Организация помощи пациентам с тяжелой бронхиальной астмой в различных субъектах Российской Федерации. От эндотипов и фенотипов бронхиальной астмы к персонализированному выбору терапии
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Avdeev S.N., Volkova O.A., Demko I.V., et al. Severe bronchial asthma patient care organization in various regions of the Russian Federation. From endotypes and phenotypes of bronchial asthma to personalized choice of therapy. Therapeutic Archive. 2020; 92 (2): 119–123. DOI: 10.26442/00403660.2020.02.000555
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Ключевые слова: тяжелая бронхиальная астма, эндотип, фенотип, Т2-бронхиальная астма, биологическая терапия бронхиальной астмы, омализумаб, меполизумаб, реслизумаб, дупилумаб, бенрализумаб.
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The meeting of the Expert board was held in Moscow on June 24, 2019, at which the following issues were considered: the applicability of a new terminology characterizing asthma endotypes and phenotypes in real clinical practice, the effect of phenotypes and biomarkers in patients with bronchial asthma on the choice of biological drug, as well as the optimal clinical profiles of patients for whom dupilumab is most effective, taking into account the data of the III phase clinical trials, regional features of medical care and changes in updated international clinical guidelines for the diagnosis and treatment of asthma. The Expert board included members of leading Russian scientific and educational medical institutions: S.N. Avdeev, corresponding member of the Russian Academy of Sciences, prof., MD; O.A. Volkova, Ph.D.; I.V. Demko, prof., MD; G.L. Ignatova, prof., MD; I.V. Leshchenko, prof., MD; Kanukova N.A.; Kudelya L.M., prof., MD; V.A. Nevzorova, prof., MD; N.G. Nedashkovskaya; O.P. Ukhanova, prof., MD; L.V. Shulzhenko, prof., MD; R.S. Fassakhov, prof., MD.
Keywords: severe bronchial asthma, endotype, phenotype, T2-bronchial asthma, biological therapy of bronchial asthma, omalizumab, mepolizumab, resilizumab, dupilumab, benilizumab.
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2. Chuchalin A, Khaltaev N, Antonov N, Galkin D. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Inter J Chronic Obstructive Pulmonary Disease. 2014:963. doi: 10.2147/copd.s67283
3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention (2018 update). Accessed June 25, 2019. Available at: www.ginasthma.org
4. Chung KF, Wenzel SE, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respiratory J. 2013;43(2):343-73. doi: 10.1183/09031936.00202013
5. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nature Medicine. 2012;18(5):716-25. doi: 10.1038/ nm.2678
6. Robinson D, Humbert M, Buhl R, et al. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exper Allergy. 2017;47(2):161-75. doi: 10. 1111/cea.12880
7. Fahy JV. Type-2 inflammation in asthma — present in most, absent in many. Nature Reviews Immunol. 2014;15(1):57-65. doi: 10.1038/ nri3786
8. Gauthier M, Ray A, Wenzel SE. Evolving Concepts of Asthma. Amer J Respir Criti Care Med. 2015;192(6):660-8. doi: 10.1164/rccm.201504-0763pp
9. Woodruf PG, Modrek B, Choy DF, et al. T-helper type 2-driven inflammation defines major subphenotypes of asthma. Amer J Respir Crit Care Med. 2009;180(5):388-95. doi: 10.1164/rccm.200903-0392oc
10. Dunican EM, Fahy JV. The Role of Type 2 Inflammation in the Pathogenesis of Asthma Exacerbations. Ann Amer Thorac Soc. 2015;12(Suppl. 2):S144-S149. doi: 10.1513/AnnalsATS.201506-377AW
11. Peters MC, Mekonnen ZK, Yuan S, Bhakta NR, Woodruff PG, Fahy JV. Measures of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. J Allergy Clin Immunol. 2014;133(2):388-94. doi: 10.1016/j.jaci.2013.07.036
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19. Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, et al. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. New Engl J Med. 2018;378(26):2475-85. doi: 10.1056/nejmoa1804093
20. Bachert C, Han JK, Desrosiers M, Hellings PW, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet. 2019;394(10209):1638-50. doi: 10.1016/s0140-6736(19)31881-1
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 БУЗ Удмуртской республики «Городская клиническая больница №6» Минздрава Удмуртской республики, Ижевск, Россия;
3 ФГБОУ ВО «Красноярский государственный медицинский университет им. профессора В.Ф. Войно-Ясенецкого» Минздрава России, Красноярск, Россия;
4 ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России, Челябинск, Россия;
5 ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России, Екатеринбург, Россия;
6 Автономная некоммерческая медицинская организация «Ставропольский краевой клинический консультативно-диагностический центр», Ставрополь, Россия;
7 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
8 ФГБОУ ВО «Тихоокеанский государственный медицинский университет» Минздрава России, Владивосток, Россия;
9 ГБУ «Областная клиническая больница №2», Ростов-на-Дону, Россия;
10 ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава России, Ставрополь, Россия;
11 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия;
12 ФГАОУ ВО «Казанский (Приволжский) федеральный университет», Казань, Россия
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S.N. Avdeev1, O.A. Volkova2, I.V. Demko3, G.L. Ignatova4, I.V. Leshchenko5, N.A. Kanukova6, L.M. Kudelya7, V.A. Nevzorova8, N.G. Nedashkovskaya9, O.P. Ukhanova10, L.V. Shulzhenko11, R.S. Fassakhov12
1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 City Clinical Hospital No.6, Izhevsk, Russia;
3 Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia;
4 South Ural State Medical University, Chelyabinsk, Russia;
5 Ural State Medical University, Yekaterinburg, Russia;
6 Stavropol Regional Clinical Consultative and Diagnostic Center, Stavropol, Russia;
7 Novosibirsk State Medical University, Novosibirsk, Russia;
8 Pacific State Medical University, Vladivostok, Russia;
9 Regional Clinical Hospital No.2, Rostov-on-Don, Russia;
10 Stavropol State Medical University, Stavropol, Russia;
11 Kuban State Medical University, Krasnodar, Russia;
12 Kazan (Volga) Federal University, Kazan, Russia