rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2016-76-88rsp-2308Research ArticleПРОГРЕСС В РЕВМАТОЛОГИИ В XXI ВЕКЕPROGRESS IN RHEUMATOLOGY IN THE XXI CENTURYМетотрексат при ревматоидном артрите – 2015: новые факты и идеиMETHOTREXATE IN RHEUMATOID ARTHRITIS – 2015: NEW FACTS AND IDEASНасоновЕ. Л.NasonovE. L.sokrat@irramn.ruФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201609122016540приложение 27688Copyright © Насонов Е.Л., 20162016Насонов Е.Л.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/2308

За последнее десятилетие, с широким внедрением новых, эффективных генно-инженерных биологических препаратов (ГИБП), произошли серьезные изменения в стратегии лечения ревматоидного артрита (РА): в ее основу легла концепция «Treat to target» («Лечение до достижения цели»). Подчеркивается, что базовая составляющая стратегии – активная ранняя агрессивная терапия метотрексатом (МТ), а при недостаточной эффективности монотерапии МТ – комбинированная терапия МТ и стандартными базисными противовоспалительными препаратами или МТ и ГИБП. Хотя в рандомизированных плацебоконтролируемых исследованиях (РПКИ) и в клинической практике МТ чаще назначается перорально, в настоящее время наблюдается тенденция к более широкому использованию его подкожной формы. Новые данные, полученные в процессе фундаментальных исследований, касающихся расшифровки механизмов действия МТ, и материалы многочисленных РПКИ, наблюдательных исследований и национальных регистров обосновывают уникальное место МТ в лечении РА, его осложнений и сопутствующих коморбидных заболеваний. Целью обзора является анализ новых данных, касающихся механизмов действия и клинической эффективности и безопасности МТ в ревматологии.

As new effective biological agents (BAs) are being widely introduced, in the past decade there have been serious changes in the rheumatoid arthritis (RA) strategy: its basis was the treat-to-target concept. It is emphasized that the basic strategy component is active early aggressive therapy with methotrexate (MT) and, if MT monotherapy is inadequatelyineffective, combined therapy with MT and standard disease-modifying antirheumatic drugs or MT and BAs. Although oral MT is more frequently prescribed in randomized placebo-controlled trials (RPCTs) and in clinical practice, there is now a tendency towards the wider use of its subcutaneous formulation. Novel evidence from fundamental studies dealing with the deciphering of the mechanism of MT action and the materials of numerous RPCTs,observational studies, and national registries substantiate the unique place of MT in the treatment of RA, its complications, and comorbidities. The purpose of the review is to analyze new data on the mechanism of action of MT and its clinical efficacy and safety in rheumatology.

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