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        Современная терапия системных васкулитов: достижения и перспективы - Журнал Терапевтический архив №1 Поликлинические проблемы и организация медицинской помощи 2018

        Современная терапия системных васкулитов: достижения и перспективы

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          Современная терапия системных васкулитов: достижения  и перспективы

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        • Аннотация
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        Аннотация
        Системные васкулиты представляют собой неоднородную группу воспалительных заболеваний, которые классифицируют в зависимости от диаметра пораженных сосудов. Лечение системных васкулитов перестает быть эмпирическим благодаря увеличению количества рандомизированных клинических исследований, которые проводятся даже у пациентов с самыми редкими заболеваниями этой группы, такими как артериит Такаясу или эозинофильный гранулематоз с полиангиитом. В последние годы отмечается стремление ограничить кумулятивную дозу глюкокортикостероидов и токсичных иммуносупрессивных препаратов, в том числе за счет применения генно-инженерных биологических препаратов (ГИБП), хотя последние не всегда превосходят стандартные средства по эффективности и/или безопасности и в большинстве случаев пока рассматриваются как препараты резерва. Необходимо учитывать, что ответ на лечение разными ГИБП отличается у пациентов с различными формами системных васкулитов, что создает основу для персонифицированной терапии этих заболеваний. Серьезную проблему представляет оценка показаний к интенсификации иммуносупрессивной терапии, особенно при васкулитах, поражающих крупные сосуды, в связи с недостаточной информативностью лабораторных маркеров воспаления. В статье рассматриваются современные подходы к лечению системных васкулитов, в том числе ассоциированных с антителами к цитоплазме нейтрофилов, гигантоклеточного артериита, артериита Такаясу и криоглобулинемического васкулита.

        Ключевые слова: гигантоклеточный артериит, артериит Такаясу, АНЦА-ассоциированные васкулиты, HCV-ассоциированный криоглобулинемический васкулит, клинические исследования.

        ________________________________________________

        Systemic vasculitis is a heterogeneous group of inflammatory diseases, which are classified according to the diameter of the affected vessels. The treatment of systemic vasculitis is no longer empirical, because of increasing number of randomized clinical trials in this field. In recent years, there was a trend to limit the cumulative dose of glucocorticosteroids and immunosuppressive drugs, partially through biological drugs usage. However, biologic therapy is not always superior to combination of glucocorticosteroids and cytotoxic drugs. The efficacy of different biologic drugs varies in patients with different forms of systemic vasculitis, which creates the ground for personalized therapy of these diseases. Another serious problem is the absence of strict criteria to immunosuppressive therapy intensification, especially in vasculitis, affecting large vessels, due to the lack of reliable laboratory markers of disease activity. The article reviews modern approaches to the treatment of some types of systemic vasculitis, including ANCA-associated vasculitides, giant cell arteritis, Takayasu`s arteritis and cryoglobulinemic vasculitis.

        Key words: large vessel vasculitis, Takayasu`s arteritis, ANCA-associated vasculitis, HCV-associated cryoglobulinemia, ongoing study, clinical trials.

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        Авторы
        П.И. НОВИКОВ1, А.С. ЗЫКОВА2, С.В. МОИСЕЕВ1,2

        1 ФГБОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава РФ, Москва, Россия;
        2 МГУ им. М.В. Ломоносова, Москва, Россия

        ________________________________________________

        P.I. NOVIKOV1, A.S. ZYKOVA2, S.V. MOISEEV1, 2 

        1 Sechenov First Moscow State Medical University, Moscow, Russia;
        2 Lomonosov Moscow State University, Moscow, Russia


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