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Научно-практическая ревматология

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Фармакотерапия ревматоидного артрита: новая стратегия, новые мишени

https://doi.org/10.14412/1995-4484-2017-409-419

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Аннотация

Ревматоидный артрит (РА) – хроническое иммуновоспалительное (аутоиммунное) заболевание, проявляющееся прогрессирующей деструкцией суставов, системным воспалением внутренних органов и широким спектром коморбидных заболеваний, связанных с хроническим воспалением, а нередко и с нежелательными лекарственными реакциями (НЛР). Однако, несмотря на большие успехи в ранней диагностике и лечении РА, приведшие к кардинальному улучшению прогноза у многих пациентов, проблема фармакотерапии РА далека от разрешения. Это определяется отсутствием «чувствительных» и «специфичных» «диагностических» и «прогностических» биомаркеров на ранней стадии заболевания и, что самое главное, гетерогенностью механизмов иммунопатогенеза как в дебюте, так и в процессе прогрессирования РА, затрудняющими персонификацию терапии у пациентов. Селективное блокирование медиаторов воспаления с использованием инновационных лекарственных препаратов нередко ассоциируется с «первичной» неэффективностью, «вторичной» резистентностью, развитием генерализованной иммуносупрессии, парадоксальной активацией аутоиммунного процесса и утяжелением течения сопутствующих коморбидных заболеваний. В то же время поиск новых «мишеней» для фармакотерапии РА затруднен, поскольку характер иммунопатологических нарушений у пациентов может существенно отличаться от воспалительного процесса, который имеет место при моделировании артрита у лабораторных животных. В статье обсуждаются новые препараты, применяемые в ревматологии для лечения РА или находящиеся на разных стадиях «преклинических» или клинических исследований: ингибиторы фактора некроза опухоли α, интерлейкина 6 (ИЛ6), ИЛ17, анти-В-клеточная терапия, биспецифические антитела, блокаторы JAK (и других сигнальных молекул), биоэлектронная активация блуждающего нерва, иммунотерапия дендритными клетками и другие виды терапии, а также подходы к вторичной профилактике РА у пациентов с недифференцированным артритом и «клинически подозрительной артралгией», имеющих высокий риск развития РА. Расшифровка механизмов патогенеза РА и хронического воспалительного процесса, в целом, создала предпосылки для разработки новых лекарственных препаратов для профилактики и лечения этого заболевания, внедрение которых в клиническую практику должно привести к кардинальному улучшению прогноза при этом заболевании.

Об авторе

Е. Л. Насонов
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России
Россия

115522 Москва, Каширское шоссе, 34А;

119991 Москва, ул. Трубецкая, 8, стр. 2

научный руководитель ФГБНУ НИИР им. В.А. Насоновой, заведующий кафедрой ревматологии ИПО ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, академик РАН, профессор, докт. мед. наук



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Для цитирования:


Насонов Е.Л. Фармакотерапия ревматоидного артрита: новая стратегия, новые мишени. Научно-практическая ревматология. 2017;55(4):409-419. https://doi.org/10.14412/1995-4484-2017-409-419

For citation:


Nasonov E.L. PHARMACOTHERAPY FOR RHEUMATOID ARTHRITIS: NEW STRATEGY, NEW TARGETS. Rheumatology Science and Practice. 2017;55(4):409-419. (In Russ.) https://doi.org/10.14412/1995-4484-2017-409-419

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ISSN 1995-4484 (Print)
ISSN 1995-4492 (Online)