Несмотря на большие успехи в диагностике и лечении иммуновоспалительных ревматических заболеваний (ИВРЗ), приведшие к существенному улучшению прогноза у многих пациентов, фундаментальные медицинские проблемы этой патологии – восстановление качества жизни и снижение летальности до популяционного уровня – далеки от разрешения. Это послужило стимулом к изучению новых подходов к фармакотерапии ИВРЗ, один из которых связан с использованием низкомолекулярных химически синтезированных препаратов, ингибирующих внутриклеточные «сигнальные» молекулы – Янус-киназы. Рассмотрены современные достижения, касающиеся применения ингибиторов Янус-киназы в лечении ИВРЗ и COVID-19.
Despite great advances in the diagnosis and treatment of immunoinflammatory rheumatic diseases, which have led to a significant improvement in the prognosis in many patients, the fundamental medical problems of this pathology – the restoration of the quality of life and the reduction of mortality to the population level – are far from being resolved. This served as a stimulus for the study of new approaches to the pharmacotherapy of IVRD, one of which is associated with the use of low molecular weight chemically synthesized drugs that inhibit intracellular "signaling" molecules – Janus kinase. Modern advances regarding the use of Janus kinase inhibitors in the treatment of immunoinflammatory rheumatic diseases and COVID -19 are considered.
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2. Szekanecz Z, McInnes IB, Schett G, et al. Autoinflammation and autoimmunity across rheumatic and musculoskeletal diseases. Nat Rev Rheumatol. 2021;17(10):585-95. DOI:10.1038/s41584-021-00652-9
3. Schett G, McInnes IB, Neurath MF. Reframing Immune-Mediated Inflammatory Diseases through Signature Cytokine Hubs. N Engl J Med. 2021;385(7):628-39. DOI:10.1056/NEJMra1909094
4. Van Wesemael T, Huizinga TW, Toes REM, van der Woude D. From phenotype to pathophysiology – placing rheumatic diseases in an immunological perspective. Lancet Rheumatol. 2022;4(3):E166-7. DOI:10.1016/S2665-9913(21)00369-6
5. Baker KF, Isaacs JD. Novel therapies for immune-mediated inflammatory diseases: What can we learn from their use in rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, psoriasis, Crohn's disease and ulcerative colitis? Ann Rheum Dis. 2018;77(2):175-87. DOI:10.1136/annrheumdis-2017-211555
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7. Burmester GR, Bijlsma JWJ, Cutolo M, McInnes IB. Managing rheumatic and musculoskeletal diseases – past, present and future. Nat Rev Rheumatol. 2017;13(7):443-8. DOI:10.1038/nrrheum.2017.95
8. Schwartz DM, Kanno Y, Villarino A, et al. JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat Rev Drug Discov. 2017;16(12):843-62. DOI:10.1038/nrd.2017.201
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10. Spinelli FR, Meylan F, O'Shea JJ, Gadina M. JAK inhibitors: Ten years after. Eur J Immunol. 2021;51(7):1615-27. DOI:10.1002/eji.202048922
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14. Насонов Е.Л., Авдеева А.С., Лила А.М. Эффективность и безопасность тофацитиниба при иммуновоспалительных ревматических заболеваниях (часть II). Научно-практическая ревматология. 2020;58(2):214-24 [Nasonov EL, Avdeeva AS, Lila AM. Efficacy and safety of tofacitinib for immunemediated inflammatory rheumatic diseases (Part II). Rheumatology Science and Practice. 2020;58(2):214-24 (in Russian)]. DOI:10.14412/1995-4484-2020-214-224
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19. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79(6):700-12. DOI:10.1136/annrheumdis-2020-217159
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24. Winthrop KL. The emerging safety profile of JAK inhibitors in rheumatic disease. Nat Rev Rheumatol. 2017;13(4):234-43. DOI:10.1038/nrrheum.2017.23
25. Nash P, Kerschbaumer A, Dörner T, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis. 2021;80(1):71-87. DOI:10.1136/annrheumdis-2020-218398
26. Yates M, Mootoo A, Adas M, et al. Venous Thromboembolism Risk With JAK Inhibitors: A Meta-Analysis. Arthritis Rheumatol. 2021;73(5):779-88. DOI:10.1002/art.41580
27. Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-26. DOI:10.1056/NEJMoa2109927
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29. Kretschmer S, Lee-Kirsch MA. Type I interferon-mediated autoinflammation and autoimmunity. Curr Opin Immunol. 2017;49:96-102. DOI:10.1016/j.coi.2017.09.003
