Yini i-Siponimod: Ukusetshenziswa, Umthamo, Imiphumela Eceleni nokuningi

I-Siponimod iyimithi kadokotela eyenzelwe ngqo ukwelapha i-multiple sclerosis (SPMS) eqhubekayo yesibili. Ingaphansi kohlu lwemithi ebizwa ngokuthi ama-sphingosine 1-phosphate receptor modulators, asebenza ngokuvimbela amaseli athile omzimba ekuhlaseleni isimiso sakho sezinzwa. Le mithi yomlomo ingasiza ukunciphisa ukuqhubeka kokukhubazeka futhi inciphise imvamisa yokuphindeka kubantu abane-SPMS.

Yini i-Siponimod?

I-Siponimod iyidakamizwa elilwa nokuzivikela komzimba elisiza ukuphatha i-multiple sclerosis eqhubekayo yesibili. Isebenza ngokugxila kuma-receptors athile ohlelweni lwakho lokuzivikela komzimba ukuvimbela amaseli omzimba ayingozi ukuthi angene ebuchosheni bakho nasemgogodleni wakho. Cabanga ngayo njengokudala isivikelo esivikelayo esivimbela uhlelo lwakho lokuzivikela komzimba ekuhlaseleni ngokungaqondile izicubu zakho zemizwa.

Le mithi imisha uma iqhathaniswa nezinye izindlela zokwelapha i-MS, njengoba igunyazwe yi-FDA ngonyaka ka-2019. Yenzelwe ngqo abantu abane-multiple sclerosis eye yaqhubeka isuka efomini eliphindayo-eliyekayo yaya esigabeni esiqhubekayo sesibili. Udokotela wakho uzonquma ukuthi i-siponimod ilungele yini isimo sakho esithile ngokusekelwe emlandweni wakho wezokwelapha nasezimpawini zamanje.

Yini i-Siponimod Esetshenziselwa Yona?

I-Siponimod isetshenziselwa ikakhulukazi ukwelapha i-multiple sclerosis (SPMS) eqhubekayo yesibili. Lolu hlobo lwe-MS ngokuvamile luvela ngemva kokuthi umuntu ebe ne-relapsing-remitting MS iminyaka eminingana. Ngesikhathi sesigaba esiqhubekayo sesibili, izimpawu zivame ukuba zimbi kancane kancane ngokuhamba kwesikhathi, ngisho nangaphandle kokuphindeka okucacile noma ukuqubuka.

Umuthi usiza ukunciphisa ukuqhubeka kokukhubazeka ngokomzimba okuvame ukuhambisana ne-SPMS. Unganciphisa futhi nenani lokuphindeka okuhlangenwe nakho, nakuba le nzuzo ingase ingabonakali kangako kunezigaba zakuqala ze-MS. Udokotela wakho wezinzwa angase ancome i-siponimod uma ezinye izindlela zokwelapha zingasebenzi ngokwanele noma uma usuka ekubuyeni-nokuxolela uye ku-secondary progressive MS.

Ngezinye izikhathi odokotela banikeza i-siponimod ezigamekweni ezithile ze-relapsing-remitting MS, ikakhulukazi lapho lesi sifo sibonisa izimpawu zokuqhubeka. Nokho, lokhu kusetshenziswa akuvamile futhi kudinga ukuhlolwa ngokucophelela kwezimo zakho.

Isebenza Kanjani I-Siponimod?

I-Siponimod isebenza ngokuvimba izamukeli ezithile ezibizwa ngokuthi ama-sphingosine 1-phosphate receptors kumaseli omzimba. Uma lezi zamukeli zivaliwe, amanye amaseli amhlophe egazi abizwa ngokuthi ama-lymphocytes abanjwa kuma-lymph nodes akho futhi awakwazi ukuya ebuchosheni bakho nasemgogodleni. Lokhu kubavimbela ekubangeleni ukuvuvukala nokulimala okubonisa i-multiple sclerosis.

Lo muthi uthathwa njengomkhulu ngokulinganisela uma uqhathaniswa nezinye izindlela zokwelapha ze-MS. Inamandla kakhulu kunezinye izidakamizwa ezindala njenge-interferons, kodwa ayinqeni njengeminye yezindlela zokwelapha ezintsha ezinokusebenza kahle kakhulu. Amandla ayenza isebenze ekunciphiseni ukuqhubeka kwesifo ngenkathi igcina iphrofayili yomphumela ohlangothini olulawulekayo kubantu abaningi.

