Фармакотерапия гигантоклеточного артериита и ревматической полимиалгии: перспективы применения моноклональных антител к интерлейкину 6

Гигантоклеточный артериит (ГКА) и ревматическая полимиалгия (РПМ) – иммуновоспалительные ревматические заболевания (ИВРЗ), особенностью которых является их развитие у лиц старше 50 лет. В настоящее время ГКА и РПМ рассматриваются в рамках единой комплексной аутоиммуно-аутовоспалительной патологии, определяемой как «заболевания спектра ГКА-РПМ» (GCA-PMR (giant cell arteritis and polymyalgia rheumatica) spectrum disease). Это нашло отражение в разработке общих рекомендация по фармакотерапии в рамках стратегии «лечение до достижения цели» (treat-to-target), хотя конкретные подходы к лечению больных с ГКА и РПМ отличаются в зависимости от клинико-патогенетических характеристик каждой нозологической формы. Глюкокортикоиды (ГК) занимают центральное место в лечении ГКА и РПМ. Обращает на себя внимание парадоксальное несоответствие между высокой эффективностью ГК в краткосрочной перспективе и нарастанием тяжести патологии, связанной с сохраняющейся воспалительной активностью и накоплением органных повреждений, индуцированных ГК, в отдаленной перспективе, что свидетельствует о необходимости совершенствования терапии, в первую очередь в направлении оптимизации применения ГК. Новые возможности фармакотерапии ГКА и РПМ (как и других ИВРЗ) связаны с применением генно-инженерных биологических препаратов (ГИБП), блокирующих активность цитокинов, участвующих в иммунопатогенезе заболеваний, а в последние годы – ингибиторов JAK (Janus kinase). Среди фармакологических «мишеней» особое внимание привлекает интерлейкин (ИЛ) 6 – плейотропный цитокин, участвующий в развитии воспаления, иммунного ответа, иммунометаболизма, канцерогенеза, ремоделирования стенки сосудов и др. В настоящее время разработано несколько ГИБП, специфичных в отношении как рецепторов ИЛ-6, так и самого ИЛ-6: гуманизированные моноклональные антитела (мАТ) к рецептору ИЛ-6 (тоцилизумаб) и человеческие мАТ к рецептору ИЛ-6 (сарилумаб и левилимаб (БИОКАД)), гуманизированные мАТ к ИЛ-6 – олокизумаб (Р-ФАРМ) и др. В статье суммированы данные, касающиеся эффективности и безопасности тоцилизумаба при ГКА и РПМ, рекомендации по применению ингибиторов ИЛ-6 при этих заболеваниях, обсуждены перспективы дальнейших исследований.

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