Анти-В-клеточная терапия при иммуновоспалительных ревматических заболеваниях: эффективность и переносимость у 229 больных

Цель – оценить эффективность и переносимость лечения ритуксимабом (РТМ) у больных с тяжелыми иммуновоспалительными ревматическими заболеваниями (ИВРЗ) – системной красной волчанкой (СКВ), системной склеродермией (ССД), системными васкулитами (СВ), болезнью Шегрена (БШ) и дерматомиозитом/полимиозитом (ДМ/ПМ).

Материал и методы. Проведен анализ эффективности и клинических исходов у 229 больных с ИВРЗ: СКВ (n=97), СВ (n=50), ССД (n=40), БШ (n=23) и ДМ/ПМ (n=19). Лечение РТМ проводилось в сочетании с ранее проводимым лечением глюкокортикоидами (ГК) и/или иммуносупрессивными препаратами (ИСП), при этом у большинства отмечены рефрактерное течение или плохая переносимость стандартной терапии. Оценка эффективности лечения проводилась в каждой группе по принятым для этого заболевания показателям. Для сравнения клинического ответа на лечение между группами применены градации, использованные в международных регистрах: полный (хороший) ответ, частичный ответ и отсутствие ответа. Средняя длительность наблюдения составила 72 (1–288) нед после первого введения РТМ. Средняя доза РТМ, которую получили больные за период наблюдения, была невысокой и колебалась от 1,6±0,84 г при ДМ/ПМ до 3,1±1,75 г при СВ. Около 80% больных получили один или два курса РТМ, за исключением больных ССД, половина из которых получили три и более курсов РТМ.

Результаты. «Полный ответ» достигнут у 50,6%, «частичный ответ» – у 35% больных. Курсы РТМ приводили к положительной динамике клинико-лабораторных показателей и позволили снизить поддерживающую дозу ГК, уменьшить дозы ИСП или отменить их. Проведение повторных курсов РТМ приводило к устойчивому и долгосрочному эффекту. При этом происходило снижение частоты рецидивов болезни, а эфективность терапии нарастала при наблюдении в течение года и более. Частота нежелательных реакций и уровень летальности были сопоставимы с данными регистров по РТМ в других странах.

Заключение. Полученные данные в сопоставлении с данными регистров разных стран по эффективности РТМ при ИВРЗ могут служить дополнительным обоснованием применения РТМ у больных с рефрактерностью к стандартной терапии.

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