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31. Gómez-Arias PJ, Gómez-García F, Hernández-Parada J, et al. Efficacy and Safety of Janus Kinase Inhibitors in Type I Interferon-Mediated Monogenic Autoinflammatory Disorders: A Scoping Review. Dermatol Ther (Heidelb). 2021;11(3):733-50. DOI:10.1007/s13555-021-00517-9
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________________________________________________
1. McGonagle D, McDermott MF. A proposed classification of the immunological diseases. PLoS Med. 2006;3(8):e297. DOI:10.1371/journal.pmed.0030297
2. Szekanecz Z, McInnes IB, Schett G, et al. Autoinflammation and autoimmunity across rheumatic and musculoskeletal diseases. Nat Rev Rheumatol. 2021;17(10):585-95. DOI:10.1038/s41584-021-00652-9
3. Schett G, McInnes IB, Neurath MF. Reframing Immune-Mediated Inflammatory Diseases through Signature Cytokine Hubs. N Engl J Med. 2021;385(7):628-39. DOI:10.1056/NEJMra1909094
4. Van Wesemael T, Huizinga TW, Toes REM, van der Woude D. From phenotype to pathophysiology – placing rheumatic diseases in an immunological perspective. Lancet Rheumatol. 2022;4(3):E166-7. DOI:10.1016/S2665-9913(21)00369-6
5. Baker KF, Isaacs JD. Novel therapies for immune-mediated inflammatory diseases: What can we learn from their use in rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, psoriasis, Crohn's disease and ulcerative colitis? Ann Rheum Dis. 2018;77(2):175-87. DOI:10.1136/annrheumdis-2017-211555
6. Nasonov EL. Pharmacotherapy for rheumatoid arthritis: New strategy, new targets. Rheumatology Science and Practice. 2017;55(4):409-19 (in Russian). DOI:10.14412/1995-4484-2017-409-419
7. Burmester GR, Bijlsma JWJ, Cutolo M, McInnes IB. Managing rheumatic and musculoskeletal diseases – past, present and future. Nat Rev Rheumatol. 2017;13(7):443-8. DOI:10.1038/nrrheum.2017.95
8. Schwartz DM, Kanno Y, Villarino A, et al. JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat Rev Drug Discov. 2017;16(12):843-62. DOI:10.1038/nrd.2017.201
9. Nasonov EL, Lila AM. Janus kinase inhibitors in immuno-inflammatory rheumatic diseases: new opportunities and prospects. Rheumatology Science and Practice. 2019;57(1):8-16 (in Russian). DOI:10.14412/1995-4484-2019-8-16
10. Spinelli FR, Meylan F, O'Shea JJ, Gadina M. JAK inhibitors: Ten years after. Eur J Immunol. 2021;51(7):1615-27. DOI:10.1002/eji.202048922
11. Tanaka Y, Luo Y, O'Shea JJ, Nakayamada S. Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach. Nat Rev Rheumatol. 2022;18(3):133-45. DOI:10.1038/s41584-021-00726-8
12. Smolen JS, van der Heijde D, Machold KP, et al. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014;73(1):3-5. DOI:10.1136/annrheumdis-2013-204317
13. Nasonov EL, Avdeeva AS, Lila AM. Efficacy and safety of tofacitinib for immune-mediated inflammatory rheumatic diseases (Part I). Rheumatology Science and Practice. 2020;58(1):62-79 (in Russian). DOI:10.14412/1995-4484-2020-62-79
14. Nasonov EL, Avdeeva AS, Lila AM. Efficacy and safety of tofacitinib for immunemediated inflammatory rheumatic diseases (Part II). Rheumatology Science and Practice. 2020;58(2):214-24 (in Russian). DOI:10.14412/1995-4484-2020-214-224
15. Nasonov EL, Lila AM. Baricitinib: new pharmacotherapy options for rheumatoid arthritis and other immune-mediated inflammatory rheumatic diseases. Rheumatology Science and Practice. 2020;58(3):304-16 (in Russian). DOI:10.14412/1995-4484-2020-304-316
16. Nasonov EL, Lila AM. The progress of rheumatology in the 21st century potential uses of upadacitinib in rheumatoid arthritis and other inflammatory rheumatic diseases. Rheumatology Science and Practice. 2020;58(5):532-43 (in Russian). DOI:10.47360/1995-4484-2020-532-543
17. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79(6):685-99. DOI:10.1136/annrheumdis-2019-216655
18. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2021;73(7):1108-23. DOI:10.1002/art.41752
19. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79(6):700-12. DOI:10.1136/annrheumdis-2020-217159
20. Nwaogu A, Bond A, Smith PJ. Guideline review: Tofacitinib for adults with moderately to severely active ulcerative colitis – NICE guidance. Frontline Gastroenterol. 2020;12(2):133-6. DOI:10.1136/flgastro-2020-101502