Lo muthi futhi uneminye imiphumela eqondile kumaseli ohlelweni lwakho lwezinzwa, okungase kusize ukuvikela imicu yezinzwa ekulimaleni. Lesi senzo esiphindwe kabili sokunciphisa ukuvuvukala nokuhlinzeka nge-neuroprotection senza i-siponimod ibe usizo ikakhulukazi ezinhlotsheni eziqhubekayo ze-MS.

Kufanele Ngiyithathe Kanjani I-Siponimod?

Kufanele uthathe i-siponimod ngendlela eqondile udokotela wakho ayala ngayo, ngokuvamile kanye ngosuku ngaphandle kokudla. Umuthi uza ngesimo samaphilisi futhi kufanele ugwinywe wonke ngamanzi. Awudingi ukuwuthatha ngobisi noma nganoma yikuphi ukudla okuthile, kodwa ukuwuthatha ngesikhathi esifanayo nsuku zonke kusiza ukugcina amazinga aqhubekayo emzimbeni wakho.

Udokotela wakho uzoqala ngesikhwama esikhethekile sokulinganisa esikhuphula kancane kancane umthamo wakho ezinsukwini ezimbalwa. Le phakethe yokuqala isiza umzimba wakho ukuthi ujwayele umuthi futhi inciphisa ingozi yemiphumela emibi. Ishejuli ejwayelekile yokuqala ikhuphuka isuka ku-0.25 mg ngosuku lokuqala iye kumthamo wakho wokugcinwa oqondiwe ngosuku lwesithupha.

Ngaphambi kokuqala i-siponimod, uzodinga ezinye izivivinyo ezibalulekile. Udokotela wakho uzohlola isigqi senhliziyo yakho nge-EKG futhi angase aqaphele izinga lokushaya kwenhliziyo yakho amahora ambalwa ngemva komthamo wakho wokuqala. Bazophinda bahlole igazi lakho ukuze bathole izimpawu ezithile zofuzo ezithinta indlela umzimba wakho osebenzisa ngayo umuthi. Lezi zinyathelo zokuphepha zisiza ukuqinisekisa ukuphepha kwakho kuyo yonke imithi.

Uma udla ngaphambi kokuthatha i-siponimod, khetha ukudla okulula kunokudla okukhulu, okunamafutha. Nakuba ukudla kungawuthinti ngokuphawulekayo ukumuncwa, abanye abantu bathola ukuthi ukukuthatha ngesnakhi esincane kusiza ukunciphisa isisu esicasulayo. Gwema ama-grapefruit nejusi le-grapefruit, njengoba lokhu kungaphazamisa indlela umzimba wakho osebenzisa ngayo umuthi.

Kufanele Ngiyithathe Isikhathi Esingakanani I-Siponimod?

I-Siponimod ngokuvamile iyindlela yokwelapha yesikhathi eside ozoqhubeka nayo unomphela uma nje isiza i-MS yakho futhi uyayibekezelela kahle. Abantu abaningi abane-secondary progressive MS badinga ukwelashwa okuqhubekayo ukuze banciphise ukuqhubeka kwesifo, ngakho ukuyeka umuthi ngokuvamile akukhuthazwa ngaphandle kwalapho kuvela izinkinga.

Udkt wakho uzoqapha impendulo yakho emuthini ngokuhlolwa njalo kanye nokuskena kwe-MRI ngezikhathi ezithile. Lokhu kuhlola kusiza ukunquma ukuthi i-siponimod iyahamba kahle yini ekunciphiseni ukuqhubeka kwesifo sakho. Uma umuthi uyeka ukusebenza noma uma uba nemiphumela emibi ekhathazayo, udkt wakho angase axoxe ngokushintshela ekwelashweni okuhlukile.

Abanye abantu bangase badinge ukuphuma e-siponimod ngezindlela zokwelapha noma uma bethola izifo ezithile. Udkt wakho uzokuqondisa kunoma yikuphi ukuma okwesikhashana futhi akusize ukuthi uqalise kabusha ngokuphepha uma kufanele. Ungalokothi uyeke ukuthatha i-siponimod ngokuzumayo ngaphandle kokuqondiswa ngudokotela, ngoba lokhu kungaholela ekubeni kubi kakhulu kwezimpawu zakho ze-MS.

