medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-15-22-28medsovet-5113Research ArticleБронхиальная астмаBronchial asthmaУспех в терапии тяжелой бронхиальной астмы: правильный выбор биологического препарата у правильно подобранных больныхSuccessful management of severe bronchial asthma: the right choice of biologic therapy in properly selected patientshttps://orcid.org/0000-0001-9322-2689ФассаховР. С.FassakhovR. S.

д.м.н., профессор,

420008, Казань, ул. Кремлевская, д. 18

18, Kremlevskaya St., Kazan, 420008

farrus@mail.ruИнститут фундаментальной медицины и биологии Казанского (Приволжского) федерального университетаРоссияInstitute of Fundamental Medicine and Biology of Kazan (Volga region) Federal UniversityRussian Federation2019041220190152228Copyright © Фассахов Р.С., 20192019Фассахов Р.С.Fassakhov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5113

Тяжелая бронхиальная астма, наряду с влиянием на качество жизни страдающих этим заболеванием, приводит к существенному медико-социальному ущербу. Исследования последнего десятилетия указывают на ведущую роль эозинофильного воспаления бронхов как основы патогенеза Т2-фенотипа бронхиальной астмы, что привело к разработке средств таргетной терапии. Наиболее эффективными в этом направлении оказались препараты гуманизированных моноклональных антител, направленных против основных, участвующих в воспалении дыхательных путей при бронхиальной астме провоспалительных цитокинов, среди которых одним из наиболее значимых по влиянию на эозинофильные лейкоциты является интерлейкин 5. Уточнение определения тяжелой астмы, выделение этих пациентов среди больных с трудно поддающейся лечению бронхиальной астмой позволяет четко определить контингент с прогнозируемым положительным эффектом этими высокоэффективными препаратами прецизионной терапии. На конкретных клинических примерах разбирается отличие трудной для лечения и тяжелой бронхиальной астмы. Детально анализируются этапы клинических исследований препарата моноклональных антител против интерлейкина 5 меполизумаб, поиска доступных в обычной практике эффективных прогностических биологических маркеров, позволяющих подобрать подходящих для лечения пациентов с тяжелой эозинофильной бронхиальной астмой. Эффективность подхода, основанного на выделении двух пороговых значений количества эозинофилов в периферической крови, убедительно подтверждают результаты, свидетельствующие о значительном снижении числа обострений, улучшении проходимости бронхов и повышении качества жизни у больных, в том числе со стероид-зависимой бронхиальной астмой, полученные не только в рандомизированных клинических исследованиях, но и в исследованиях в реальной клинической практике.

Severe asthma along with the impact on the quality of life of those suffering from this disease leads to significant medical and social damage. Studies of the last decade indicate the leading role of eosinophilic inflammation of the bronchi as the basis of the pathogenesis of the T2 phenotype of bronchial asthma, which led to the development of targeted therapy. The most effective in this direction were preparations of humanized monoclonal antibodies directed against the main pro-inflammatory cytokines involved in respiratory tract inflammation in bronchial asthma, one of the most significant among which is interleukin 5. Refinement of the definition of severe asthma, selection of these patients among patients with difficult to treat bronchial asthma allows to clearly determine the contingent with a predicted positive effect these highly effective drugs precision therapy. On clinical examples, the difference between difficult to treat and severe bronchial asthma is discussed. The stages of clinical trials of the preparation of monoclonal antibodies against interleukin 5 Mepolizumab are analyzed in detail, the search for effective prognostic biological markers available in normal practice, allowing to select patients suitable for the treatment of patients with severe eosinophilic bronchial asthma. The effectiveness of the approach based on the allocation of two threshold values of the number of eosinophils in the peripheral blood is convincingly confirmed by the results indicating a significant reduction in the number of exacerbations, improved of lung function and an increase of the quality of life in patients, including with steroiddependent bronchial asthma, obtained not only in randomized clinical studies, but also in studies in real clinical practice.

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The authors declare that there are no conflicts of interest present.