Научные статьи \ Прикладные науки. Медицина. Технология \ Mедицинские науки \ Патология. Клиническая медицина \ Заболевания опорно-двигательной системы. Скелет и мышечная система

Фармакотерапия ревматоидного артрита: новая стратегия, новые мишени

Фармакотерапия ревматоидного артрита: новая стратегия, новые мишени

Автор: Насонов Е.Л.

Журнал: Научно-практическая ревматология @journal-rsp

Рубрика: Прогресс в ревматологии в XXI веке

Статья в выпуске: 4 т.55, 2017 года.

Бесплатный доступ

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 а, 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.

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Ревматоидный артрит, генно-инженерные биологические препараты, цитокины

Короткий адрес: https://sciup.org/14945841

IDR: 14945841   |   DOI: 10.14412/1995-4484-2017-409-419

Pharmacotherapy for rheumatoid arthritis: new strategy, new targets

Rheumatoid arthritis (RA) is a chronic immunoinflammatory (autoimmune) disease manifested by progressive joint destruction, systemic inflammation of the internal organs, and a wide range of comorbidities associated with chronic inflammation and frequently with adverse drug reactions. However, despite the major advances in the early diagnosis and treatment of RA, which have led to the radical improvement of prognosis in many patients, the problem of pharmacotherapy for RA is far from being solved. This is determined by a lack of sensitive and specific diagnostic and prognostic biomarkers in the early stage of the disease and, most importantly, by the heterogeneity of immunopathogenesis mechanisms in both at the onset of RA and during its progression, which make the personalization of therapy difficult in the patients. Selective block of inflammatory mediators with innovative medicines is frequently associated with primary inefficiency, secondary drug resistance, the development of generalized immunosuppression, the paradoxical activation of an autoimmune process, and the aggravation of comorbidities. At the same time, it is difficult to search for new RA pharmacotherapy targets since the nature of immunopathological disorders in patients can be substantially different from the inflammatory process that takes place when simulating arthritis in laboratory animals. The paper discusses the novel drugs that are used in rheumatology to treat RA or tested in different phases of preclinical or clinical trials, such as tumor necrosis factor-а inhibitors, interleukin-6 (IL-6), IL-17, anti-B cell therapy, bispecific antibodies, blockers of JAK (and other signaling molecules), bioelectronic vagus nerve activation, dendritic cell-based immunotherapy, and other therapies, as well as approaches to secondary prevention of RA in patients with undifferentiated arthritis and clinically suspect arthralgia, who are at high risk for RA. Decoding the mechanisms underlying the pathogenesis of RA and a chronic inflammatory process as a whole has created preconditions for the design of novel medications for the prevention and treatment of this disease, the introduction of which into clinical practice should lead to a radical improvement of prognosis in this disease.

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