Метотрексат и иммуногенность вакцин у пациентов с иммуновоспалительными ревматическими заболеваниями

В настоящее время метотрексат (МТ) остается одним из наиболее часто применяемых в ревматологии иммуносупрессивных препаратов, однако его влияние на иммуногенность вакцин до недавнего времени изучалось лишь в ограниченной степени, что привело к отсутствию четких рекомендаций по применению МТ во время вакцинации. Значительный прогресс был достигнут во время пандемии COVID-19 благодаря динамичному развитию исследований вакцин, в том числе у пациентов с иммуновоспалительными ревматическими заболеваниями. В обзоре представлены данные о влиянии МТ на иммуногенность вакцин против гриппа, пневмококка, опоясывающего герпеса, столбняка/дифтерии/коклюша, желтой лихорадки и COVID-19 (включая гуморальный и клеточный ответы) у ревматологических больных. Продемонстрирована необходимость соблюдения определенных временных интервалов при проведении вакцинации в случае использования МТ. Представлены потенциальные механизмы, посредством которых МТ оказывает влияние на иммуногенность вакцин. Подчеркивается важность дальнейших клинических исследований с целью оценки воздействия терапии МТ на вакцинальный ответ и отработки методик его оптимизации.

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