Yini Imiphumela Emibi ye-Siponimod?

Njengayo yonke imithi, i-siponimod ingabangela imiphumela emibi, nakuba kungewona wonke umuntu oyitholayo. Imiphumela eminingi emibi imild kuya kokulingene futhi ivame ukuthuthuka njengoba umzimba wakho uzivumela emuthini. Ukuqonda ukuthi yini ongayilindela kungakusiza ukuthi uzizwe ulungiseleleke kakhulu futhi wazi ukuthi ungaxhumana nini nethimba lakho lokunakekelwa kwezempilo.

Nansi imiphumela emibi evame kakhulu ongase uyithole:

• Ikhanda, elivame ukuthuthuka ngemva kwamasonto ambalwa okuqala
• Umfutho wegazi ophezulu ukuthi udkt wakho uzoqapha njalo
• Ukuhlolwa komsebenzi wesibindi okungajwayelekile, ngokuvamile ngaphandle kwezimpawu
• Isiyezi noma ukuzwa ukukhathala, ikakhulukazi uma usukuma
• Ukucasuka kwesisu noma ukungakhululeki, ikakhulukazi ngenyanga yokuqala
• Ukuvuvukala emilenzeni yakho, emaqakaleni, noma ezinyaweni
• Ukuthuthumela noma ukuthuthumela okuncane, ngokuvamile okulula

Le miphumela emibi evamile ivame ukulawuleka futhi ivame ukwehla ngokuhamba kwesikhathi. Udkt wakho uzokuqapha eduze, ikakhulukazi ezinyangeni ezimbalwa zokuqala zokwelashwa.

Ezinye izinto ezingavamile kodwa ezinzima kakhulu zidinga ukunakekelwa kwezempilo ngokushesha. Lokhu kufaka phakathi izimpawu zokutheleleka okukhulu njengomkhuhlane, amaqhwa, noma ukukhwehlela okuqhubekayo, ngoba i-siponimod inganciphisa ikhono lomzimba wakho lokulwa nezifo. Kufanele futhi ubheke izimpawu zezinkinga zesibindi njengokuphuzi kwesikhumba sakho noma amehlo, umchamo omnyama, noma ubuhlungu obukhulu besisu.

Ngokuvamile, i-siponimod ingabangela izinkinga ezinzima kakhulu. Lokhu kungabandakanya izinkinga ezinzima zokushaya kwenhliziyo, ukuvuvukala okukhulu emzimbeni wakho wonke, noma izimpawu zokutheleleka kobuchopho obizwa nge-PML (i-progressive multifocal leukoencephalopathy). Ngenkathi lezi zinkinga ezinzima ezingavamile, ukuzazi kuzokusiza ukuthi ufune ukunakekelwa kwezempilo ngokushesha uma kudingeka.

Abanye abantu bangase babe nezinguquko zemizwa noma ukucindezeleka ngenkathi bethatha i-siponimod. Uma uqaphela izinguquko ezinkulu emizweni yakho, amaphethini okulala, noma imicabango, kubalulekile ukuxoxa ngalokhu nomhlinzeki wakho wezempilo ngokushesha.

Ubani Ongafanele Athatha I-Siponimod?

I-Siponimod ayilungile kuwo wonke umuntu, futhi izimo ezithile zezokwelapha noma izimo zikwenza kungaphephile ukuyisebenzisa. Udokotela wakho uzobuyekeza ngokucophelela umlando wakho wezokwelapha kanye nesimo sakho sempilo samanje ngaphambi kokukuyala lo muthi. Ukwethembeka ngezimo zakho zempilo kusiza ekuqinisekiseni ukuphepha kwakho.

Akufanele uthathe i-siponimod uma unezimo ezithile zenhliziyo. Lokhu kufaka phakathi ukuhlaselwa yinhliziyo kwakamuva, i-angina engazinzile, ukuhluleka kwenhliziyo okukhulu, noma izinhlobo ezithile zokushaya kwenhliziyo okungajwayelekile. Umuthi ungathinta izinga lokushaya kwenhliziyo yakho nokushaya, ikakhulukazi uma uqala ukuwuthatha.

