Сравнительная оценка влияния синтетических базисных противовоспалительных и генно-инженерных биологических препаратов на клиническое течение, скорость развития деструктивных изменений и качество жизни больных ревматоидным артритом

There are few studies of the efficiency of therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with early rheumatoid arthritis (eRA) as part of a treat-to-target strategy.Objective: to investigate the effects of DMARDs and BAs used in combination with methotrexate (MTX) on clinical course, quality of life (QoL), and the evolution of articular erosions and synovitis in patients with RA.Patients and methods. The investigation enrolled 151 patients with eRA. At the first stage, the patients received DMARDs. At the second stage, 101 patients with persistent moderate and high disease activity were prescribed MTX at a dose of 25 mg/week or 20 mg/week in combination with infliximab (INF), or 20 mg/week in combination with rituximab (RTX). At the third stage, 20patients with persistent high disease activity were switched to tocilizumab (TCZ) therapy.Results and discussion. At 12 months of DMARD therapy, a clinical remission was more often achieved in the MTX group. The use of INF or RTX significantly improved QoL in the patients. That of TCZ as a second- and third-line drug led to a significant decrease in DAS28-CRP. Conclusion. There were no statistically significant differences between the INF and RTMgroups with respect to the time course of changes in CRP, ESR, circulating immune complexes, and the indicators of X-ray progression, which confirms the possibility of switching from a first-line BA to its subsequent lines with an increasing clinical disease activity. TCZ can be a second- and third-line drug when the effect of therapy with other BAs escapes.Исследования эффективности терапии базисными противовоспалительными препаратами (БПВП), а также генно-инженерными биологическими препаратами (ГИБП) у пациентов с ранним ревматоидным артритом (рРА) в рамках стратегии «Лечение до достижения цели» немногочисленны.Цель настоящей работы — изучить влияние БПВП и ГИБП в комбинации с метотрексатом (МТ) на клиническое течение, качество жизни (КЖ) и эволюцию суставных эрозий и синовита у больных РА.Пациенты и методы. В исследование включен 151 больной рРА. На первом этапе пациенты получали БПВП. На втором этапе 101 пациенту с сохраняющейся умеренной и высокой степенью активности был назначен МТ 25 мг/нед, либо 20 мг/нед в комбинации с инфликсимабом (ИНФ), либо 20 мг/нед в комбинации с ритуксимабом (РТМ). На третьем этапе 20 пациентов с сохраняющейся высокой активностью заболевания были переведены на терапию тоцилизумабом (ТЦЗ).Результаты и обсуждение. К12 мес лечения БПВП клиническая ремиссия чаще достигалась в группе МТ. Назначение ИНФ или РТМ приводило к значимому улучшению КЖ пациентов. Применение ТЦЗ как препарата второй и третьей линии способствовало достоверному снижению DAS28 СРБ.Выводы. Между группами больных, получавших терапию ИНФ и РТМ, не выявлено статистически значимых различий в динамике СРБ, СОЭ, циркулирующих иммунных комплексов и показателей рентгенологического прогрессирования, что подтверждает возможность «переключения» с первого ГИБП на препараты последующих линий при нарастании активности. ТЦЗ может быть препаратом второй и третьей линии при ускользании эффекта от терапии другими ГИБП

Comparative evaluation of the effects of synthetic disease-modifying antirheumatic drugs and biological agents on clinical course, the rate of development of destructive changes, and quality of life in patients with rheumatoid arthritis

There are few studies of the efficiency of therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with early rheumatoid arthritis (eRA) as part of a treat-to-target strategy.Objective: to investigate the effects of DMARDs and BAs used in combination with methotrexate (MTX) on clinical course, quality of life (QoL), and the evolution of articular erosions and synovitis in patients with RA.Patients and methods. The investigation enrolled 151 patients with eRA. At the first stage, the patients received DMARDs. At the second stage, 101 patients with persistent moderate and high disease activity were prescribed MTX at a dose of 25 mg/week or 20 mg/week in combination with infliximab (INF), or 20 mg/week in combination with rituximab (RTX). At the third stage, 20patients with persistent high disease activity were switched to tocilizumab (TCZ) therapy.Results and discussion. At 12 months of DMARD therapy, a clinical remission was more often achieved in the MTX group. The use of INF or RTX significantly improved QoL in the patients. That of TCZ as a second- and third-line drug led to a significant decrease in DAS28-CRP. Conclusion. There were no statistically significant differences between the INF and RTMgroups with respect to the time course of changes in CRP, ESR, circulating immune complexes, and the indicators of X-ray progression, which confirms the possibility of switching from a first-line BA to its subsequent lines with an increasing clinical disease activity. TCZ can be a second- and third-line drug when the effect of therapy with other BAs escapes