rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-80-90rsp-3120Research ArticleПРОГРЕСС В РЕВМАТОЛОГИИ В XXI ВЕКЕPROGRESS IN RHEUMATOLOGY IN THE XXI CENTURYПерспективы применения моноклональных антител к интерлейкину 23 гуселькумаба при псориатическом артрите: новые данныеProspects for the use of monoclonal antibodies to interleukin 23 Gusеlkumab in psoriatic arthritis: New dataНасоновЕ. Л.NasonovE. L.

д.м.н., профессор, академик РАН, научный руководитель 

115522, Москва, Каширское шоссе, 34а

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

Evgeny Nasonov

115522, Moscow, Kashirskoye Highway, 34A

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

nasonov@irramn.ruhttps://orcid.org/0000-0003-0579-1131КоротаеваТ. В.KorotaevaT. V.

д.м.н., начальник отдела спондилоартритов, заведующая лаборатории псориатического артрита

115522, Москва, Каширское шоссе, 34а

Tatiana V. Korotaeva

115522, Moscow, Kashirskoye Highway, 34A

РодолфиС.RodolfiS.

Руководитель лаборатории ревматологии и клинической иммунологии; отделение биомедицинских наук

Роццано, МиланПьеве Эмануэле, Милан

Stefano Rodolfi

Rheumatology and Clinical Immunology; Department of Biomedical Sciences

Rozzano, MilanPieve Emanuele, Milan

https://orcid.org/0000-0002-0323-0376СелмиК. Ф.SelmiC. F.

Зав. отделением ревматологии и клинической иммунологии; отделение биомедицинских наук, доцент кафедры ревматологии

Роццано, МиланПьеве Эмануэле, Милан

Carlo F. Selmi

Rheumatology and Clinical Immunology; Department of Biomedical Sciences

Rozzano, MilanPieve Emanuele, Milan

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 FederationГуманитарный Клинический и Научный Центр (IRCCS); Гуманитарный УниверситетИталияHumanitas Clinical and Research Center (IRCCS); Humanitas UniversityItaly20220103202260180–90Copyright © Насонов Е.Л., Коротаева Т.В., Родолфи С., Селми К.Ф., 20222022Насонов Е.Л., Коротаева Т.В., Родолфи С., Селми К.Ф.Nasonov E.L., Korotaeva T.V., Rodolfi S., Selmi C.F.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/3120

В спектре механизмов патогенеза иммуновоспалительных заболеваний (ИВЗ) человека особое внимание привлечено к патологической активации Th17-типа иммунного ответа, связанного с дисрегуляцией синтеза цитокинов, формирующих ось интерлейкин (ИЛ) 23 и ИЛ-17. Блокада ИЛ-23 является инновационным подходом к лечению псориаза и псориатического артрита (ПсА). Особый интерес привлекает гуселькумаб (ГУС) (Gusеlkumab, TREMFYA, Janssen, Johnson&Johnson, США), который представляет собой полностью человеческие моноклональные антитела (мАТ) IgG-λ, взаимодействующие с р19-субъединицей ИЛ-23, и является первым препаратом этого класса, разрешенным к применению у пациентов с псориазом и ПсА. ГУС не уступает по эффективности другим генно-инженерным биологическом препаратам, использующимся для лечения ПсА, и более эффективен у пациентов с псориазом, чем мАТ к ИЛ-12/ИЛ-23 устекинумаб и мАТ к ИЛ-17 секукинумаб. По сравнению с ингибиторами фактора некроза опухоли альфа (ФНО-α) ГУС реже вызывает развитие инфекционных осложнений и не увеличивает риск реактивации латентной туберкулезной инфекции. В новых рекомендациях GRAPPA (2021) применение ГУС (и других ингибиторов ИЛ-23) рекомендуется пациентам с ПсА, резистентным к терапии стандартными БПВП, имеющим периферический артрит, энтезиты, дактилит, псориатическое поражение кожи и ногтей. Обсуждаются новые данные, касающиеся эффективности ГУС у пациентов, резистентных к ингибиторам ФНО-α, положительного влияния терапии на аксиальные проявления ПсА и безопасности применения ГУС в период пандемии COVID-19.

Among the pathophysiological mechanisms of immune-mediated inflammatory diseases (IMIDs), specific attention has been paid to the abnormal activation of Th17 type immune response related to the dysregulated synthesis of cytokines forming the interleukin (IL)-23 and IL-17 axis. IL-23 blockade is an innovative approach to the treatment of psoriasis and psoriatic arthritis (PsA). Much of the interest has focused on guselkumab (GUS) (TREMFYA, Janssen, Johnson & Johnson, USA), a fully human IgG λ monoclonal antibody (mAb) targeting the p19 IL-23 subunit and the first-in-class treatment approved for patients with psoriasis and PsA. In patients with psoriasis, GUS is at least as effective as other biologic therapies for PsA and is superior to ustekinumab, an anti-IL-12/IL-23 mAb, and secukinumab, an anti-IL-17 mAb. Compared with TNF-α inhibitors, GUS therapy is less likely to cause infections and does not increase the risk of the reactivation of latent TB infection. The new GRAPPA guidelines (2021) recommend GUS (and other IL-23 inhibitors) for patients with PsA resistant to conventional disease-modifying antirheumatic drugs (DMARDs), who have peripheral arthritis, enthesitis, dactylitis, psoriatic skin and nail lesions. The paper discusses new data on the efficacy of GUS in patients resistant to TNF-α inhibitors, its benefits in patients with axial PsA, and safety during the COVID-19 pandemic.

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