medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-12-28-34medsovet-5862Research ArticleЗАБОЛЕВАНИЯ КОЖИDERMAL DISEASESПсориаз: персонифицированный подход к терапии. Предпочтительный выбор системных агентов с учетом коморбидных патологийPsoriasis: a personalized approach to therapy. The preferred choice of systemic agents considering comorbid pathologieshttps://orcid.org/0000-0002-9578-5490ПотекаевН. Н.PotekaevN. N.

Потекаев Николай Николаевич – доктор медицинских наук, профессор, заведующий кафедрой кожных болезней и косметологии факультета дополнительного профессионального образования, РНИМУ имени Н.И. Пирогова МЗ РФ;; директор, МНПЦДК ДЗМ.117997, Москва, ул. Островитянова, д. 1; 119071, Москва, Ленинский проспект, д. 17.

Nikolay N. Potekaev - Dr. of Sci. (Med.), Professor, Head of Department of Skin Diseases and Cosmetology, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Director, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department.1, Ostrovityanov St., Moscow, 117997; 17, Leninskiy Prospect, Moscow, 119071.

klinderma@inbox.ruhttps://orcid.org/0000-0001-5723-6573ЖуковаО. В.ZhukovaO. V.

Жукова Ольга Валентиновна - доктор медицинских наук, профессор, заведующая кафедрой кожных и венерических болезней медицинского института, РУДН; главный врач, МНПЦДК ДЗМ.117198, Москва, ул. Миклухо-Маклая, д. 6; 119071, Москва, Ленинский проспект, д. 17.

Olga V. Zhukova - Dr. of Sci. (Med.), Professor, Head of Department of Skin and Sexually Transmitted Diseases, Peoples' Friendship University of Russia; Chief Medical Officer, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department.6, Miklukho-Maklai St., Moscow, 117198; 17, Leninskiy Prospect, Moscow, 119071.

klinderma@inbox.ruhttps://orcid.org/0000-0002-2793-8862АртемьеваС. И.ArtemyevaS. I.

Артемьева Софья Иосифовна - младший научный сотрудник, врач-дерматовенеролог.119071, Москва, Ленинский проспект, д. 17.

Sofya I. Artemyeva - Junior Researcher, Dermatologist, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department.17, Leninskiy Prospect, Moscow, 119071.

sofya.chern@gmail.comРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова; Московский научно-практический центр дерматовенерологии и косметологииРоссияPirogov Russian National Research Medical University; Moscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian FederationМосковский научно-практический центр дерматовенерологии и косметологии; Российский университет дружбы народовРоссияMoscow Scientific and Practical Center of Dermatovenereology and Cosmetology; Peoples' Friendship University of RussiaRussian FederationМосковский научно-практический центр дерматовенерологии и косметологииРоссияMoscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian Federation2020141120200122834Copyright © Потекаев Н.Н., Жукова О.В., Артемьева С.И., 20202020Потекаев Н.Н., Жукова О.В., Артемьева С.И.Potekaev N.N., Zhukova O.V., Artemyeva S.I.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/5862

Псориаз является хроническим воспалительным заболеванием кожи, которое в настоящее время рассматривается как системный процесс с учетом связи с множеством коморбидных состояний. С появлением генно-инженерных биологических препаратов (ГИБП) лечение псориаза претерпело значительные перемены благодаря их высокой эффективности и благоприятному профилю безопасности. Клинически доказано, что применение данного вида терапии оказывает положительное воздействие, в т. ч. и на коморбидные заболевания. Однако необходимо понимать, что некоторые виды препаратов могут оказывать и негативное влияние на течение этих состояний. У каждого отдельного препарата такие характеристики, как скорость наступления ремиссии, долгосрочная эффективность, профиль безопасности и влияние на сопутствующие заболевания, различны. Лучшее понимание данных характеристик приводит к правильному персонифицированному выбору терапии, следовательно, к улучшению выживаемости препаратов, удовлетворенности пациентов и минимизации воздействия псориаза на качество жизни больных.В данной статье рассматривается эффективность и безопасность биопрепаратов у пациентов с псориазом, обсуждается их влияние на сопутствующие заболевания, патогенетически связанные с псориазом.На сегодняшний день известно, что в патогенезе псориаза ключевую роль играет сигнальный путь ИЛ-23/ИЛ-17. Многообещающие результаты показывает применение биологического препарата, нацеленного на ингибирование ИЛ-23, а именно блокатора ИЛ-23 гуселькумаба. Помимо высокого уровня терапевтического ответа в отношении псориаза, выявлены и другие свойства: препарат также показал эффективность у пациентов с сопутствующей болезнью Крона. Исследования описывают положительные ответные реакции при лечении гуселькумабом псориаза «трудных» локализаций, псориатического артрита и Hidradenitis Suppurativa, а его применение у пациентов с кардиоваскулярными рисками не привело к каким-либо проявлениям отрицательной динамики. Таким образом, перспективным направлением является дальнейшее изучение влияния блокатора ИЛ-23 на коморбидные патологии при псориазе.

Psoriasis is a chronic inflammatory skin disease that is currently viewed as a systemic process due to its association with many comorbid conditions. With the appearance of genetically engineered biological drugs (GEBDs), the treatment of psoriasis has undergone significant changes due to their high efficiency and favorable safety profile. It has been clinically proven that the use of this type of therapy has a positive effect, including on comorbid diseases. However, it must be highlighted that some types of drugs can have a negative effect on the course of these conditions. The characteristics of each individual drug, such as the rate of onset of remission, long-term efficacy, safety profile and effect on comorbidities are different. A better understanding of these characteristics leads to the correct personalized choice of therapy, hence to improved survival of drugs, patient satisfaction and minimization of the impact of psoriasis on the quality of life of patients.This article examines the efficacy and safety of biological drugs in patients with psoriasis, discusses their effect on concomitant diseases pathogenetically associated with psoriasis.To date it is known that the signaling pathway IL-23 / IL-17 plays a key role in the pathogenesis of psoriasis. Promising results are shown by the use of a biological drug aimed at inhibiting IL-23, namely the IL-23 blocker guselkumab. In addition to the high level of therapeutic response in psoriasis, other properties oa the drug have been identified - it has also shown efficacy in patients with concomitant Crohn's disease. Studies describe positive responses in the guselkumab treatment of psoriasis with “difficult” localisations, psoriatic arthritis and Hidradenitis Suppurativa, and its use in patients with cardiovascular risks did not lead to any manifestations of negative dynamics. Thus, further study of the effect of the IL-23 blocker on comorbid pathologies in psoriasis is a promising area.

 

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