rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-192-200rsp-3022Research ArticleПРОГРЕСС В РЕВМАТОЛОГИИ В XXI ВЕКЕPROGRESS IN RHEUMATOLOGY IN THE XXI CENTURYПерспективы применения танезумаба при хронической болиUse of tanezumab for chronic pain treatmenthttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

Каратеев Андрей Евгеньевич, д.м.н, заведующий лаборатории патофизиологии боли и полиморфизма скелетномышечных заболеваний

115522, Москва, Каширское шоссе, 34а

Andrey E. Karateev

115522, Moscow, Kashirskoye Highway, 34A

aekarat@yandex.ruhttps://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

д.м.н, профессор, директор ФГБНУ НИИР им. В.А. Насоновой, заведующий кафедрой ревматологии ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России

115522, Москва, Каширское шоссе, 34а125993, Москва, ул. Баррикадная, 2/1, стр. 1

Aleksander M. Lila

115522, Moscow, Kashirskoye Highway, 34A125993, Moscow, Barrikadnaya str., 2/1, building 1

https://orcid.org/0000-0001-7017-0898АлексееваЛ. И.AlekseevaL. I.

д.м.н, заведующая лабораторией остеоартроза

115522, Москва, Каширское шоссе, 34а

Lyudmila I. Alekseeva

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian Federation202112052021592192200Copyright © Каратеев А.Е., Лила А.М., Алексеева Л.И., 20212021Каратеев А.Е., Лила А.М., Алексеева Л.И.Karateev A.E., Lila A.M., Alekseeva L.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3022

Проблема хронической скелетно-мышечной боли, определяющей тяжелые страдания и инвалидизацию сотен миллионов жителей нашей планеты, далека от своего решения. Особенно сложным контроль боли представляется у пациентов с тяжелыми формами остеоартрита (ОА) и хронической неспецифической болью в спине (ХНБС). Популярные анальгетики – нестероидные противовоспалительные препараты (НПВП) и опиоиды – демонстрируют при этой патологии умеренную эффективность и высокий риск нежелательных явлений (НЯ). Это заставляет искать новые подходы для анальгетической терапии. Танезумаб – генно-инженерный биологический препарат (моноклональное антитело), специфически блокирующий фактор роста нервов, который играет ключевую роль в развитии хронической боли. Серия исследований II и III фазы оказали, что танезумаб при внутривенном или подкожном введении в дозе от 2,5 до 20 мг 1 раз через 8 недель у больных ОА или ХНБС оказывает выраженное и стойкое обезболивающее действие, превосходящее действие плацебо и равное или превосходящее эффект многомесячного ежедневного приема напроксена, целекоксиба, диклофенака, оксикодона и трамадола. Танезумаб может вызывать различные НЯ, прежде всего быстрое прогрессирование ОА (у 2,6–6,0%) и неврологические нарушения (парестезии и гипостезии, у ≈5%). При этом прогрессирование ОА значительно чаще отмечалось при комбинированном использовании танезумаба и НПВП. Тем не менее, учитывая сложную категорию больных, у которых использовался танезумаб (пациенты с болью, рефрактерной к стандартному лечению; пациенты с тяжелыми формами ОА), хороший анальгетический потенциал танезумаба позволяет рассматривать его как перспективное средство для контроля хронической скелетно-мышечной боли, которое будет широко востребовано в реальной клинической практике.

The problem of chronic musculoskeletal pain, the cause of severe suffering and disability of hundreds of millions of people on our planet, is far from being solved. Pain control is particularly difficult in patients with severe forms of osteoarthritis (OA) and chronic non-specific low back pain (CLBP). Popular analgesics – nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, demonstrate moderate effectiveness and a high risk of adverse events (AE). This leads to the search for new approaches for analgesic therapy. Tanezumab is a monoclonal antibody that specifically blocks nerve growth factor, which plays a key role in the development of chronic pain. A series of phase II and III studies showed that tanezumab was administered intravenously or subcutaneously at a dose of 2.5 mg to 20 mg once every 8 weeks. In patients with OA or CNSLBP, it has a pronounced and persistent analgesic effect that exceeds the effect of placebo, and is equal to or superior to the effect of many months of daily intake of naproxen, celecoxib, diclofenac, oxycodone and tramadol. Tanezumab can cause various AE, primarily rapid progression of OA (in 2.6–6.0%) and neurological disorders (paresthesia and hyposthesia, in ≈5%). At the same time, the progression of OA was significantly more often observed with the combined use of tanezumab and NSAIDs. Nevertheless, taking into account the characteristics of patients who used tanezumab (patients with pain refractory to standard treatment; severe forms of OA), the good analgesic potential of tanezumab allows us to consider it as a promising tool for the control of chronic musculoskeletal pain, which will be widely used in real clinical practice.

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