно (приблизительно 13-25%) повышалась при приеме за 30 мин до приема пищи с нормальным или высоким содержанием жиров.

Общая экспозиция (AUC) деферазирокса при приеме в виде суспензии с апельсиновым или яблочным соком была эквивалентной экспозиции препарата при применении в виде водной суспензии (относительные значения AUC 103% и 90% соответственно).

В равновесном состоянии Cmax и AUC0 -24 ч деферазирокса повышаются почти линейно с дозой. Деферазирокс накапливается в организме, фактор кумуляции — 1.3-2.3.

Распределение

В высокой степени деферазирокс связывается с белками плазмы крови (99%), главным образом с альбумином. Имеет небольшой объем распределения — приблизительно 14 литров у взрослых.

Метаболизм

Главным путем метаболизма деферазирокса является глюкуронизация с последующей экскрецией с желчью. Деферазирокс подвергается энтерогепатической рециркуляции. Происходит деконъюгация глюкуронатов в кишечнике и последующая их реабсорбция. У здоровых пациентов, получавших колестирамин после однократного приема деферазирокса, AUC деферазирокса снижалась на 45%. Деферазирокс подвергается глюкуронизации главным образом с помощью UGT1A1 (уридиндифосфатглюкуронилтрансферазы /УГТ/ семейства 1, полипептид А1) и в меньшей степени — UGT1A3 (УГТ семействa 1, пoлипептид A3).

Окислительный метаболизм деферазирокса, опосредуемый CYP450, выражен в небольшой степени (около 8%). In vitro не наблюдалось ингибирования метаболизма деферазирокса гидроксикарбамидом.

Выведение

Деферазирокс и его метаболиты выводятся преимущественно с калом (84% дозы). Почечная экскреция деферазирокса и его метаболитов минимальна (8% дозы). Средний период полувыведения колеблется от 8 до 16 часов.

Фармакокинетика в особых клинических случаях.

Детский возраст.

После однократного и многократного приемов деферазирокса у детей (от 2 до 12 лет) и подростков (от 12 до 17 лет) oбщая биодоступность была ниже, чем у взрослых. У детей младше 6 лет биодoступность ниже на 50%, чем у взрослых. Вместе с тем, это не имеет клинического значения, поскольку режим дозирования препарата устанавливают индивидуально.

Пожилой возраст.

Фармакокинетика деферазирокса у пациентов пожилого возраста (старше 65 лет) не изучена.

Нарушения функции печени пли почек.

У пациентов с нарушениями функции печени пли почек фармакокинетика деферазирокса не изучена. Среднее AUC деферазирокса у пациентов с нарушениями функции печени (А и В по шкале Чайлд-Пью) было выше, чем у пациентов с нормальной функцией печени на 16% и 76%, соответственно. Среднее максимальнaя концентрация у пациентов с нарушениями функции печени легкой и средней степени тяжести превышало на 22% значение данного показателя у пациентов с нормальной функцией печени.
Повышение активности печеночных трансаминаз до 5 раз по сравнению с ВГН не оказывает влияния на фармакокинетику деферазирокса.

Фармацевтические характеристики.

Таблетки почти белого цвета, плоскоцилиндрические, круглые. Таблетки со скошенным краем и оттиском «J 250/NVR».

Упаковка, срок годности, условия хранения

По 28 таблеток в упаковке.
Хранить при температуре не выше 30 °C, в оригинальной упаковке.
Хранить в недоступном для детей месте.
Срок годности препарата Эксиджад 3 года.

 

 

 

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    Stem Cell Therapy in the USA in 2024: Balancing Costs and Life-Changing Benefits

    Stem cell therapy has emerged as a revolutionary medical
    procedure, offering hope to patients across the United States and beyond.
    This innovative treatment involves injecting stem
    cells—immature, self-renewing cells—into targeted areas of the body to promote healing and regeneration. In recent years, its popularity has surged,
    not only as a treatment for serious illnesses but also as a preventative and regenerative option. However, as a cutting-edge technology, stem cell therapy comes with
    a significant price tag, making it essential for patients to weigh its costs against its transformative potential.

    At our clinic, we believe in empowering patients with clear, actionable
    information. This article explores the factors driving stem cell
    therapy costs in the USA, highlights its remarkable benefits, and offers practical guidance for choosing the right clinic—without breaking the bank.

    Why Stem Cell Therapy Is a Game-Changer

    Stem cell therapy has demonstrated impressive success in treating
    a range of conditions, from blood-related cancers to autoimmune diseases.
    Its most notable achievements include high success rates in managing aplastic anemia, immunodeficiencies,
    and cancers like leukemia, where hematopoietic stem cell transplants replace damaged cells after intensive treatment.

