rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-427-437rsp-3195Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESДинамика показателей, оцениваемых самим пациентом, при использовании различных генно-инженерных биологических препаратов при ревматоидном артритеDynamics of patient reported outcomes during the use various biological disease-modifying antirheumatic drugs for rheumatoid arthritishttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а;

125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A;

125993, Moscow, Barrikadnaya str., 2/1, building 1

https://orcid.org/0000-0002-5290-156XПаневинТ. С.PanevinT. S.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-8627-5341ПотаповаА. С.PotapovaA. S.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-6862-2645СемашкоА. С.SemashkoA. S.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-9958-8988БобковаА. О.BobkovaA. O.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5382-6357АмирджановаВ. Н.AmirjanovaV. N.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-4579-2836ЗоткинЕ. Г.ZotkinE. G.

115522, Москва, Каширское шоссе, 34а

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 Federation202206092022604427437Copyright © Каратеев А.Е., Лила А.М., Паневин Т.С., Потапова А.С., Семашко А.С., Бобкова А.О., Амирджанова В.Н., Зоткин Е.Г., 20222022Каратеев А.Е., Лила А.М., Паневин Т.С., Потапова А.С., Семашко А.С., Бобкова А.О., Амирджанова В.Н., Зоткин Е.Г.Karateev A.E., Lila A.M., Panevin T.S., Potapova A.S., Semashko A.S., Bobkova A.O., Amirjanova V.N., Zotkin E.G.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/3195

Одной из принципиальных задач современной комплексной терапии ревматоидного артрита (РА) является максимально полное восстановление качества жизни пациентов. Для этого необходимо не только добиться ремиссии или низкой активности, но также успешно контролировать основные, наиболее тягостные, проявления болезни. Поэтому при оценке результатов лечения РА следует учитывать динамику не только стандартных индексов (DAS28 (Disease Activity Score 28), CDAI (Clinical Disease Activity Index), SDAI (Simplified Disease Activity Index)), но и т. н. «показателей, оцениваемых пациентом» (ПОП) – общей оценки активности заболевания пациентом (ООАЗП), боли, функциональных нарушений и утомляемости.

В настоящем обзоре рассматривается влияние одного из главных классов противоревматических средств – генно-инженерных биологических препаратов (ГИБП) – на ПОП. Приведены результаты серии рандомизированных контролируемых исследований, в которых изучались изменения ПОП при использовании различных ингибиторов фактора некроза опухоли α (ФНО-α), ингибитора ко-стимуляции Т-лимфоцитов абатацепта, ингибитора CD20 ритуксимаба и ингибиторов интерлейкина (ИЛ) 6.

Показано, что применение ГИБП в комбинации с метотрексатом (МТ) обеспечивает уменьшение ООАЗП и боли на 50–60%, функциональных нарушений по HAQ (Health Assessment Questionnaire) и утомляемости по FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – на 15–30%. Монотерапия ГИБП (за исключением влияния тоцилизумаба на HAQ) не превосходит монотерапию МТ по влиянию на ПОП. Монотерапия тоцилизумабом обеспечивает более благоприятную динамику ООАЗП и боли, чем монотерапия ингибиторами ФНО-α. Важным преимуществом ингибиторов ИЛ-6 является быстрое достижение клинического эффекта, которое отмечается уже в первые 2 недели после первого введения препарата. 

One of the main tasks of modern complex therapy of rheumatoid arthritis (RA) is to improve the quality of life of patients. To do this, it is necessary not only to achieve remission or low activity, but also to successfully control the main, most painful, manifestations of the disease. Therefore, when evaluating the results of RA treatment, the dynamics of not only standard indices (DAS28 (Disease Activity Score 28), CDAI (Clinical Disease Activity Index), SDAI (Simplified Disease Activity Index)), but also the so-called “patient reported outcomes” (PRO) – a patient’s global assessment of disease activity (PGA), pain, functional disorders and fatigue.

This review examines the effect of one of the main classes of anti–rheumatic drugs - biological disease-modifying antirheumatic drugs (bDMARDs) on the PROs. The results of a series of randomized controlled trials are presented, in which changes in PROs were studied using various tumor necrosis factor α (TNF-α) inhibitors, abatacept T-lymphocyte co-stimulation inhibitor, rituximab CD20 inhibitor and interleukin (IL) 6 inhibitors.

The use of bDMARDs in combination with methotrexate (MTX) provides a reduction in PGA and pain by 50-60%, functional disorders according to HAQ (Health Assessment Questionnaire) and fatigue according to FACIT-F (Functional Assessment of Chronic Illness Therapy – Fatigue) – by 15-30%. B DMARDs monotherapy (with the exception of the effect of tocilizumab on HAQ) does not exceed MTX monotherapy in its effect on PROs. Monotherapy with tocilizumab provides more favorable dynamics of PGA and pain than monotherapy with TNF-α inhibitors. An important advantage of IL-6 inhibitors is the rapid achievement of a clinical effect, which is noted already in the first 2 weeks after the first administration of the drug. 

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