rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2014-159-168rsp-1919Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHЭффективность терапии ритуксимабом у больных рефрактерной к стандартной терапии системной красной волчанкой при длительном динамическом наблюденииRITUXIMAB TREATMENT EFFICACY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS REFRACTORY TO STANDARD THERAPY IN THE LONG-TERM FOLLOW-UPЦанянМ. Э.TsanyanM. E.maridoc@bk.ruСоловьевС. К.SolovievS. K.ТоргашинаА. В.TorgashinaA. V.АлександроваЕ. Н.AleksandrovaE. N.Раденска-ЛоповокС. Г.Radenska-LopovokS. G.НиколаеваЕ. В.NikolaevaE. V.НасоновЕ. Л.NasonovE. L.ФГБУ «Научно- исследовательский институт ревматологии им. В.А. Насоновой» РАМН, МоскваРоссияV.A. Nasonova Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow, RussiaRussian Federation201417062014522НАУЧНО-ПРАКТИЧЕСКАЯ РЕВМАТОЛОГИЯ 52 No 2-2014159168Copyright © Цанян М.Э., Соловьев С.К., Торгашина А.В., Александрова Е.Н., Раденска-Лоповок С.Г., Николаева Е.В., Насонов Е.Л., 20142014Цанян М.Э., Соловьев С.К., Торгашина А.В., Александрова Е.Н., Раденска-Лоповок С.Г., Николаева Е.В., Насонов Е.Л.Tsanyan M.E., Soloviev S.K., Torgashina A.V., Aleksandrova E.N., Radenska-Lopovok S.G., Nikolaeva E.V., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1919

Цель – оценить эффективность и безопасность терапии ритуксимабом (РТМ) при длительном динамиче- ском наблюдении у больных системной красной волчанкой (СКВ), рефрактерной к стандартной терапии. Материал и методы. Терапия РТМ была назначена 97 больным СКВ с высокой активностью заболевания и недостаточной эффективностью высоких доз глюкокортикоидов (ГК) и цитостатиков. Медиана [25-й; 75-й перцентили] длительности наблюдения составили 18 [12; 36] мес. Наиболее распространенными кли- ническими проявлениями СКВ были нефрит (62%), поражение кожи (33%) и нервной системы (22,7%). Клиническая оценка активности СКВ осуществлялась с использованием индекса активности SLEDAI2K. При оценке эффективности терапии использовались такие понятия, как частичный ответ (ЧО), полный от- вет (ПО), обострение. Обострение классифицировали как умеренное (УО) и тяжелое (ТО) с помощью инде- кса обострения СКВ (SFI). Результаты. Сразу после терапии РТМ деплеция В-клеток определялась у 78% больных СКВ. В течение 6 лет наблюдения эффект терапии РТМ получен у 84% больных после повторных курсов РТМ (ПО – 56%, ЧО – 28%). В общей сложности обострения наблюдались у 24 (24,7%) больных, медиана промежутка от введения РТМ до обострения составила 12 [12; 24] мес. При многолетнем динамическом наблюдении отмечались сни- жение индекса SLEDAI2K, нормализация лабораторных показателей и снижение суточной дозы ГК. Боль- шинство больных как первый, так и повторные курсы терапии РТМ переносили хорошо. Заключение. По результатам многолетнего динамического наблюдения терапия РТМ является высокоэффек- тивным методом лечения больных СКВ с неэффективностью ранее проводимой стандартной терапии ГК и цитостатиками. Отмечалась хорошая переносимость терапии РТМ, не выявлено повышения риска инфек- ционных осложнений или нежелательных реакций. 

Objective. To evaluate the efficacy and safety of rituximab (RTM) treatment in the long-term follow-up of patients with systemic lupus erythematosus (SLE) refractory to standard therapy. Material and methods. RTM therapy was prescribed to 97 SLE patients with high disease activity and insufficient effica- cy of using high doses of glucocorticoids (GC) and cytostatics. The median follow-up time (25th; 75th percentiles) was 18 [12; 36] months. The most common clinical manifestations of SLE included nephritis (62%), skin lesion (33%), and lesion of the nervous system (22.7%). The clinical assessment of the SLE activity was carried out using the SLEDAI-2K activity index. In assessing the therapy efficacy, the following concepts were used: the partial response (PR), complete response (CR), and flare. Flare was classified as moderate (MF) and severe (SF) using the SLE flare index (SFI). Results. Immediately after RTM therapy, depletion of B-cells was determined in 78% of the patients with SLE. During the 6-year follow-up, the effect of RTM therapy was achieved in 84% of the patients after repeated courses of RTM (CR – 56%, PR – 28%). In total, flares were observed in 24 (24.7%) patients; the median interval from RTM administration to flare was 12 [12; 24] months. In the long-term follow-up, the decline in the SLEDAI-2K index, normalization of laboratory test values, and the decrease in the daily GC dose were noted. Most patients tolerated well both the first and repeated courses of RTM therapy. Conclusion. According to the results of the long-term follow-up, RTM therapy is a highly effective method to treat SLE patients with the ineffectiveness of previously conducted standard therapy with GC and cytostatics. Good tolerance of RTM treatment has been noted; no increase in risk of infectious complications or adverse reactions has been found. 

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The authors declare that there are no conflicts of interest present.