Abantu abanezifo zesibindi ezinzima kufanele bagweme i-siponimod ngoba isibindi sisebenzisa lo muthi. Udokotela wakho uzohlola ukusebenza kwesibindi sakho ngaphambi kokuqala ukwelashwa futhi akuqaphele njalo ngenkathi uthatha umuthi. Uma une-hepatitis esebenzayo noma ukukhubazeka kwesibindi okukhulu, i-siponimod kungenzeka ingaphephile kuwe.

Ezinye izici zofuzo nazo ziyathinta ukuthi ungayithatha ngokuphepha yini i-siponimod. Abantu abanezinguquko ezithile zofuzo (ezibizwa ngokuthi i-CYP2C9*3/*3) balucubungula kancane kakhulu umuthi, okungaholela emazingeni ayingozi egazini. Udokotela wakho uzohlola lezi zimaki zofuzo ngaphambi kokukuyalela i-siponimod.

Kufanele futhi ukugweme i-siponimod uma ukhulelwe, uhlela ukukhulelwa, noma uncelisa. Umuthi ungamlimaza umntwana osakhulayo futhi udlulela obisini. Abesifazane abaneminyaka yokuzala badinga ukusebenzisa izindlela zokuvimbela inzalo ezisebenzayo ngenkathi bethatha i-siponimod kanye okungenani izinsuku eziyi-10 ngemuva kokuyeka.

Izifo ezinzima eziqhubekayo ezinye isizathu sokugwema noma ukuhlehlisa ukuqala i-siponimod. Njengoba umuthi ucindezela amasosha akho omzimba, ungenza izifo ezikhona zibe zimbi noma kube nzima ukuzelapha. Udokotela wakho uzoqinisekisa ukuthi noma yiziphi izifo zelashwa ngendlela efanele ngaphambi kokuqala lo muthi.

Amagama Omkhiqizo we-Siponimod

I-Siponimod ithengiswa ngaphansi kwegama lomkhiqizo elithi Mayzent e-United States nakwamanye amazwe amaningi. Leli yigama eliyinhloko lomkhiqizo ozolibona ebhodleleni lakho lemithi kanye nokupakishwa kwemithi. I-Mayzent yenziwa yi-Novartis, inkampani yezemithi eyathuthukisa lo muthi ngqo wokwelapha i-multiple sclerosis.

Njengamanje, azikho izinhlobo ezivamile ze-siponimod ezitholakalayo. Lokhu kusho ukuthi i-Mayzent iyona kuphela uhlobo lwe-siponimod ongayithola ngomyalo kadokotela. Izinhlobo ezivamile zivame ukutholakala eminyakeni eminingana ngemuva kokuthi umuthi wegama lomkhiqizo ulahlekelwe ukuvikelwa kwelungelo lobunikazi, kodwa lokhu akukenzeki okwamanje nge-siponimod.

Kwamanye amazwe angaphandle kwe-United States, i-siponimod ingase itholakale ngaphansi kwamanye amagama omkhiqizo noma ingase ingavunyelwa okwamanje. Uma uhamba noma uthuthela kwamanye amazwe, kubalulekile ukusebenza nomhlinzeki wakho wokunakekelwa kwezempilo ukuqinisekisa ukuqhubeka kokwelashwa kwakho.

Ezinye izindlela ze-Siponimod

Eminye imithi eminingi ingelapha i-multiple sclerosis eqhubekayo yesibili uma i-siponimod ingakulungele. Udokotela wakho uzocabangela isimo sakho esithile, okuhlanganisa umlando wakho wezokwelapha, ezinye izimo zempilo, nokuthi usabele kahle kangakanani ekwelashweni kwangaphambilini lapho enza iziphakamiso zezinye izindlela.

I-Ocrelizumab (Ocrevus) ngomunye umuthi ovunyelwe i-secondary progressive MS. Inikezwa njenge-intravenous infusion njalo ezinyangeni eziyisithupha futhi isebenza ngendlela ehlukile kune-siponimod ngokugxila kumaseli athile omzimba. Abanye abantu bakhetha ukulula kokuthatha imithi kaningi, kanti abanye bakhetha ukuthatha iphilisi nsuku zonke.

Kubantu abane-relapsing-remitting MS abangase bashintshele ku-secondary progressive, kunezinketho eziningi. Lokhu kufaka phakathi i-fingolimod (Gilenya), esebenza ngendlela efanayo ne-siponimod kodwa inerekhodi elide, kanye ne-natalizumab (Tysabri), esebenza kahle kakhulu kodwa idinga ukuqapha njalo ngenxa yokutheleleka kobuchopho okungavamile.

