32 research outputs found
Π¦Π΅ΡΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π± ΠΏΠ΅Π³ΠΎΠ» Π² ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ°
The paper reviews the literature on the new tumor necrosis factor-Ξ± (TNF-Ξ±) antagonist certolizumab pegol (CZP). It considers the experience in using the drug in Russia within the framework of the RAPID 2 trial. The currently obtained material suggests that CZP has extended the capacities of RA treatment. The drug may be successfully used both alone and in combination with other disease-modifying anti-rheumatic drugs and it is effective in all degrees of disease activity. The agent is noted for a particularly rapid achievement of its therapeutic effect, early exhibits antidestructive properties, and enables prediction of the long-term results of therapy at a relatively early stage of its use. It is improbable that the administration of CZP versus other TNF-Ξ± antagonists in pregnancy may be safer since it does not seem to penetrate the placental barrier. Emphasis is laid on the most convenient method for administration of the drug, namely, its subcutaneous route at large intervals. In this case there may be rare local reactions.ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ Π½ΠΎΠ²ΠΎΠΌΡ Π°Π½ΡΠ°Π³ΠΎΠ½ΠΈΡΡΡ Π€ΠΠ Ξ± - ΡΠ΅ΡΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±Ρ ΠΏΠ΅Π³ΠΎΠ»Ρ (Π¦ΠΠ). Π Π°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅ΡΡΡ ΠΎΠΏΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π² Π ΠΎΡΡΠΈΠΈ Π² ΡΠ°ΠΌΠΊΠ°Ρ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ RAPID 2. ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠΉ ΠΊ Π½Π°ΡΡΠΎΡΡΠ΅ΠΌΡ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΡΠΈΡΠ°ΡΡ, ΡΡΠΎ Π¦ΠΠ ΡΠ°ΡΡΠΈΡΠΈΠ» Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Π Π. ΠΠ½ ΠΌΠΎΠΆΠ΅Ρ ΡΡΠΏΠ΅ΡΠ½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ ΠΊΠ°ΠΊ Π² Π²ΠΈΠ΄Π΅ ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΠ°ΠΊ ΠΈ Π² ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ Π±Π°Π·ΠΈΡΠ½ΡΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ, ΡΡΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ ΠΏΡΠΈ Π²ΡΠ΅Ρ
ΡΡΠ΅ΠΏΠ΅Π½ΡΡ
Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ. ΠΡΠ΅ΠΏΠ°ΡΠ°Ρ ΠΎΡΠ»ΠΈΡΠ°Π΅ΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ Π±ΡΡΡΡΡΠΌ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ°, ΡΠ°Π½ΠΎ ΠΏΡΠΎΡΠ²Π»ΡΠ΅Ρ Π°Π½ΡΠΈΠ΄Π΅ΡΡΡΡΠΊΡΠΈΠ²Π½ΡΠ΅ ΡΠ²ΠΎΠΉΡΡΠ²Π°, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΏΡΠ΅Π΄ΡΠΊΠ°Π·Π°ΡΡ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ°Π½Π½Π΅ΠΌ ΡΡΠ°ΠΏΠ΅ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ. ΠΠ΅ ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΎ, ΡΡΠΎ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ Π°Π½ΡΠ°Π³ΠΎΠ½ΠΈΡΡΠ°ΠΌΠΈ Π€ΠΠ Ξ± ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π¦ΠΠ ΠΏΡΠΈ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΡΠΈ ΠΌΠΎΠΆΠ΅Ρ ΠΎΠΊΠ°Π·Π°ΡΡΡΡ Π±ΠΎΠ»Π΅Π΅ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΡΠΌ, ΠΏΠΎΡΠΊΠΎΠ»ΡΠΊΡ ΠΎΠ½, ΠΏΠΎ-Π²ΠΈΠ΄ΠΈΠΌΠΎΠΌΡ, Π½Π΅ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΡ ΡΠ΅ΡΠ΅Π· ΠΏΠ»Π°ΡΠ΅Π½ΡΠ°ΡΠ½ΡΠΉ Π±Π°ΡΡΠ΅Ρ. ΠΠΎΠ΄ΡΠ΅ΡΠΊΠΈΠ²Π°Π΅ΡΡΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ΄ΠΎΠ±Π½ΡΠΉ Π΄Π»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΌΠ΅ΡΠΎΠ΄ Π²Π²Π΅Π΄Π΅Π½ΠΈΡ - ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΡΠΉ, Ρ Π±ΠΎΠ»ΡΡΠΈΠΌΠΈ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»Π°ΠΌΠΈ. Π ΡΠ°ΠΊΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ Π½Π°Π±Π»ΡΠ΄Π°ΡΡΡΡ ΡΠ΅Π΄ΠΊΠΈΠ΅ ΠΌΠ΅ΡΡΠ½ΡΠ΅ ΡΠ΅Π°ΠΊΡΠΈΠΈ
Russian registry of Infliximab.Impact of therapy on the functional status of patients with rheumatoid arthritis
