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Современные вызовы терапии коморбидных пациентов: новый взгляд на целекоксиб
Зырянов С.К., Байбулатова Е.А. Современные вызовы терапии коморбидных пациентов: новый взгляд на целекоксиб. Терапевтический архив. 2024;96(5):531–542. DOI:10.26442/00403660.2024.05.202769
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
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Zyryanov SK, Baybulatova EA. Current challenges for therapy of comorbid patients: a new look at celecoxib. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(5):531–542. DOI:10.26442/00403660.2024.05.202769
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Аннотация
Использование нестероидных противовоспалительных препаратов (НПВП) в качестве лекарственной терапии широкого спектра заболеваний растет, отчасти – из-за увеличения численности пожилого населения. Пациенты пожилого возраста отличаются повышенной уязвимостью для нежелательных реакций от лекарственных средств, включая побочные эффекты и неблагоприятные последствия межлекарственных взаимодействий, часто встречающихся у данной категории пациентов в связи с полиморбидностью и полипрагмазией. Одним из наиболее популярных в мире НПВП является целекоксиб. Это селективный ингибитор циклооксигеназы (ЦОГ)-2, ингибирующее действие которого на ЦОГ-2 в 375 раз сильнее, чем на ЦОГ-1. Благодаря этому целекоксиб имеет более высокий профиль безопасности для желудочно-кишечного тракта по сравнению с неселективными НПВП. Переносимость со стороны желудочно-кишечного тракта является важным фактором, который врачи должны учитывать при выборе НПВП для пациентов пожилого возраста. Целекоксиб можно применять при широком спектре заболеваний опорно-двигательного аппарата и ревматологических заболеваниях, для лечения острой боли у женщин при первичной дисменорее. Он также все чаще используется как часть мультимодального режима периоперационного обезболивания. Появляются убедительные доказательства того, что ЦОГ-2 активно участвует в патогенезе ишемического повреждения головного мозга, а также в развитии и прогрессировании нейродегенеративных заболеваний, таких как болезнь Альцгеймера. НПВП являются терапией 1-й линии при лечении острых приступов мигрени. Целекоксиб хорошо переносится пациентами, имеющими факторы риска развития НПВП-ассоциированной нефропатии. Данный препарат не вызывает снижения скорости клубочковой фильтрации у больных пожилого возраста и пациентов с хронической почечной недостаточностью. Многочисленные метаанализы и эпидемиологические исследования не подтвердили повышенный риск сердечно-сосудистых осложнений, наблюдавшийся в предыдущих клинических исследованиях, и не выявили повышения риска сердечно-сосудистых заболеваний при приеме целекоксиба независимо от дозировки. Активация ЦОГ-2 является одним из ключевых факторов, способствующих воспалению, связанному с ожирением. Специфическое ингибирование ЦОГ-2 целекоксибом повышает чувствительность к инсулину у пациентов с избыточной массой тела или ожирением. Использование комбинированной терапии может стать новой многообещающей областью лечения ожирения и сахарного диабета.
Ключевые слова: целекоксиб, нестероидные противовоспалительные препараты, пожилые, заболевания центральной нервной системы, сердечно-сосудистые заболевания, сахарный диабет, ожирение, хроническая болезнь почек, заболевания желудочно-кишечного тракта
Ключевые слова: целекоксиб, нестероидные противовоспалительные препараты, пожилые, заболевания центральной нервной системы, сердечно-сосудистые заболевания, сахарный диабет, ожирение, хроническая болезнь почек, заболевания желудочно-кишечного тракта
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The use of non-steroidal anti-inflammatory drugs (NSAIDs) for a wide range of diseases is increasing, in part due to an increasing elderly population. Elderly patients are more vulnerable to adverse drug reactions, including side effects and adverse effects of drug-drug interactions, often occurring in this category of patients due to multimorbidity and polypharmacy. One of the most popular NSAIDs in the world is celecoxib. It is a selective cyclooxygenase (COX)-2 inhibitor with 375 times more COX-2 inhibitory activity than COX-1. As a result, celecoxib has a better gastrointestinal tract safety profile than non-selective NSAIDs. Gastrointestinal tolerance is an essential factor that physicians should consider when selecting NSAIDs for elderly patients. Celecoxib can be used in a wide range of diseases of the musculoskeletal system and rheumatological diseases, for the treatment of acute pain in women with primary dysmenorrhea, etc. It is also increasingly used as part of a multimodal perioperative analgesia regimen. There is strong evidence that COX-2 is actively involved in the pathogenesis of ischemic brain damage, as well as in the development and progression of neurodegenerative diseases, such as Alzheimer's disease. NSAIDs are first-line therapy in the treatment of acute migraine attacks. Celecoxib is well tolerated in patients with risk factors for NSAID-associated nephropathy. It does not decrease the glomerular filtration rate in elderly patients and patients with chronic renal failure. Many meta-analyses and epidemiological studies have not confirmed the increased risk of cardiovascular events reported in previous clinical studies and have not shown an increased risk of cardiovascular events with celecoxib, irrespective of dose. COX-2 activation is one of the key factors contributing to obesity-related inflammation. Specific inhibition of COX-2 by celecoxib increases insulin sensitivity in overweight or obese patients. Combination therapies may be a promising new area of treatment for obesity and diabetes.
Keywords: celecoxib, nonsteroidal anti-inflammatory drugs, elderly, diseases of the central nervous system, cardiovascular diseases, diabetes mellitus, obesity, chronic kidney disease, gastrointestinal diseases
Полный текст
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Авторы
С.К. Зырянов, Е.А. Байбулатова*
ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия
*baybulatova-ea@rudn.ru
ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия
*baybulatova-ea@rudn.ru
________________________________________________
Sergey K. Zyryanov, Elena A. Baybulatova*
Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russia
*baybulatova-ea@rudn.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.