Инновационные методы лечения артериита Такаясу: в фокусе ингибиторы интерлейкина 6. Собственный опыт применения тоцилизумаба и обзор литературы

Необходимость дальнейшего совершенствования методов лечения артериита Такаясу (АТ), прогресс в представлениях о механизмах заболевания и внедрение генно-инженерных биологических препаратов (ГИБП) в ревматологическую практику создали предпосылки для разработки нового направления фармакотерапии АТ с использованием ГИБП, связанных с ингибированием интерлейкина 6 (ИЛ6). Представлены два собственных наблюдения применения тоцилизумаба (ТЦЗ) при АТ осложненного течения. Проанализированы результаты лечения ТЦЗ по данным предварительных исследований у 115 больных АТ, опубликованных в 30 источниках литературы, а также результаты двойного слепого рандомизированного плацебоконтролируемого исследования (РПКИ) III фазы по изучению безопасности и эффективности ТЦЗ у 18 больных рефрактерным АТ. В одном собственном наблюдении с длительным анамнезом АТ осложненного течения контроль активности АТ и снижение дозы глюкокортикоидов в результате применения ТЦЗ способствовали благополучному течению беременности и родов. Во втором случае, с дебютом АТ и очаговым туберкулезом легких, назначение на фоне противотуберкулезных препаратов монотерапии ТЦЗ в течение 6 мес позволило контролировать АТ и добиться излечения туберкулеза. Согласно данным предварительных исследований, в результате лечения ТЦЗ ремиссия или улучшение наблюдаются у 85% больных АТ, в том числе при рефрактерном течении. В соответствии с РПКИ безрецидивная выживаемость через 6 мес поддерживающего лечения ТЦЗ выше, чем в группе плацебо (51 и 23% соответственно), но различия не достигли статистической значимости (р=0,0596). В связи с возможностью рецидива АТ у пациентов, получающих лечение ТЦЗ, целесообразно сочетать его с назначением цитостатиков, прежде всего метотрексата. Применение ингибиторов ИЛ6  следует рассматривать как потенциально эффективный и относительно безопасный  инновационный (off-label) метод лечения АТ при рефрактерном течении, непереносимости  или наличии противопоказаний к стандартной терапии, что требует дальнейшего изучения с проведением более масштабных рандомизированных клинических испытаний. Поскольку  в настоящее время не существует универсального способа визуализации, который мог бы  предоставить исчерпывающую информацию о состоянии сосудов при АТ, для  стандартизации последующих клинических исследований ГИБП требуется совершенствование методов оценки эффективности лечения АТ, при этом мониторинг активности АТ должен включать комплексную оценку клинических данных, современных лабораторных биомаркеров и инструментальных методов визуализации, в первую очередь неинвазивных.

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