Роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (Ацеллбия, «БИОКАД») у больных ревматоидным артритом
Роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (Ацеллбия, «БИОКАД») у больных ревматоидным артритом
Авдеева А.С., Черкасова М.В., Кусевич Д.А. и др. Роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (Ацеллбия, «БИОКАД») у больных ревматоидным артритом. Терапевтический архив. 2019; 91 (5): 26–33. DOI: 10.26442/00403660.2019.05.000230
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Avdeeva A.S., Cherkasova M.V., Kusevich D.A., et al. The role of laboratory biomarkers in monitoring of rituximab biosimilar therapy (Acellbia, “BIOCAD”) in patients with rheumatoid arthritis. Therapeutic Archive. 2019; 91 (5): 26–33. DOI: 10.26442/00403660.2019.05.000230
Роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (Ацеллбия, «БИОКАД») у больных ревматоидным артритом
Авдеева А.С., Черкасова М.В., Кусевич Д.А. и др. Роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (Ацеллбия, «БИОКАД») у больных ревматоидным артритом. Терапевтический архив. 2019; 91 (5): 26–33. DOI: 10.26442/00403660.2019.05.000230
________________________________________________
Avdeeva A.S., Cherkasova M.V., Kusevich D.A., et al. The role of laboratory biomarkers in monitoring of rituximab biosimilar therapy (Acellbia, “BIOCAD”) in patients with rheumatoid arthritis. Therapeutic Archive. 2019; 91 (5): 26–33. DOI: 10.26442/00403660.2019.05.000230
Цель: оценить роль лабораторных биомаркеров в мониторинге эффективности терапии биоаналогом ритуксимаба (РТМ) в суммарной дозе 1200 мг. Материалы и методы. Обследовано 20 больных с достоверным диагнозом ревматоидного артрита (РА; 18 женщин, медиана возраста 61,5 [54–66,5] лет, длительность заболевания 39,5 [20–84] лет, индекс DAS28 5,6 [4,9–6,8]). Всем больным проведено по 2 инфузии РТМ (Ацеллбия®) в дозе 600 мг внутривенно с интервалом в 2 нед на фоне терапии метотрексатом (МТ), нестероидными противовоспалительными препаратами (НПВП) и глюкокортикоидами (ГК). Клинические и лабораторные показатели анализировали непосредственно перед началом терапии, а затем через 12 и 24 нед после первой инфузии препарата. Результаты. У ответчиков на терапию индекс DAS28, скорость оседания эритроцитов и уровень С-реактивного белка достоверно снижались через 12 и 24 нед после применения РТМ. Снижение концентрации иммуноглобулина (Ig) M ревматоидного фактора (РФ) в сыворотках ответчиков выявлено на 12-й и 24-й неделе и составило 79,7 и 87,1% от исходного уровня соответственно (p<0,05). Уровень IgA РФ снижался на 72 и 85% от исходного уровня соответственно на 12-й и 24-й неделе терапии РТМ у больных с хорошим эффектом препарата (p<0,05). Концентрация антител к циклическому цитруллинированному пептиду в сыворотках ответчиков оставалась высокой на всем протяжении наблюдения. Деплеция CD19+ В-лимфоцитов достигнута к 12-й неделе терапии у всех пациентов (абсолютное содержание 0), к 24-й неделе отмечено нарастание уровня CD19+ B-клеток (0,0030 [0,0003–0,0270] 109/л). Средние уровни иммуноглобулинов как в группе пациентов с хорошим, так и с удовлетворительным эффектом оставались в пределах нормы. Применение ацеллбии также сопровождалось быстрым и выраженным снижением концентрации практически всего спектра показателей цитокинового профиля через 12–24 нед после первой инфузии. Заключение. Анализ иммунологических эффектов биоаналога РТМ свидетельствует о его способности вызывать снижение лабораторных показателей воспалительной активности, концентрации аутоантител, провоспалительных цитокинов, хемокинов и факторов роста, полную деплецию В-лимфоцитов. Серопозитивность по IgM РФ и/или антителам к цитруллинированным белкам и повышенные уровни данных аутоантител в сыворотке крови, а также повышенный уровень интерлейкина-17 через 12 нед лечения можно рассматривать в качестве предикторов хорошего ответа на проводимую терапию.
Aim: to evaluate the role of laboratory biomarkers in monitoring effectiveness of rituximab (RTM) biosimilar therapy in a total dose of 1200 mg. Materials and methods. 20 patients (pts) with rheumatoid arthritis (RA) (18 woman, mean age 61.5(54–66.5) years, mean disease duration 39.5(20–84) months, mean DAS28 5.6(4.9–6.8)) received two intravenous RTM biosimilar infusions (600 mg №2) in combination with DMARDs and glucocorticoids. Laboratory biomarkers were assessed at baseline and weeks 12 and 24 after the first infusion of RTX. Results. RTM biosimilar induced decreases in DAS28, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) at week 12 and 24, p<0.05. The decrease in the concentration of immunoglobulin (Ig) M rheumatoid factor (RF) was detected at week 12 and 24 and amounted to 79.7% and 87.1% of the initial level, respectively (p<0.05). IgA RF level decreased by 72% and 85% from baseline, respectively, at the 12 and 24 week of RTM therapy in patients with a good effect of the drug (p<0.05). The concentration of antibodies to cyclic citrullinated peptide in the sera did not reduced. Depletion of CD19+ B-cells was achieved at week 12 in all patients (absolute number 0), with an increase in the level of B-cells at week 24 (0.0030 (0.0003–0.0270) 109/l). The immunoglobulin level decreased at week 24, but remained normal. RTM biosimilar therapy was accompanied by a rapid and pronounced decrease in the concentration of cytokine profile by 12–24 weeks after the first infusion. Conclusion. RTX biosimilar therapy induced a rapid and significant improvement in ESR, CRP, IgM/IgA RF, anti-MCV, proinflammatory cytokines, chemokines and growth factors levels and CD19+ B-cells depletion in RA pts. IgM RF and/or antibodies to citrullinated proteins seropositivity, increased levels of interleukin-17 after 12 weeks of treatment can be considered as predictors of a good response to RTM biosimilar therapy.
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1. Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Nasonov EL, Nasonova VA, editors. Revmatologiya. Natsional'noe rukovodstvo (Rheumatology. Nationalguidance). Moscow: GEOTAR-Media, 2008: 290-331 (In Russ.).
2. Nasonov EL. Rituximab. V kn.: Genno-inzhenernyebiologicheskiepreparaty v lecheniirevmatoidnogoartrita. Pod red. E.L. Nasonova Edited by EL. Nasonov. Moscow: IMA-PRESS, 2013:200-221 (In Russ.).
3. Huscher D, Mittendorf T, von Hinuber U, et al. Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis. 2015;74(4):738-45. doi.org/10.1136/annrheumdis-2013-204311
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1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»» Минздрава России (Сеченовский Университет), Москва, Россия;
3 Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Научно-исследовательский институт трансляционной медицины, отдел регенеративной медицины; институт биологии развития (ИБР) РАН, лаборатория проблем клеточной пролиферации, Москва, Россия
1 V.A. Nasonova Scientific and Research Institute of Rheumatology, Moscow, Russia;
2 I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia;
3 Department of Regenerative Medicine; Institute of Developmental Biology, Russian Academy of Sciences, Laboratory of Cell Proliferation, Pirogov Russian National Research Medical University, Moscow, Russia