medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-3-49-58medsovet-5570Research ArticleКлиническая лекцияClinical lectureМиома матки: новые и перспективные варианты медикаментозного леченияUterine myoma: new and perspective options for medicinal treatmenthttps://orcid.org/0000-0002-9441-3468КареваЕ. Н.KarevaE. N.

Карева Елена Николаевна, доктор медицинских наук, профессор кафедры фармакологии, Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); профессор кафедры молекулярной фармакологии и радиобиологии имени академика П.В. Сергеева, Федеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации

119991,  Москва, ул. Трубецкая, д. 8, стр. 2, 

117997,  Москва, ул. Островитянова, д. 1

Elena N. Kareva, Dr. of Sci. (Med.), Professor, Chair for Pharmacology, Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Sechenov University); Professor, Chair for Molecular Pharmacology and Radiobiology named after Academician P.V. Sergeev, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University“ of the Ministry of Health of the Russian Federation

8, p. 2, Trubetskaya St., Moscow, 119991, 

1, Ostrovityanova St., Moscow, 117997

elenakareva@mail.ruСамойловаT. E.SamoylovaТ. Е.

Самойлова Татьяна Евгеньевна, доктор медицинских наук, профессор кафедры женских болезней и репродуктивного здоровья Института усовершенствования врачей

105203, Москва, ул. Нижняя Первомайская, д. 65

Tatiana E. Samoylova, Dr. of Sci. (Med.), Professor, Chair for Gynecopathy and Reproductive Health, Institute for Advanced Physicians

65, Nizhnyaya Pervomayskaya St., Moscow, 105203

tesamoylova@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет); Российский научно-исследовательский медицинский университет им. Н.И. ПироговаРоссияMoscow State Medical University named after I.M. Sechenov (Sechenov University); Pirogov Russian National Research Medical UniversityRussian FederationНациональный медико-хирургический центр им. Н.И. ПироговаРоссияNational Medical and Surgical Center named after N.I. PirogovRussian Federation202016042020034958Copyright © Карева Е.Н., Самойлова T.E., 20202020Карева Е.Н., Самойлова T.E.Kareva E.N., Samoylova Т.Е.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5570

В обзоре представлены сведения о возможностях терапии миомы матки – доброкачественной опухоли, происходящей из миометрия, которая является наиболее распространенной доброкачественной опухолью малого таза, а также наиболее частым показанием к операции у женщин. Миома матки, как правило, вызывает аномальное маточное кровотечение, симптомы, связанные с давлением, выкидыши и в некоторых случаях бесплодие. Аномальное маточное кровотечение (меноррагия и метроррагия) является основной причиной, по которой женщины обращаются для лечения миомы и основной причиной хирургического вмешательства. В статье проанализированы сведения о медикаментозном лечении миомы матки в сравнительном аспекте. В качестве медикаментозного лечения первыми были предложены гестагены и их комбинации с эстрогеном, которые не продемонстрировали надежной эффективности. Позже была обнаружена очевидная польза применения агонистов/антагонистов гонадотропинрилизинг-гормона, которые вызывают эффект «центральной» химической кастрации, и поэтому их использование ограничено 6 месяцами, и они с успехом используются для подготовки пациенток к операции. Недавно предложены непептидные, перорально активные антагонисты рецепторов гонадотропин-рилизинг-гормона, которые находятся на ранних стадиях клинических испытаний. Однако изменения лекарственной формы и пути введения препаратов, тормозящих активность гонадотропин-рилизинг-гормона, не улучшают профиль их безопасности. Очередным прорывом в терапии миомы матки стало использование селективных модуляторов рецепторов прогестерона, которые ранее называли «антипрогестинами». Препараты данной группы обладают сравнимой с антагонистами гонадотропин-рилизинг-гормона эффективностью и лучшей переносимостью, что делает возможным длительное лечение миомы матки, особенно у женщин в пременопаузе, с помощью этих препаратов.

The review provides information on the medical treatment of uterine fibroids (MM) in a comparative aspect. MM are one of the most common gynecological diseases requiring surgical intervention in the presence of symptoms. As a drug treatment, gestagens and their combinations with estrogens, which did not demonstrate reliable efficacy, were the first to be proposed. Later, obvious advantages of using GnRH agonists/antagonists that cause the effect of “central” chemical castration were discovered, and therefore their use is limited to 6 months, and they are successfully used to prepare patients for surgery. Recently, non-peptide orally active GnRH receptor antagonists have been proposed that are in the early stages of clinical trials. However, changes in the dosage form and route of administration of drugs that inhibit the activity of GRH do not improve their safety profile. Another breakthrough in MM therapy has been the use of selective progesterone receptor modulators, previously called “antiprogestins.” The drugs of this group have comparable efficacy and better tolerance to AGnRH, which makes the possible long-term treatment of uterine fibroids, especially in premenopausal women, using these drugs.

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