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Современная ревматология

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Возможные причины неэффективности генно-инженерных биологических препаратов при ревматоидном артрите и пути ее предотвращения

https://doi.org/10.14412/1996-7012-2012-725

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Аннотация

Генно-инженерные биологические препараты (ГИБП) заняли прочное место в лечении ревматоидного артрита (РА). Отбор больных для такого лечения проводится в соответствии с международными и отечественными рекомендациями. Вопрос о присоединении ГИБП к терапии базисными противовоспалительными препаратами (БПВП) ставится после неадекватного ответа на терапию двумя базисными препаратами, одним из которых должен быть метотрексат. Назначение ингибиторов ФНО α в качестве первого лечебного средства показано только при высокой активности РА. Четких предикторов эффективности ГИБП мало.Отмечено, что в соответствии с принципами программы «Treatment to Target» лечение РА проводится под контролем количественных показателей, оцениваемых у больных с высокой/умеренной активностью ежемесячно, при отсутствии ремиссии (или альтернативной цели – низкой активности) через 3 мес решается вопрос о коррекции терапии. В рутинной практике при появленииэффекта ГИБП, который у многих больных наблюдается в первые недели лечения, нередко начинают отменять симптоматические препараты, а подчас и снижать дозу или отменять БПВП, что может привести к нарастанию симптомов артрита и ошибочно интерпретируется как недостаточная эффективность или отсутствие эффекта ГИБП.Существуют объективные причины возможной неэффективности ГИБП. Достоверным предиктором ответа на ингибиторыФНО α является исходная экспрессия ФНО α клетками синовиальной оболочки. Важно также учитывать характер предшествующей назначению ГИБП терапии. Отмечена высокая эффективность всех ГИБП при взвешенном подходе к отбору и ведениюбольных, при этом нужно избегать быстрой отмены симптоматической терапии.

Об авторе

Наталья Владимировна Чичасова

Department of Rheumatology, Faculty for Postgraduate Training of Physicians


Литература

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Для цитирования:


Чичасова Н.В. Возможные причины неэффективности генно-инженерных биологических препаратов при ревматоидном артрите и пути ее предотвращения. Современная ревматология. 2012;6(2):31-41. https://doi.org/10.14412/1996-7012-2012-725

For citation:


Chichasova N.V. Possible reasons for the inefficacy of genetically engineered biological agents in rheumatoid arthritis and ways of its prevention. Modern Rheumatology Journal. 2012;6(2):31-41. (In Russ.) https://doi.org/10.14412/1996-7012-2012-725

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ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)