21. Kerschbaumer A, Smolen JS, Nash P, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a systematic literature research. RMD Open. 2020;6(3):e001374. DOI:10.1136/rmdopen-2020-001374
22. Campanaro F, Batticciotto A, Zaffaroni A, et al. JAK inhibitors and psoriatic arthritis: A systematic review and meta-analysis. Autoimmun Rev. 2021;20(10):102902. DOI:10.1016/j.autrev.2021.102902
23. Keeling S, Maksymowych WP. JAK inhibitors, psoriatic arthritis, and axial spondyloarthritis: a critical review of clinical trials. Expert Rev Clin Immunol. 2021;17(7):701-15. DOI:10.1080/1744666X.2021.1925541
24. Winthrop KL. The emerging safety profile of JAK inhibitors in rheumatic disease. Nat Rev Rheumatol. 2017;13(4):234-43. DOI:10.1038/nrrheum.2017.23
25. Nash P, Kerschbaumer A, Dörner T, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis. 2021;80(1):71-87. DOI:10.1136/annrheumdis-2020-218398
26. Yates M, Mootoo A, Adas M, et al. Venous Thromboembolism Risk With JAK Inhibitors: A Meta-Analysis. Arthritis Rheumatol. 2021;73(5):779-88. DOI:10.1002/art.41580
27. Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-26. DOI:10.1056/NEJMoa2109927
28. Khosrow-Khavar F, Kim SC, Lee H, et al. Tofacitinib and risk of cardiovascular outcomes: results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) study. Ann Rheum Dis. 2022:annrheumdis-2021-221915. DOI:10.1136/annrheumdis-2021-221915
29. Kretschmer S, Lee-Kirsch MA. Type I interferon-mediated autoinflammation and autoimmunity. Curr Opin Immunol. 2017;49:96-102. DOI:10.1016/j.coi.2017.09.003
30. Nasonov EL, Avdeeva AS. Immunoinflammatory rheumatic diseases associated with type i interferon: new evidence. Rheumatology Science and Practice. 2019;57(4):452-61 (in Russian). DOI:10.14412/1995-4484-2019-452-461
31. Gómez-Arias PJ, Gómez-García F, Hernández-Parada J, et al. Efficacy and Safety of Janus Kinase Inhibitors in Type I Interferon-Mediated Monogenic Autoinflammatory Disorders: A Scoping Review. Dermatol Ther (Heidelb). 2021;11(3):733-50. DOI:10.1007/s13555-021-00517-9
32. Psarras A, Emery P, Vital EM. Type I interferon-mediated autoimmune diseases: pathogenesis, diagnosis and targeted therapy. Rheumatology (Oxford). 2017;56(10):1662-75. DOI:10.1093/rheumatology/kew431
33. Chapman S, Kwa M, Gold LS, Lim HW. Janus kinase inhibitors in dermatology: Part I. A comprehensive review. J Am Acad Dermatol. 2022;86(2):406-13. DOI:10.1016/j.jaad.2021.07.002
34. Chapman S, Gold LS, Lim HW. Janus kinase inhibitors in dermatology: Part II. A comprehensive review. J Am Acad Dermatol. 2022;86(2):414-22. DOI:10.1016/j.jaad.2021.06.873
35. Nasonov EL. Coronavirus disease 2019 (COVID-19): a rheumatologist’s thoughts. Rheumatology Science and Practice. 2020;58(2):123-32 (in Russian). DOI:10.14412/1995-4484-2020-123-132
36. Nasonov EL. 2019 Coronavirus disease (COVID-19): contribution of rheumatology. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(5):537-50 (in Russian).
DOI:10.2644/00403660.2021.05.200799
37. Fajgenbaum DC, June CH, Cytokine Storm. N Engl J Med. 2020;383:2255-73. DOI:10.1056/NEJMra2026131
38. Grom AA, Horne A, De Benedetti F. Macrophage activation syndrome in the era of biologic therapy. Nat Rev Rheumatol. 2016;12(5):259-68. DOI:10.1038/nrrheum.2015.179
39. Leisman DE, Ronner L, Pinotti R, et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020;8(12):1233-44. DOI:10.1016/S2213-2600(20)30404-5
40. Nissen CB, Sciascia S, de Andrade D, et al. The role of antirheumatics in patients with COVID-19. Lancet Rheumatol. 2021;3(6):e447-59. DOI:10.1016/S2665-9913(21)00062-X
41. Stebbing J, Krishnan V, de Bono S, et al. Sacco Baricitinib Study Group. Mechanism of baricitinib supports artificial intelligence-predicted testing in COVID-19 patients. EMBO Mol Med. 2020;12(8):e12697. DOI:10.15252/emmm.202012697
42. Florescu DF, Kalil AC. Janus Kinase inhibitors for the treatment of hospitalized patients with COVID-19. Curr Opin Crit Care. 2021;27(5):493-6. DOI:10.1097/MCC.0000000000000869
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Авторы
Е.Л. Насонов*
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*nasonov@irramn.ru
________________________________________________
Evgeny L. Nasonov*
Nasonova Research Institute of Rheumatology, Moscow, Russia;
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*nasonov@irramn.ru