Objective. To evaluate the functional state of rheumatoid arthritis (RA) patients receiving Infliximab therapy (IF) in real clinical practice and its efficiency. Subjects and methods. The analysis covered 225 patients receiving IF therapy, the follow-up duration in whom was 54 weeks. Disease activity was estimated by the DAS 28 index; functional status was assessed according to the Health Assessment Questionnaire (HAQ). The authors made an analysis of a Per-Protocol (PP) population (n = 154) at 54 weeks of treatment and an analysis that could consider the results of treatment (by the ACR and EULAR criteria) in patients who had been withdrawn before the control time - a LOCF (Last Observation Carried Forward analysis) population. Results. The mean age of the patients was 47.6Β±11.4 years; the duration of the disease was 7.8Β±6.4 years; DAS 28 activity scores were 6.6Β±1.1; the majority of patients had significant functional impairments (HAQ scores of 2.0Β±0.7), 86.7% of the patients had extraarticular manifestations; 79.6% were found to have rheumatoid factor (RF); the patients received an average of > 2 disease-modifying antirheumatic drugs (DMARDs). After 2 week-therapy, there was a reduction in RA activity by DAS 28 index in both the PP (from 6.7Β±1.1 to 4.0Β±1.4) and LOCF (6.6Β±1.1 and 4.2Β±1.4; p < 106) populations. Drug-induced remission (DAS 28 < 2.6) at 54 weeks was observed in 16.9 and 15.1% of the patients, respectively. Functional improvement was noted in the PP population: HAQ decreased from 2.0Β±0.7 to 1.7Β±0.7 scores by week 2; its reduction continued until week 14 (p < 0.05), by remaining stable later on. HAQ dropped from 2.0Β±0.7 to 1.2Β±0.7 scores in the LOCF population. At 54 weeks, normal population values of functional activity were achieved in 16.4%. Log regression analysis in the LOCF population indicated that the previous use of DMARDs and a short history of the disease were predictors of an ACR70 response to IF therapy [OR=1.61 (1.13-2.30), p = 0.008 and OR = 0.91 (0.84-0.98), p = 0.018, respectively]. RF seronegativity was a predictor for achievement of low RA activity [OR = 0.44 (0.23-0.84)]. The previous use of glucocorticoids failed to increase the probability of a good response to IF therapy and achievement of clinical remission [OR = 0.26 (0.11-0.60), p = 0.001]. Conclusion. Therapy with IF in combination with methotrexate or other DMARDs reduces RA activity and improves the functional capacities of patients with RA in real clinical practice
Efficiency of tocilizumab therapy for an exacerbation of systemic lupus erythematosus: A case report and a review of literature
Interleukin-6 (IL-6) is one of the major proinflammatory cytokines, which, by interacting with hepatocytes, induces the synthesis of a broadΒ spectrum of acute phase inflammatory proteins. IL-6 plays an important role in the development and progression of systemic lupus erythematosusΒ (SLE), participates in the differentiation of CD4/CD8 regulatory T lymphocytes and in the production of autoantibodies by B lymphocytes,Β and increases the survival of plasmablasts. Tocilizumab (TCZ) is a humanized anti-IL-6 receptor antibody that neutralizes theΒ pleiotropic effects of the cytokine. The use of this drug in SLE can have acceptable efficiency with the high inflammatory activity that is accompaniedΒ by fever, polyarthritis, polyserositis, skin lesions, and hemolytic anemia.Β The authors demonstrated the successful use of TCZ in a female patient with a documented diagnosis of SLE with a high activity (SLEDAI-2K-11). The use of the drug was justified by the prevalence of musculoarticular, constitutional (fever) disease, a high immunological activityΒ (anti-DNA antibodies, 150 IU/ml; antinuclear factor, 1/1280 h; CRP, 88). This therapy could achieve complete relief of fever at day 2 afterΒ the first infusion of TCZ, a reduction, and subsequently complete relief of arthritis and normalization of laboratory blood parameters. TCZ hasΒ a satisfactory safety profile and may be considered as an alternative treatment for SLE when glucocorticoids, cytostatic agents, and rituximabΒ are ineffective
ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡ Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π±ΠΎΠΌ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΠΊΡΠ°ΡΠ½ΠΎΠΉ Π²ΠΎΠ»ΡΠ°Π½ΠΊΠΈ. ΠΠΏΠΈΡΠ°Π½ΠΈΠ΅ ΡΠ»ΡΡΠ°Ρ ΠΈ ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ
Interleukin-6 (IL-6) is one of the major proinflammatory cytokines, which, by interacting with hepatocytes, induces the synthesis of a broadΒ spectrum of acute phase inflammatory proteins. IL-6 plays an important role in the development and progression of systemic lupus erythematosusΒ (SLE), participates in the differentiation of CD4/CD8 regulatory T lymphocytes and in the production of autoantibodies by B lymphocytes,Β and increases the survival of plasmablasts. Tocilizumab (TCZ) is a humanized anti-IL-6 receptor antibody that neutralizes theΒ pleiotropic effects of the cytokine. The use of this drug in SLE can have acceptable efficiency with the high inflammatory activity that is accompaniedΒ by fever, polyarthritis, polyserositis, skin lesions, and hemolytic anemia.Β The authors demonstrated the successful use of TCZ in a female patient with a documented diagnosis of SLE with a high activity (SLEDAI-2K-11). The use of the drug was justified by the prevalence of musculoarticular, constitutional (fever) disease, a high immunological activityΒ (anti-DNA antibodies, 150 IU/ml; antinuclear factor, 1/1280 h; CRP, 88). This therapy could achieve complete relief of fever at day 2 afterΒ the first infusion of TCZ, a reduction, and subsequently complete relief of arthritis and normalization of laboratory blood parameters. TCZ hasΒ a satisfactory safety profile and may be considered as an alternative treatment for SLE when glucocorticoids, cytostatic agents, and rituximabΒ are ineffective.ΠΠ½ΡΠ΅ΡΠ»Π΅ΠΉΠΊΠΈΠ½ 6 (ΠΠ6) β ΠΎΠ΄ΠΈΠ½ ΠΈΠ· ΠΎΡΠ½ΠΎΠ²Π½ΡΡ
ΠΏΡΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΉ, Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΡΡ Ρ Π³Π΅ΠΏΠ°ΡΠΎΡΠΈΡΠ°ΠΌΠΈ, ΠΈΠ½Π΄ΡΡΠΈΡΡΠ΅ΡΒ ΡΠΈΠ½ΡΠ΅Π· ΡΠΈΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΠΊΡΡΠ° Π±Π΅Π»ΠΊΠΎΠ² ΠΎΡΡΡΠΎΠΉ ΡΠ°Π·Ρ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ. ΠΠ6 ΠΈΠ³ΡΠ°Π΅Ρ Π²Π°ΠΆΠ½ΡΡ ΡΠΎΠ»Ρ Π² ΡΠ°Π·Π²ΠΈΡΠΈΠΈ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉΒ ΠΊΡΠ°ΡΠ½ΠΎΠΉ Π²ΠΎΠ»ΡΠ°Π½ΠΊΠΈ (Π‘ΠΠ), ΠΏΡΠΈΠ½ΠΈΠΌΠ°Π΅Ρ ΡΡΠ°ΡΡΠΈΠ΅ Π² Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠ΅ CD4/CD8 T-Π»ΠΈΠΌΡΠΎΡΠΈΡΠΎΠ², Π’-ΡΠ΅Π³ΡΠ»ΡΡΠΎΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ, ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠΈΒ Π°ΡΡΠΎΠ°Π½ΡΠΈΡΠ΅Π» Π-Π»ΠΈΠΌΡΠΎΡΠΈΡΠ°ΠΌΠΈ, ΠΏΠΎΠ²ΡΡΠ°Π΅Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΠ»Π°Π·ΠΌΠΎΠ±Π»Π°ΡΡΠΎΠ². Π’ΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π± (Π’Π¦Π) ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ Π³ΡΠΌΠ°Π½ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ Π°Π½ΡΠΈΡΠ΅Π»ΠΎ ΠΊ ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠ°ΠΌ ΠΠ6, ΠΊΠΎΡΠΎΡΠΎΠ΅ Π½Π΅ΠΉΡΡΠ°Π»ΠΈΠ·ΡΠ΅Ρ ΠΏΠ»Π΅ΠΉΠΎΡΡΠΎΠΏΠ½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ ΡΠΈΡΠΎΠΊΠΈΠ½Π°. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΡΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΏΡΠΈΒ Π‘ΠΠ ΠΌΠΎΠΆΠ΅Ρ ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΠΏΡΠΈΠ΅ΠΌΠ»Π΅ΠΌΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ ΠΏΡΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ, ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π°ΡΡΠ΅ΠΉΡΡ Π»ΠΈΡ