    Beyond these, researchers are exploring its potential for conditions such as type 1 diabetes, Parkinson’s
    disease, amyotrophic lateral sclerosis (ALS), heart failure,
    and osteoarthritis.

    The promise of stem cell therapy lies in its ability to regenerate tissues and restore
    function, offering patients a chance at improved quality of
    life. However, with innovation comes cost, and understanding the financial aspects is key to making
    informed decisions.
    What Drives the Cost of Stem Cell Therapy?

    In the USA, the cost of stem cell therapy varies widely, ranging from $5,000
    to $500,000 depending on the treatment specifics.
    The most common price range for a single session falls between $10,000 and
    $20,000. Several factors influence these costs:

    Type and Source of Stem Cells: Options like umbilical cord cells or
    mesenchymal stem cells differ in price and application.
    Condition Being Treated: More complex conditions, such as spinal injuries or advanced cancers, require
    higher doses or multiple sessions.
    Location of the Facility: Clinics in major U.S. cities often charge more due to overhead and demand.

    For example:

    Knee or hip injuries: $5,000–$10,000
    Spinal conditions: $10,000–$20,000
    Anti-aging treatments: $5,000–$15,000

    Beyond the procedure itself, patients should anticipate additional expenses
    such as diagnostic tests, follow-up visits, and supportive therapies.
    For international patients traveling to the USA, travel
    and accommodation costs further increase the total investment.

    The Process: What to Expect

    At our clinic, we prioritize transparency and personalized care.
    The stem cell therapy process typically involves:

    Initial Assessment: A thorough physical examination and symptom review to confirm eligibility and establish a diagnosis.

    Diagnostic Testing: For complex cases, advanced imaging like CT scans or MRIs may be
    required to tailor the treatment plan.
    Cost Estimation: After assessing the patient’s condition and determining the stem cell type and dosage, we provide
    a detailed cost breakdown.

    The severity and duration of the condition play a significant role in pricing.
    For instance, early-stage osteoarthritis might require
    fewer stem cells and sessions compared to advanced joint degeneration, resulting in a lower overall
    cost.
    Hidden Costs to Consider

    While the quoted price for stem cell therapy is a starting point, hidden costs can add up.
    Diagnostic tests, often performed at external facilities,
    are rarely included in initial estimates.
    Travel and lodging expenses also apply, particularly for patients seeking treatment abroad or across state lines.
    Our clinic advises patients to factor these into their budget for a
    realistic financial plan.
    Insurance and Stem Cell Therapy

    In the USA, insurance coverage for stem cell
    therapy remains limited. Most private insurers do not cover these treatments,
    deeming them experimental. However, Medicare offers partial coverage for FDA-approved procedures like hematopoietic and autologous stem cell transplants, primarily for blood-related cancers.
    Patients should consult their insurance
    provider to explore available options.
    Affordable Alternatives: Stem Cell Therapy Abroad

    For those deterred by high costs in the USA, international clinics offer a
    compelling alternative. Countries like Serbia, Thailand, and the
    Philippines provide high-quality stem cell therapy at significantly lower prices—often without sacrificing technology or expertise.
    At the IM Clinic in Belgrade, Serbia, for example, patients can access both therapeutic and anti-aging stem cell treatments at a fraction of U.S.
    prices. Beyond affordability, Serbia’s rich culture and tranquil landscapes create an ideal setting for recovery,
    blending medical care with a restorative experience.

    Choosing the Right Clinic

    Selecting a clinic for stem cell therapy requires
    careful consideration. To ensure quality and affordability, we recommend:

    Researching Credentials: Verify the clinic’s certifications,
    experience, and success rates.
    Comparing Costs: Request detailed quotes from multiple providers to
    assess value.
    Checking Stem Cell Sources: Confirm the types (e.g., mesenchymal, umbilical cord) and their appropriateness for your condition.
    Accounting for Hidden Costs: Include diagnostics, travel, and follow-up care in your budget.

    At the IM Clinic, we pride ourselves on offering cutting-edge treatments with clear pricing and
    a patient-centered approach, making advanced care accessible to all.

    The Future of Stem Cell Therapy

    Stem cell therapy stands at the forefront of medical innovation, offering life-changing possibilities
    for patients with chronic and degenerative conditions.
    While costs in the USA remain a hurdle, affordable options
    abroad and strategic planning can make this transformative treatment attainable.

    If you’re ready to explore how stem cell therapy can enhance your health, contact the IM
    Clinic in Belgrade, Serbia. Our expert team is here to guide you through every step—from
    consultation to recovery—delivering world-class care in a
    supportive environment. Take the first step toward a healthier future today.

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