Терапия остеоартрита коленных суставов с точки зрения доказательной медицины: ожидаемые краткосрочные, среднесрочные и долгосрочные результаты применения рецептурного кристаллического глюкозамина сульфата

The need for effective drugs for the treatment of knee osteoarthritis (OA) is constantly growing. Current guidelines recommend the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) such as glucosamine (GCA) in this disease. Among various drugs containing GCA, high bioavailability and clinical efficacy have been shown only for prescription crystalline GCA sulfate (pGCAS) administration. Several meta-analyses and network meta-analyses have shown that efficacy of pGCAS 1500 mg once daily is superior to other GCA-based products (such as GCA hydrochloride with or without sodium sulfate) and the combination of GCA with chondroitin sulfate (CS) in terms of reducing the intensity of pain and improving the functional state. These studies confirmed the favorable safety profile of pGCAS, which was comparable to placebo in the incidence of adverse events. Pharmacoeconomic studies have also demonstrated greater cost-effectiveness of pGCAS compared to other GCA drugs.A group of Russian experts at a meeting of the advisory committee reviewed the evidence in favor of the use of pGCAS and evidence of its effectiveness in the treatment of knee OA in comparison with other products that include GCA, and the fixed combination of GCA with CS. Taking into account the results obtained, the use of pGCAS at a dose of 1500 mg once a day is recommended as a rational choice for the treatment of knee OA.Потребность в эффективных препаратах для терапии остеоартрита (ОА) коленных суставов (КС) постоянно растает. В современных руководствах рекомендуется применять при этом заболевании симптоматические средства замедленного действия (SYSADOA), такие как глюкозамин (ГКА). Среди различных лекарственных средств, содержащих ГКА, высокая биодоступность и клиническая эффективность доказаны только для рецептурного кристаллического ГКА сульфата (рГКАС). В нескольких метаанализах и сетевых метаанализах было показано, что рГКАС в дозе 1500 мг 1 раз в сутки превосходит по эффективности другие продукты на основе ГКА (такие как ГКА гидрохлорид с натрия сульфатом или без него) и комбинации ГКА с хондроитина сульфатом (ХС) с точки зрения снижения интенсивности боли и улучшения функционального состояния. В этих исследованиях был подтвержден благоприятный профиль безопасности рГКАС, который по частоте развития нежелательных явлений был сопоставим с плацебо. Фармакоэкономические исследования также продемонстрировали большую экономическую эффективность рГКАС по сравнению с другими лекарственными средствами ГКА.Группа российских экспертов на совещании консультативного комитета рассмотрела свидетельства в пользу применения рГКАС и доказательства его эффективности при лечении ОА КС в сравнении с другими продуктами, в состав которых входит ГКА, и фиксированной комбинации ГКА с ХС. С учетом полученных результатов использование рГКАС в дозе 1500 мг 1 раз в сутки рекомендовано в качестве рационального выбора для лечения ОА КС

Возможности фармакологического лечения остеоартрита: фокус на симптоматические медленно действующие препараты (SYSADOA) и индивидуальные особенности пациента. Резолюция международного совещания экспертов

The paper presents the results of the Osteoarthritis (OA) Expert Council held on September 8, 2019, which was attended by Russian and foreign specialists. The experts considered pharmacological treatment options for OA. The expert meeting resolution states that the treatment of patients with OA should be based on an individual assessment of the patient and on a modern evidence base of therapy efficacy.Treatment of patients with OA is based on the principles of evidence-based medicine that requires an integrated approach and the need of SYSADOAs prescription. Combined drugs with therapeutic dosages of chondroitin sulfate and glucosamine in the early stages of the disease are available as basic agents. The place of paracetamol in the anesthetic therapy algorithm in OA needs to be clarified. It is also noted that when choosing nonsteroidal anti-inflammatory drugs for OA treatment, it is important to take into account individual patient characteristics and the presence of comorbidities.Представлены результаты Экспертного совета по остеоартриту (ОА), проходившего 8 сентября 2019 г., в котором приняли участие российские и зарубежные специалисты. Рассматривались возможности фармакологического лечения ОА. В резолюции совещания указано, что лечение больных ОА должно быть основано на индивидуальной оценке состояния пациента и современных доказательствах эффективности терапии. Лечение больных ОА на основании принципов доказательной медицины предполагает комплексный подход и назначение SYSADOA. Комбинированные препараты с терапевтическими дозами хондроитина сульфата и глюкозамина уже на ранних стадиях заболевания рассматриваются в качестве базисных средств. Место парацетамола в алгоритме обезболивающей терапии при ОА требует уточнения. Отмечено также, что при выборе нестероидных противовоспалительных препаратов для лечения ОА важно учитывать индивидуальные особенности пациента и наличие коморбидных состояний

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

EXPERIENCE WITH RITUXIMAB IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Objective: to analyze the efficacy of rituximab (RTM) in patients with active ankylosing spondylitis (AS) resistant to conventional therapy. Subjects and methods. The trial enrolled 10 male patients with the reliable and valid diagnosis of AS who received therapy with RTM used in cases of steadily high AS activity, resistance to standard therapy, and contraindications to the use of tumor necrosis factor-α inhibitors. The number of patients meeting the Assessment of Spondyloarthritis International Society (ASAS) criteria for 20% improvements 24 weeks after treatment initiation was the main indicator of therapeutic effectiveness. Results. After 24-week therapy, 7 and 4 of the 10 patients showed 20 and 40% improvements, respectively; and 2 patients had partial remission according to the ASAS criteria. During the treatment, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) significantly decreased (p = 0.046), the Bath Ankylosing Spondylitis Functional Index (BASFI) remained substantially unchanged. Treatment response did not depend on the development of an early (at 2 weeks) complete depletion of CD20 lymphocytes. No significant effect could be achieved in patients with high baseline BASDAI and BASFI scores. Conclusion. RTM used patients with AS can ensure clinical improvement and even remission in a number of cases; however, it is unpromising in cases of high disease activity and severe functional failure