Вакцинация против SARS-CoV-2 при ревматических заболеваниях: вопросы безопасности

Проблема коронавирусной болезни 2019 (COVID-19, coronavirus disease 2019) спустя два года по-прежнему остается актуальной как в социальном, так и в медицинском плане. В качестве одного из методов борьбы с текущей пандемией COVID-19 большинство экспертов делают ставку на широкое использование вакцинации. Однако применение вакцин против SARS-CoV-2 у больных ревматическими заболеваниями (РЗ) поднимает ряд вопросов, связанных с эффективностью, иммуногенностью, а также с безопасностью иммунизации, включая нивелирование рисков обострения основного заболевания или развития новых аутоиммунных феноменов. Исходя из этого весьма важен анализ данных по вышеназванным аспектам в режиме реального времени, особенно с учетом того, что пациенты ревматологического круга были исключены из программ клинической разработки вакцин против SARS-CoV-2. В настоящем обзоре представлены результаты исследований последнего года по проблеме безопасности вакцинации против COVID-19 у больных РЗ. Дана краткая характеристика основных антиковидных вакцин. Поствакцинальные нежелательные явления были достаточно частыми после первой, второй или обеих доз вакцин у пациентов с РЗ, что согласуется с данными, полученными в общей популяции. В целом частота обострения РЗ после вакцинации против COVID-19 представляется достаточно низкой (5–7%) и не имеет статистически значимых ассоциаций с конкретной вакциной или проводимой противоревматической терапией. В то же время однозначная интерпретация этих данных затруднена как минимум по трем причинам: а) во многих исследованиях учитывались только симптомы, развивающиеся после первой дозы вакцины; б) ограниченный во времени поствакцинальный период наблюдения; в) значительные расхождения в трактовке обострений заболевания. В рамках рассматриваемой проблемы имеются еще очень много вопросов, ответы на которые должны быть получены в крупных проспективных контролируемых исследованиях.

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