rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2016-138-144rsp-2202Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHПрименение подкожной формы метотрексата для лечения больных активным ревматоидным артритом (исследование РЕМАРКА)USE OF SUBCUTANEOUS METHOTREXATE FOR THE TREATMENT OF PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: THE REMARCA TRIALКаратеевД. Е.KarateevD. E.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

dekar@inbox.ruЛучихинаЕ. Л.LuchikhinaE. L.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

ДемидоваН. В.DemidovaN. V.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

ГридневаГ. С.GridnevaG. S.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

ЛукинаГ. В.LukinaG. V.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

КанонироваМ. А.KanonirovaM. A.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

МуравьевЮ. В.MuravyevYu. V.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

КасумоваК. А.KasumovaK. A.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

АлександроваЕ. Н.AleksandrovaE. N.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

НовиковА. А.NovikovA. A.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

АвдееваА. С.AvdeevaA. S.

115522 Москва, Каширское шоссе, 34А 

34A, Kashirskoe Shosse, Moscow 115522

НасоновЕ. Л.NasonovE. L.

кафедра ревматологии Института профессионального образования

115522 Москва, Каширское шоссе, 34А

119991 Москва, ул. Трубецкая, 8, стр. 2 

Department of Rheumatology, Institute of Professional Education

34A, Kashirskoe Shosse, Moscow 115522;

ФГБНУ Научно- исследовательский институт ревматологии им. В.А. Насоновой, МоскваРоссияV.A. Nasonova Research Institute of Rheumatology, MoscowRussian FederationФГБНУ Научно- исследовательский институт ревматологии им. В.А. Насоновой, Москва; ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, МоскваРоссияV.A. Nasonova Research Institute of Rheumatology, Moscow; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, MoscowRussian Federation201617072016542138144Copyright © Каратеев Д.Е., Лучихина Е.Л., Демидова Н.В., Гриднева Г.С., Лукина Г.В., Канонирова М.А., Муравьев Ю.В., Касумова К.А., Александрова Е.Н., Новиков А.А., Авдеева А.С., Насонов Е.Л., 20162016Каратеев Д.Е., Лучихина Е.Л., Демидова Н.В., Гриднева Г.С., Лукина Г.В., Канонирова М.А., Муравьев Ю.В., Касумова К.А., Александрова Е.Н., Новиков А.А., Авдеева А.С., Насонов Е.Л.Karateev D.E., Luchikhina E.L., Demidova N.V., Gridneva G.S., Lukina G.V., Kanonirova M.A., Muravyev Y.V., Kasumova K.A., Aleksandrova E.N., Novikov A.A., Avdeeva A.S., 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/2202

Раннее назначение метотрексата (МТ), использование высоких (по стандартам ревматологической практики) доз препарата способствуют повышению эффективности терапии и уменьшению «тяжести» ревматоидного артрита (РА). Одним из важных достоинств МТ при лечении РА является возможность подбора дозы и путей введения (перорально или подкожно), что позволяет индивидуализировать лечение. Особое внимание в последнее время уделяется именно подкожной лекарственной форме МТ, применение которой создает предпосылки для существенного улучшения эффективности терапии РА. В статье приводятся данные исследования РЕМАРКА (российское исследование метотрексата и генно-инженерных биологических препаратов при раннем активном артрите), касающиеся оценки результатов лечения РА при использовании подкожной формы МТ в качестве препарата «первого ряда» и разработки тактики ее применения при этом заболевании.

Материал и методы

Материал и методы. В исследование включен 191 пациент с активным РА (34 мужчины, 157 женщин), из которых у 51,8% был очень ранний РА (длительность болезни <6 мес). 115 больных РА завершили 24-месячный период наблюдения, и их данные были проанализированы более детально.

Результаты и обсуждение

Результаты и обсуждение. Полученные результаты позволяют обосновать тактику лечения, основанную на назначении подкожной формы МТ (без предварительного использования его пероральной формы) пациентам с ранней стадией РА и с высокой активностью болезни, применяя стартовую дозу 15 мг/нед и проводя быструю эскалацию с достижением максимально переносимых доз за 4–8 нед, что позволяет добиться ремиссии (или низкой активности заболевания) у большинства больных без применения глюкокортикоидов и генно-инженерных биологических прапаратов.

The early administration of methotrexate (MTX) and the use of its high (by the rheumatology practice standards) doses contribute to the enhanced efficiency of therapy and the reduced severity of rheumatoid arthritis (RA). One of the important merits of MTX in the treatment of RA is the possibility of adjusting its dose and choosing its (oral or subcutaneous) administration routes, which makes it possible to individualize treatment. Particular emphasis has been recently placed just on a subcutaneous MTX formulation that creates prerequisites for substantially improving the efficiency of RA therapy. The paper gives the data of the REMARCA (Russian investigation of methotrexate and biologicals for early active arthritis) trial assessing the results of RA treatment in the use of the subcutaneous MTX dosage form as a first-line drug and in the elaboration of management tactics for this disease.

Subjects and methods

Subjects and methods. The investigation included 191 patients (34 men and 157 women) with active RA; of whom 51.8% had very early RA (< 6 months' disease duration). 115 patients with RA completed a 24-month follow-up period; and their data were analyzed in more detail.

Results and discussion

Results and discussion. The findings may substantiate treatment policy based on the prescription of subcutaneous MTX (without previously administering its oral formulation) in patients with early RA and high disease activity, starting the drug at 15 mg/week and rapidly escalating with the highest tolerable doses during 4-8 weeks, which allows remission (or low disease activity) in the majority of patients without using glucocorticoids and biological agents.

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