Imithi endala efana ne-interferon beta ne-glatiramer acetate iseyizinketho kwabanye abantu, nakuba ngokuvamile ingasebenzi kahle njengokwelashwa okusha. Udokotela wakho angase acabangele lokhu uma unezimo zempilo ezithile ezingenza imithi emisha ingafaneleki.

Ukukhetha phakathi kwezinye izindlela kuncike ezintweni eziningi okuhlanganisa iminyaka yakho, ezinye izimo zempilo, izimpendulo zokwelashwa kwangaphambilini, nezintandokazi zomuntu siqu mayelana nezinto ezinjengokuphindaphinda kokujova kanye nezidingo zokuqapha.

Ingabe i-Siponimod ingcono kune-Fingolimod?

Kokubili i-siponimod ne-fingolimod zisebenza ngendlela efanayo ngokuthinta ama-sphingosine 1-phosphate receptors, kodwa zinezinye izinto ezibalulekile ezingafani. I-Siponimod ivunyelwe ngokuqondile i-secondary progressive MS, kuyilapho i-fingolimod isetshenziswa ikakhulukazi i-relapsing-remitting MS. Lokhu kwenza ukuqhathanisa okuqondile kube nzima ngandlela thize njengoba ngokuvamile zisetshenziselwa izigaba ezihlukene zesifo.

ISiponimod kungenzeka sinamanye amathuba ngokwemiphumela emibi. Akungenzeki ukuthi kubangele izinkinga zamehlo (i-macular edema) ezingenzeka nge-fingolimod, futhi kungenzeka kube nemiphumela emincane ekusebenzeni kwamaphaphu. Kodwa-ke, womabili lawo machiza adinga ukuqapha inhliziyo ngokucophelela uma uqala ukuwathatha.

Ukukhetha phakathi kwalawo machiza kuvame ukwehla ngohlobo lwakho oluthile lwe-MS nesimo sakho sezempilo. Uma une-secondary progressive MS, i-siponimod yenzelwe ngqo isimo sakho. Uma une-relapsing-remitting MS, i-fingolimod ingase ifaneleke kakhulu, nakuba udokotela wakho ezocabangela zonke izici.

Womabili lawo machiza asebenza kahle, futhi akukho nelilodwa elithi “lungcono” kunelinye. Udokotela wakho wezinzwa uzokusiza ukuthi uqonde ukuthi yiliphi imithi okungenzeka ukuthi izokuzuzisa esimweni sakho esithile ngenkathi kuncishiswa izingozi ngokusekelwe kuphrofayili yakho yonke yezempilo.

Imibuzo Evame Ukubuzwa Mayelana ne-Siponimod

Ingabe i-Siponimod iphephile kubantu abanezifo zenhliziyo?

I-Siponimod idinga ukuhlolwa ngokucophelela uma unezifo zenhliziyo. Imithi inganciphisa izinga lokushaya kwenhliziyo yakho futhi ingase ibangele ukushaya kwenhliziyo okungajwayelekile, ikakhulukazi uma uqala ukuwuthatha. Uma unezifo zenhliziyo ezilula, udokotela wakho angase akubhalele i-siponimod kodwa uzokuqapha eduze.

Ngaphambi kokuqala i-siponimod, uzodinga i-electrocardiogram (EKG) ukuze uhlole ukushaya kwenhliziyo yakho. Uma unezimo ezithile zenhliziyo njengokuhlaselwa yinhliziyo kwakamuva, ukwehluleka kwenhliziyo okukhulu, noma izinkinga eziyingozi zokushaya kwenhliziyo, i-siponimod kungenzeka ingakuphephile. Udokotela wakho wenhliziyo nodokotela wakho wezinzwa bazosebenzisana ukuze banqume ukuthi izinzuzo zidlula izingozi esimweni sakho esithile.

Ngingenzani uma ngithatha i-Siponimod eningi ngengozi?

Uma ngabe uthathe i-siponimod eningi kunaleyo oyinikiwe, xhumana nodokotela wakho noma isikhungo sokulawula ubuthi ngokushesha. Ungalindi ukubona ukuthi uzizwa yini izimpawu, njengoba ukweqisa kungadala izinkinga ezinkulu zenhliziyo ezingase zingabonakali ngokushesha.

