rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-384-393rsp-3054Research ArticleПРОБЛЕМЫ РЕВМАТОЛОГИИ В ПЕРИОД ПАНДЕМИИ КОРОНОВИРУСНОЙ БОЛЕЗНИ 2019PROBLEMS OF RHEUMATOLOGY DURING THE 2019 CORONAVIRUS PANDEMICДеплеция В-клеток при иммуновоспалительных ревматических заболеваниях и коронавирусная болезнь 2019 (COVID-19)B cell depletion in immune-mediated rheumatic diseases and coronavirus disease 2019 (COVID-19)https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

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

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

119991, Russian Federation, Moscow, Trubetskaya str., 8, building 2

nasonov@irramn.ruАвдееваА. С.AvdeevaA. S.

115522, Российская Федерация, Москва, Каширское шоссе, 34а

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202105092021594384–393Copyright © Насонов Е.Л., Авдеева А.С., 20212021Насонов Е.Л., Авдеева А.С.Nasonov E.L., Avdeeva A.S.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/3054

У пациентов с иммуновоспалительными (аутоиммунными) ревматическими заболеваниями (ИВРЗ) существует ряд факторов (пожилой возраст, неконтролируемое воспаление, исходно необратимое повреждение внутренних органов, коморбидная патология, генетические и другие факторы), которые потенциально могут приводить к увеличению «чувствительности» к SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) и сопутствующим вирусным и бактериальным инфекциям, нарастанию риска тяжелого течения COVID-19 (coronavirus disease 2019), снижению эффективности терапии как ИВРЗ, так и COVID-19. Важное направление фармакотерапии ИВРЗ и других аутоиммунных заболеваний связано с использованием анти-В-клеточных препаратов, в первую очередь ритуксимаба (РТМ), представляющего собой химерные (мышь/человек) моноклональные антитела (мАТ) к CD20 антигену В-клеток. В настоящее время в России широко применяется биоаналог РТМ – ацеллбия (БИОКАД), – не уступающий РТМ по эффективности и безопасности. Рассмотрены проблемы анти-В-клеточной терапии в период пандемии COVID-19 в отношении риска инфицирования, тяжелого течения и недостаточной эффективности вакцинации против SARS-CoV-2. Согласно рекомендациям Ассоциации ревматологов России, необходима более строгая оценка показаний к проведению индукционной и поддерживающей терапии РТМ и гармонизации сроков введения препарата и вакцинации.

In patients with immune-mеdiated (autoimmune) rheumatic diseases (IMIRD), there are a number of factors (advanced age, uncontrolled inflammation, initially irreversible damage to internal organs, comorbid pathology, genetic and other factors) that can potentially lead to an increase in “sensitivity” to SARS-CoV -2 (severe acute respiratory syndrome coronavirus-2) and concomitant viral and bacterial infections, an increase in the risk of a severe course of COVID-19 (coronavirus disease 2019), a decrease in the effectiveness of therapy for both IMIRDs and COVID-19. An important area of pharmacotherapy for IMIRDs and other autoimmune diseases is associated with the use of anti-B-cell drugs, primarily rituximab (RTX), which is a chimeric (mouse/human) monoclonal antibody (mAb) to the CD20 antigen of B cells. At present, in Russia, the RTM biosimilar, acellbia (BIOCAD), is widely used, which is not inferior to RTX in terms of efficiency and safety. The problems of anti-B-cell therapy during the COVID-19 pandemic in relation to the risk of infection, severe course and insufficient effectiveness of vaccination against SARSCoV- 2 are considered. According to the recommendations of the Association of Rheumatologists of Russia, a more rigorous assessment of indications for induction and maintenance therapy of RTX therapy and harmonization of the timing of drug administration and vaccination is required.

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