ΠΎΡΠ°Π΄ΠΊΠΎΠΉ,Β ΠΏΠΎΠ»ΠΈΠ°ΡΡΡΠΈΡΠΎΠΌ, ΠΏΠΎΠ»ΠΈΡΠ΅ΡΠΎΠ·ΠΈΡΠΎΠΌ, ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΆΠΈ ΠΈ Π³Π΅ΠΌΠΎΠ»ΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°Π½Π΅ΠΌΠΈΠ΅ΠΉ.Β ΠΠ°ΠΌΠΈ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π’Π¦Π Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ Ρ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ Π‘ΠΠ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈΒ (SLEDAI-2K-11). ΠΠ°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΎΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π»ΠΎΡΡ ΠΏΡΠ΅Π²Π°Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΡΡΠ°Π²Π½ΠΎ-ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ, ΠΊΠΎΠ½ΡΡΠΈΡΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ (Π»ΠΈΡ
ΠΎΡΠ°Π΄ΠΊΠ°)Β ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ, Π²ΡΡΠΎΠΊΠΈΠΌ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΈΠΌΠΌΡΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ (Π°Π½ΡΠΈΡΠ΅Π»Π° ΠΊ ΠΠΠ β 150 ΠΠ΄/ΠΌΠ», Π°Π½ΡΠΈΠ½ΡΠΊΠ»Π΅Π°ΡΠ½ΡΠΉ ΡΠ°ΠΊΡΠΎΡ β 1/1280 h,Β Π‘Π Π β 88). ΠΠ»Π°Π³ΠΎΠ΄Π°ΡΡ ΡΠ°ΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ΄Π°Π»ΠΎΡΡ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡ ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΠΊΡΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π»ΠΈΡ
ΠΎΡΠ°Π΄ΠΊΠΈ ΠΊΠΎ 2-ΠΌΡ Π΄Π½Ρ ΠΏΠΎΡΠ»Π΅ ΠΏΠ΅ΡΠ²ΠΎΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΈ Π’Π¦Π,Β ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ, Π° Π² ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΌ ΠΈ ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΠΊΡΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π°ΡΡΡΠΈΡΠΎΠ², Π½ΠΎΡΠΌΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΊΡΠΎΠ²ΠΈ. Π’Π¦Π ΠΈΠΌΠ΅Π΅Ρ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΏΡΠΎΡΠΈΠ»Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ ΠΈ ΠΌΠΎΠΆΠ΅Ρ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΊΠ°ΠΊ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΡΠΉ ΠΌΠ΅ΡΠΎΠ΄ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π‘ΠΠ ΠΏΡΠΈ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΌ ΡΡΡΠ΅ΠΊΡΠ΅ Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄ΠΎΠ², ΡΠΈΡΠΎΡΡΠ°ΡΠΈΠΊΠΎΠ² ΠΈ ΡΠΈΡΡΠΊΡΠΈΠΌΠ°Π±Π°
ΠΠ½ΡΠ»ΠΈΠΊΡΠΈΠΌΠ°Π± Π² ΡΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅
The study of infliximab began (INF) in Russia in 2001. It was the first genetically engineered biological agent (GEBA) registered in our country to treat patients with rheumatoid arthritis (RA). With the advent of infliximab, a Russian biological rheumatoid arthritis therapy registry started its work. In October 2005, it was set up on the basis of GEBA centers founded in the leading rheumatology clinics of Russia. Objective: to generalize the Russian experience in using INF (its efficacy, tolerance, and side effects) in patients with RA in real clinical practice within the framework of a multicenter observational study. Subjects and methods. The register included patients with a valid diagnosis of RA in whom INF treatment was first started. The main indication for this was previous basic therapy failure. This investigation analyzed 396 patients receiving INF therapy. Prior to INF administration, all the patients were examined to identify whether they had possible latent tuberculosis, by