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Значение иммуногенности при лечении ревматических заболеваний ингибиторами фактора некроза опухоли α

https://doi.org/10.14412/1996-7012-2015-4-4-12

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Аннотация

Иммуногенность является характерным свойством белков, влияющих на иммунный ответ, проявляется в образовании антител к препарату (АТП) и/или иммунных комплексов.

В статье обсуждается влияние иммуногенности на эффективность и безопасность ингибиторов фактора некроза опухоли α (иФНОα) при различных ревматических заболеваниях. Приводятся данные о влиянии иммуногенности на фармакодинамику и фармакокинетику лекарственных препаратов и об отсутствии такого влияния. Продемонстрирована частота выявления АТП при использовании различных генно-инженерных биологических препаратов (ГИБП) при ревматоидном артрите, анкилозирующем спондилоартрите, псориатическом артрите, псориазе и болезни Крона. Охарактеризовано влияние на иммуногенность смены иФНОα, сопутствующей терапии метотрексатом (МТ), перерывов в лечении. Показано уменьшение иммуногенности при использовании комбинации иФНОα с МТ по сравнению с монотерапией ГИБП, причем назначение терапевтических доз МТ по сравнению с низкими недельными дозами (2,5–5 мг) позволяло в большей степени уменьшить частоту образования антител к иФНОα. По данным рандомизированных клинических исследований, наличие или отсутствие АТП более существенно влияет на частоту развития нежелательных реакций – НР (инфузионных или инъекционных), чем изменение эффективности иФНОα. Это подтверждается данными реальной клинической практики (регистры ГИБП разных стран), показавшими, что достоверной разницы в продолжительности лечения разными иФНОα не отмечается, уменьшение продолжительности лечения иФНОα при наличии АТП происходит в основном вследствие НР, а не вследствие неэффективности. Описаны методы выявления АТП и сложность их интерпретации.

Об авторе

Н. В. Чичасова
ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова»
Россия

Кафедра ревматологии,

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



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Для цитирования:


Чичасова Н.В. Значение иммуногенности при лечении ревматических заболеваний ингибиторами фактора некроза опухоли α. Современная ревматология. 2015;9(4):4-12. https://doi.org/10.14412/1996-7012-2015-4-4-12

For citation:


Chichasova N.V. Value of immunogenicity in the TNF-α inhibitor treatment of rheumatic diseases. Modern Rheumatology Journal. 2015;9(4):4-12. (In Russ.) https://doi.org/10.14412/1996-7012-2015-4-4-12

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