Ukuthatha i-siponimod eningi kungadala ukwehla okuyingozi kwesilinganiso senhliziyo yakho, ukushaya kwenhliziyo okungajwayelekile, noma ukwehla okukhulu kwengcindezi yegazi. Uma uzwa ubuhlungu besifuba, isiyezi esikhulu, ukuquleka, noma ubunzima bokuphefumula ngemuva kokuthatha imithi eyengeziwe, funa ukunakekelwa kwezempilo okuphuthumayo ngokushesha. Letha ibhodlela lakho lemithi nawe ukuze abahlinzeki bezempilo bazi kahle ukuthi uthathe ini nokuthi uthathe malini.

Kufanele Ngenzeni Uma Ngeqe Umthamo We-Siponimod?

Uma weqa umthamo we-siponimod, isenzo okufanele usithathe sincike ekutheni usukade ungayithathi isikhathi esingakanani imithi. Uma weqa umthamo owodwa noma emibili nje, ngokuvamile ungaqhubeka nohlelo lwakho olujwayelekile ngaphandle kokuqala kabusha inqubo yokulinganisa. Kodwa-ke, uma weqe izinsuku ezingaphezu kwezimbili, kungase kudingeke uqale kabusha ngokunyuka komthamo kancane kancane.

Xhumana nodokotela wakho ngokushesha lapho uqaphela ukuthi weqe imithamo, ikakhulukazi uma sekudlule izinsuku ezingaphezu kwezimbili. Bazokweluleka ukuthi ngabe ungaqhubeka nje nomthamo wakho ojwayelekile noma ngabe udinga ukuqala kabusha iphakethe lokulinganisa. Ungalokothi uphinde imithamo ukuze ulungise leyo oyigeqile, ngoba lokhu kungadala imiphumela emibi.

Ngingayeka Nini Ukuthatha I-Siponimod?

Kufanele uyeke kuphela ukuthatha i-siponimod ngaphansi kokuqondisa kwezokwelapha. I-multiple sclerosis yisimo esingamahlalakhona esivame ukudinga ukwelashwa okuqhubekayo ukuvimbela ukuqhubeka nokubuyela emuva. Ukuyeka i-siponimod ngokuzumayo kungaholela ekubhebhethekeni okukhulu kwezimpawu zakho ze-MS, ngezinye izikhathi okubizwa ngokuthi umphumela wokubuyela emuva.

Udkt wakho angase ancome ukuyeka i-siponimod uma uba nemiphumela emibi kakhulu, uma umuthi uyeka ukusebenza ngempumelelo, noma uma udinga ukushintshela ekwelashweni okuhlukile. Bazokwenza uhlelo lokushintsha ngokuphepha emuthini futhi mhlawumbe baqale okunye. Abanye abantu bangase badinge ukuphumula ku-siponimod ngenxa yezinqubo zezokwelapha noma ngesikhathi sokutheleleka okukhulu, kodwa lokhu kufanele kwenziwe ngaso sonke isikhathi ngesiqondiso sezokwelapha.

Ngingakwazi yini ukugonywa ngenkathi ngithatha i-Siponimod?

Ukugonywa kudinga ukucatshangelwa okukhethekile ngenkathi uthatha i-siponimod. Njengoba lo muthi ucindezela amasosha akho omzimba, imithi yokugoma ephilayo (njenge-MMR noma umuthi wokugoma i-chickenpox) kufanele igwenywe ngoba ingase ibangele izifo ezinzima. Kodwa-ke, imithi yokugoma engasebenzi (njengomjovo womkhuhlane noma imithi yokugoma i-COVID-19) ngokuvamile iphephile futhi iyanconywa.

Kufanele uthole noma yikuphi ukugonywa okudingekayo ngaphambi kokuqala i-siponimod uma kungenzeka, njengoba ukusabela kwakho komzimba emithini yokugoma kungancipha ngenkathi uthatha umuthi. Uma udinga ukugonywa ngenkathi use-siponimod, udokotela wakho uzokusiza ukuthi unqume isikhathi esiphephe kakhulu nokuthi yimiphi imithi yokugoma efanele isimo sakho. Njalo yazisa abahlinzeki bezempilo ukuthi uthatha i-siponimod ngaphambi kokuthola noma yimiphi imithi yokugoma.