applying chest X-ray study and Mantoux test. The European League Against Rheumatism criteria were used to evaluate the efficiency of INF therapy. The relationship between the therapeutic effects of the drug and its cumulative dose was specially used. The trend in X-ray progression was estimated using the Sharp method modified by van der Heijde. INF was given in a dose of 3 mg/kg by the classical regimen: at 0, 2, and 6 weeks, then every 8 weeks. The main assessment periods were at 22 and 46β54 weeks. Results. Analysis of the data of real clinical practice in Russia demonstrates that the use of INF in RA patients with the inadequate effect of traditional disease-modifying antirheumatic drugs (DMARDs) is able to cause a rapid and pronounced reduction in disease activity. There is significant evidence that the IFN-treated patients with RA had also suppressed bone destruction. INF treatment for early RA gives rise to remissions more frequently in the early stage of therapy than that for extensive-stage disease. INF was shown to have a clear dose-dependent effect: in the patients receiving more than 4 infusions of the drug, bone destruction was more noticeably suppressed than in those having its fewer infusions. In most cases, suppressed destruction was accompanied by clinical improvement. A significant therapeutic effect was seen when both an annual course of INF and average (5β7 infusions per year) doses of the drug were used. The results of the analysis suggest that the probable efficiency of INF therapy increases in RF-negative patients with lower baseline RA activity and fewer HAQ scores. INF was quiet satisfactorily tolerated and caused no unusual side effects. Conclusion. The Russian experience in using INF strongly suggests that it is effective in real practice in severe RA resistant to therapy with traditional DMARDs.ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΠ½ΡΠ»ΠΈΠΊΡΠΈΠΌΠ°Π±Π° (ΠΠΠ€) Π² Π ΠΎΡΡΠΈΠΈ Π½Π°ΡΠ°Π»ΠΎΡΡ Π² 2001 Π³. ΠΠ½ Π±ΡΠ» ΠΏΠ΅ΡΠ²ΡΠΌ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΠΌΠΈ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ (ΠΠΠΠ), Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Π² Π½Π°ΡΠ΅ΠΉ ΡΡΡΠ°Π½Π΅ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ (Π Π). Π‘ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΠΠ€ Π½Π°ΡΠ°Π» ΡΠ²ΠΎΡ ΡΠ°Π±ΠΎΡΡ Π ΠΎΡΡΠΈΠΉΡΠΊΠΈΠΉ ΡΠ΅Π³ΠΈΡΡΡ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ° (ΠΠ ΠΠΠ’Π ), ΡΠΎΠ·Π΄Π°Π½Π½ΡΠΉ Π² ΠΎΠΊΡΡΠ±ΡΠ΅ 2005 Π³. Π½Π° Π±Π°Π·Π΅ ΡΠ΅Π½ΡΡΠΎΠ² ΠΠΠΠ, ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΡ
Π² Π²Π΅Π΄ΡΡΠΈΡ
ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ°Ρ
Π ΠΎΡΡΠΈΠΈ. Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠ±ΠΎΠ±ΡΠ΅Π½ΠΈΠ΅ ΡΠΎΡΡΠΈΠΉΡΠΊΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ° ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠΠ€ (ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ, ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΡ ΠΈ ΠΏΠΎΠ±ΠΎΡΠ½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ) Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π Π Π² ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ Π² ΡΠ°ΠΌΠΊΠ°Ρ
ΠΌΠ½ΠΎΠ³ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ΅Π³ΠΈΡΡΡ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ Π Π, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΠΏΠ΅ΡΠ²ΡΠ΅ Π½Π°ΡΠ°ΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ€. ΠΡΠ½ΠΎΠ²Π½ΡΠΌ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠ΅ΠΌ Π΄Π»Ρ ΡΡΠΎΠ³ΠΎ Π±ΡΠ»Π° Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²ΡΡΡΠ΅ΠΉ Π±Π°Π·ΠΈΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. Π Π½Π°ΡΡΠΎΡΡΠ΅ΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 396 Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΠΎΠ»ΡΡΠ°Π²ΡΠΈΡ
ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΠΠ€. ΠΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π΄ΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΠΠ€ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈΡΡ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΠ³ΠΎ Π»Π°ΡΠ΅Π½ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ±Π΅ΡΠΊΡΠ»Π΅Π·Π°: ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ³ΡΠ°ΡΠΈΡ Π³ΡΡΠ΄Π½ΠΎΠΉ ΠΊΠ»Π΅ΡΠΊΠΈ ΠΈ ΠΏΡΠΎΠ±Π° ΠΠ°Π½ΡΡ. ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠ€ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ EULAR. Π‘ΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎ ΠΈΠ·ΡΡΠ°Π»Π°ΡΡ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ° ΠΎΡ ΡΡΠΌΠΌΠ°ΡΠ½ΠΎΠΉ Π΄ΠΎΠ·Ρ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°. ΠΡΠ΅Π½ΠΊΠ° Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ ΠΏΠΎ ΠΌΠ΅ΡΠΎΠ΄Ρ Sharp Π² ΠΌΠΎΠ΄ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Van der Heijde. ΠΠΠ€ Π½Π°Π·Π½Π°ΡΠ°Π»ΡΡ Π² Π΄ΠΎΠ·Π΅ 3 ΠΌΠ³/ΠΊΠ³ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡ
Π΅ΠΌΠ΅: 0; 2; 6-Ρ Π½Π΅Π΄Π΅Π»ΠΈ, Π΄Π°Π»Π΅Π΅ ΠΊΠ°ΠΆΠ΄ΡΠ΅ 8 Π½Π΅Π΄. ΠΡΠ½ΠΎΠ²Π½ΡΠΌΠΈ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°ΠΌΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±ΡΠ»ΠΈ 22-Ρ ΠΈ 46-54-Ρ Π½Π΅Π΄Π΅Π»ΠΈ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠ½Π°Π»ΠΈΠ· Π΄Π°Π½Π½ΡΡ
ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ Π² Π ΠΎΡΡΠΈΠΈ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅Ρ, ΡΡΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ€ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π Π Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΌ ΡΡΡΠ΅ΠΊΡΠΎΠΌ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΡ
ΠΠΠΠ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎ Π² Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ ΡΠ»ΡΡΠ°Π΅Π² ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊ Π±ΡΡΡΡΠΎΠΌΡ ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠΌΡ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ ΡΠ°ΠΊΠΆΠ΅ ΡΠΎΡΠΌΠΎΠΆΠ΅Π½ΠΈΠ΅ ΠΊΠΎΡΡΠ½ΠΎΠΉ Π΄Π΅ΡΡΡΡΠΊΡΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π Π, ΠΏΠΎΠ»ΡΡΠ°ΡΡΠΈΡ
ΠΠΠ€. ΠΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ€ ΠΏΡΠΈ ΡΠ°Π½Π½Π΅ΠΌ Π Π ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΠΎΠΌΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅ΠΌΠΈΡΡΠΈΠΉ Π½Π° Π½Π°ΡΠ°Π»ΡΠ½ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌΠΈ ΠΏΡΠΈ ΡΠ°Π·Π²Π΅ΡΠ½ΡΡΠΎΠΉ ΡΡΠ°Π΄ΠΈΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ. ΠΠΎΠΊΠ°Π·Π°Π½ ΡΠ΅ΡΠΊΠΈΠΉ Π΄ΠΎΠ·ΠΎΠ·Π°Π²ΠΈΡΠΈΠΌΡΠΉ ΡΡΡΠ΅ΠΊΡ ΠΠΠ€: Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠΎΠ»ΡΡΠΈΠ²ΡΠΈΡ
Π±ΠΎΠ»Π΅Π΅ 4 ΠΈΠ½ΡΡΠ·ΠΈΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°, ΠΊΠΎΡΡΠ½Π°Ρ Π΄Π΅ΡΡΡΡΠΊΡΠΈΡ ΡΠΎΡΠΌΠΎΠ·ΠΈΠ»Π°ΡΡ Π±ΠΎΠ»Π΅Π΅ ΠΎΡΡΠ΅ΡΠ»ΠΈΠ²ΠΎ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΠΎΠ»ΡΡΠΈΠ²ΡΠΈΠΌΠΈ ΠΌΠ΅Π½ΡΡΠ΅Π΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΈΠ½ΡΡΠ·ΠΈΠΉ. Π Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ ΡΠ»ΡΡΠ°Π΅Π² ΡΠΎΡΠΌΠΎΠΆΠ΅Π½ΠΈΠ΅ Π΄Π΅ΡΡΡΡΠΊΡΠΈΠΈ ΡΠΎΡΠ΅ΡΠ°Π»ΠΎΡΡ Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ. ΠΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΉ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡ ΠΎΡΠΌΠ΅ΡΠ΅Π½ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ΠΊΠ°ΠΊ Π³ΠΎΠ΄ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΡΡΡΠ° ΠΠΠ€, ΡΠ°ΠΊ ΠΈ Β«ΡΡΠ΅Π΄Π½ΠΈΡ
