Россия, 115522 Москва, Каширское шоссе, 34А
34A, Kashirskoe Shosse, Moscow 115522, Russia
Россия, 115522 Москва, Каширское шоссе, 34А
34A, Kashirskoe Shosse, Moscow 115522, Russia
Россия, 115522 Москва, Каширское шоссе, 34А
34A, Kashirskoe Shosse, Moscow 115522, Russia
Россия, 115522 Москва, Каширское шоссе, 34А
34A, Kashirskoe Shosse, Moscow 115522, Russia
Россия, 115522 Москва, Каширское шоссе, 34А
34A, Kashirskoe Shosse, Moscow 115522, Russia
кафедра ревматологии Института профессионального образования
Россия, 115522 Москва, Каширское шоссе, 34А;Россия, 119991, Москва, ул. Трубецкая, 8, стр.2
Department of Rheumatology, Institute of Professional Education
34A, Kashirskoe Shosse, Moscow 115522, Russia; 8, Trubetskaya St., Build. 2, Moscow 119991, Russia
Цель исследования – определение эффективности последовательной (комбинированной) терапии с применением ритукисмаба (РТМ) и белимумаба (БЛМ) у пациентов с активной системной красной волчанкой (СКВ).
Пациенты и методы. Под наблюдением находилось 12 пациентов с достоверной СКВ высокой и средней степени активности. У 6 из них отмечались кожно-суставные проявления, у 6 – поражение почек, васкулит. Пациенты получали РТМ в дозе 500–2000 мг с премедикацией 6-метилпреднизолоном, после чего им назначали БЛМ по стандартной схеме 10 мг/кг 1 раз в месяц. Срок наблюдения – 1 год. Исходно после введения РТМ и затем каждые 3 мес оценивали эффективность и переносимость терапии, определяли концентрацию аутоантител и компонентов комплемента, регистрировали дозу пероральных глюкокортикоидов (ГК).
Результаты и обсуждение. На фоне комбинированной терапии генно-инженерными биологическими препаратами (ГИБП) наблюдалось значительное клинико-лабораторное улучшение: снижение активности заболевания (медиана, Ме SLEDAI-2K исходно – 12 [9,5; 17] баллов, на момент визита 4 – 2 [2; 6] балла), Ме концентрации антител к двуспиральной ДНК – АТ к дс-ДНК (101 [39; 250] и 28 [6; 112] Ед/мл соответственно), С3-компонента комплемента (0,44 [0,39; 0,59] и 0,83 [0,81; 0,87] г/л соответственно), С4-компонента комплемента (0,06 [0,031; 0,1] и 0,16 [0,15; 0,18] г/л соответственно). Большинство пациентов получали средние и низкие дозы пероральных ГК в качестве инициирующей терапии. За год доза ГК была уменьшена более чем на четверть, а у части больных удалось полностью их отменить.
Заключение. Комбинированная терапия ГИБП с применением РТМ и БЛМ является перспективным методом лечения активной СКВ. Использование такой схемы способствует быстрому и эффективному снижению активности заболевания, нормализации лабораторных маркеров СКВ (уровня АТ к дс-ДНК, С3-, С4-компонентов комплемента), уменьшению дозы пероральных ГК и как следствие – риска развития необратимых органных повреждений.
Objective: to determine the efficiency of sequential (combined) therapy with rituximab (RTM) and belimumab (BLM) in patients with active systemic lupus erythematosus (SLE).
Patients and methods. Twelve patients with true SLE having moderate-to-high activity were followed up. Six of them were noted to have skin and articular manifestations and 6 had kidney damage, vasculitis. The patients took RTM at 500–2000-mg doses, with 6-methylprednisolone as premedication, whereupon they were prescribed BLM according to the standard regimen of 10 mg/kg once monthly. The follow-up period was 1 year. At baseline and every three months after RTM administration, the efficiency and tolerability of therapy were evaluated, the concentrations of autoantibodies and complement components was estimated, and the dose of oral glucocorticoids (GCs) was recorded.
Results and discussion. During combined therapy with the biological agents (BAs), there was a considerable clinical and laboratory improvement: reductions in disease activity (median (Me) SLEDAI-2K scores were 12 [9.5; 17] at baseline and 2 [2; 6] at Visit 4), the Me concentrations of anti-double-stranded DNA (anti-ds-DNA) antibodies, 101 [39; 250] and 28 [6; 112] U/ml, respectively; those of complement component 3 (C3), 0.44 [0.39; 0.59] and 0.83 [0.81; 0.87] g/L, respectively; and those of complement C4, 0.06 [0.031; 0.1] and 0.16 [0.15; 0.18] g/l, respectively). Most patients received the medium and low doses of oral GCs as initiating therapy. During the year, the dose of GCs was reduced by more than a quarter and they could be completely discontinued.
evaluated, the concentrations of autoantibodies and complement components was estimated, and the dose of oral glucocorticoids (GCs) was recorded. Results and discussion. During combined therapy with the biological agents (BAs), there was a considerable clinical and laboratory improvement: reductions in disease activity (median (Me) SLEDAI-2K scores were 12 [9.5; 17] at baseline and 2 [2; 6] at Visit 4), the Me concentrations of anti-double-stranded DNA (anti-ds-DNA) antibodies, 101 [39; 250] and 28 [6; 112] U/ml, respectively; those of complement component 3 (C3), 0.44 [0.39; 0.59] and 0.83 [0.81; 0.87] g/L, respectively; and those of complement C4, 0.06 [0.031; 0.1] and 0.16 [0.15; 0.18] g/l, respectively). Most patients received the medium and low doses of oral GCs as initiating therapy. During the year, the dose of GCs was reduced by more than a quarter and they could be completely discontinued. Conclusion. Combined biological therapy with RTM and BLM is a promising treatment for active SLE. The use of this regimen promotes a rapid and effective reduction in disease activity, normalization of laboratory markers of SLE (anti-ds-DNA antibody and complement C3 and C4 levels), and decreases in the dose of oral GCs and, as a consequence, in the risk of irreversible organ damages.. Combined biological therapy with RTM and BLM is a promising treatment for active SLE. The use of this regimen promotes a rapid and effective reduction in disease activity, normalization of laboratory markers of SLE (anti-ds-DNA antibody and complement C3 and C4 levels), and decreases in the dose of oral GCs and, as a consequence, in the risk of irreversible organ damages.
The authors declare that there are no conflicts of interest present.