Перспективы применения моноклональных антител к интерлейкину 23 гуселькумаба при псориатическом артрите: новые данные

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.

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