Β» (5β7 ΠΈΠ½ΡΡΠ·ΠΈΠΉ Π·Π° Π³ΠΎΠ΄) Π΄ΠΎΠ· ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π°ΡΠ΅Π³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΡΡΡ ΠΎ ΡΠΎΠΌ, ΡΡΠΎ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠ€ Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π΅Ρ Ρ Π Π€-Π½Π΅Π³Π°ΡΠΈΠ²Π½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΡΠΈ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΌΠ΅Π½Π΅Π΅ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π Π ΠΈ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΎΠΉ Π²Π΅Π»ΠΈΡΠΈΠ½Π΅ HAQ. ΠΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΡ ΠΠΠ€ Π±ΡΠ»Π° Π²ΠΏΠΎΠ»Π½Π΅ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ, Π½Π΅ΠΎΠ±ΡΡΠ½ΡΡ
ΠΏΠΎΠ±ΠΎΡΠ½ΡΡ
ΡΡΡΠ΅ΠΊΡΠΎΠ² Π½Π΅ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΠΎΡΡΠΈΠΉΡΠΊΠΈΠΉ ΠΎΠΏΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠΠ€ ΡΠ±Π΅Π΄ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ²ΠΈΠ΄Π΅ΡΠ΅Π»ΡΡΡΠ²ΡΠ΅Ρ ΠΎ Π΅Π³ΠΎ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π² ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ ΠΏΡΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌ Π Π, ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΠΌ ΠΊ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΠΠΠΠ
Point mutation of tyrosine 759 of the IL-6 family cytokine receptor, gp130, augments collagen-induced arthritis in DBA/1J mice
<p>Abstract</p> <p>Background</p> <p>Knock-in mice (gp130F759) with a Y759F point mutation in gp130, a signal transducing receptor subunit shared by members of the IL-6 cytokine family, show sustained activation of STAT3, enhanced acute-phase or immune responses, and autoimmune arthritis. We conducted a detailed analysis of collagen-induced arthritis (CIA) in gp130F759 with a DBA/1J background (D/J.gp130F759).</p> <p>Methods</p> <p>We backcrossed gp130F759 to C57BL/6 and DBA/1J, and compared the pathologic changes, including occurrence of arthritis, in the two distinct genetic backgrounds. We analyzed CIA in D/J.gp130F759 and investigated the effects of methotrexate (MTX) on CIA.</p> <p>Results</p> <p>C57BL/6 background gp130F759 mice, but not D/J.gp130F759, spontaneously developed polyarthritis and glomerulonephritis. On the other hand, keratitis of the eyes only developed in D/J.gp130F759, indicating the influence of genetic background on disease development in gp130F759 mice. Resistance of the DBA/1J background against spontaneous arthritis urged us to examine CIA in D/J.gp130F759. CIA in D/J.gp130F759 was more severe, with greater bone destruction, than the control mice. After collagen immunization, splenomegaly and serum levels of rheumatoid factor and anti-DNA antibody were augmented in D/J.gp130F759. Bio-Plex analysis of serum cytokines revealed increased IL-12p40 and PDGF-BB before immunization, and increased levels of IFN-Ξ³, IL-17, TNF-Ξ±, IL-9, and MIP-1Ξ² 8 days after the booster dose. IL-6 and PDGF-BB in D/J.gp130F759 showed distinct kinetics from the other cytokines; higher levels were observed after arthritis development. MTX partially attenuated the development of arthritis and inhibited bone destruction in D/J.gp130F759, with reduction of anti-type II collagen antibody levels, suggesting that MTX mainly affects antigen-specific immune responses in CIA.</p> <p>Conclusion</p> <p>The Tyr-759 point mutation of the IL-6 family cytokine receptor subunit, gp130, caused autoimmune disease, and this was also influenced by the genetic background. CIA in D/J.gp130F759 is useful for evaluating drugs in a relatively short period because sustained activation of STAT3 may enhance the disease symptoms.</p
GOLIMUMAB SAFETY ACCORDING TO CLINICAL FINDINGS
