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Современные вызовы терапии коморбидных пациентов: новый взгляд на целекоксиб
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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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
Keywords: celecoxib, nonsteroidal anti-inflammatory drugs, elderly, diseases of the central nervous system, cardiovascular diseases, diabetes mellitus, obesity, chronic kidney disease, gastrointestinal diseases
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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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
Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russia
*baybulatova-ea@rudn.ru
ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы», Москва, Россия
*baybulatova-ea@rudn.ru
________________________________________________
Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russia
*baybulatova-ea@rudn.ru
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