Динамика показателей, оцениваемых самим пациентом, при использовании различных генно-инженерных биологических препаратов при ревматоидном артрите

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. 

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