The review analyzes trials dealing with the safety of golimumab (GLM) Β used in rheumatology.Β This drug was the latestΒ Contact: Galina Lukina;[email protected]Β ΠΠΎΡΡΡΠΏΠΈΠ»Π° 12.05.14tumor necrosis factor Ξ± (TNF-Ξ±) inhibitor introduced Β into clinical practice and therefore the estimation of its tolerability is particularly relevant. The data obtained in large-scale clinical trials suggest that GLM has a good safety profile. The most common Β adverse events (AE) were infections, more often mild. The rate of infections was higher with the use of GLM 100 mg than with that of 50 mg. The overall cancer rate did not increase during a follow-up of less than 160 weeks. However, the rate of lymphomas in patients receiving GLM 100 mg proved to be higher than in those taking GLM 50 mg, in the general population, and in the placebo group in particular. AE were evenly distributed among patients with rheumatoid Β arthritis, psoriatic arthritis, or ankylosing spondylitis. Overall, the findings are in agreement with the data on the safety of previously used TNF-Ξ± inhibitors. No fundamentally new AE have been encountered. It is necessary to accumulate Β data on the use of GLM in real clinical practice, which will be able to more objectively define its place in the current therapy of rheumatic diseases
Certolizumab pegol in therapy for rheumatoid arthritis
The paper reviews the literature on the new tumor necrosis factor-Ξ± (TNF-Ξ±) antagonist certolizumab pegol (CZP). It considers the experience in using the drug in Russia within the framework of the RAPID 2 trial. The currently obtained material suggests that CZP has extended the capacities of RA treatment. The drug may be successfully used both alone and in combination with other disease-modifying anti-rheumatic drugs and it is effective in all degrees of disease activity. The agent is noted for a particularly rapid achievement of its therapeutic effect, early exhibits antidestructive properties, and enables prediction of the long-term results of therapy at a relatively early stage of its use. It is improbable that the administration of CZP versus other TNF-Ξ± antagonists in pregnancy may be safer since it does not seem to penetrate the placental barrier. Emphasis is laid on the most convenient method for administration of the drug, namely, its subcutaneous route at large intervals. In this case there may be rare local reactions
NΠW APPROACHES Π’Π ANALYSE OF PATHOGENESIS AND PATHOGENETIC THIRAPY OF RHEUMATOID ARTHRITIS
Combination therapy for rheumatoid arthritis with rituximab and leflunomide(preliminary results of the Russian ARBITR Registry)
The paper analyzes the efficiency and tolerability of a combination of rituximab (RTM) and leflunomide (LEF) for the treatment of rheumatoid arthritis (RA) versus the conventional combination of RTM and methotrexate (MT). The results of 24-week therapy were assessed in the RA patients included into the Russian Biological Therapy Register. A good effect of therapy was achieved in 31.8% of the patients who had received RTM+LEF (p = 0.1). The development of clinical remissions in RA was observed at a practically equal frequency of 13.6 and 11.7%, respectively. The doses of glucocorticoids and nonsteroidal anti-inflammatory drugs used in concurrent anti-inflammatory therapy could be substantially reduced in both groups. In both groups, the rate of side effects was very equal: 21.7% for the RTM+LEF group and 25.7% for the RTM+MT group. Thus, the combination therapy of RTM and LEF in real clinical practice is not considerably different from the most commonly used combination of RMT and MT in efficiency and tolerability and may be successfully used if there are any contraindications to the use of MT