medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-17-9-16medsovet-5871Research ArticleАктуальная проблемаActual problemТаргетная терапия бронхиальной астмы. Бенрализумаб: в фокусе внимания пациенты, принимающие системные глюкокортикостероидыTargeted therapy in bronchial asthma. Benralizumab: focus on patients using systemic glucocorticosteroidshttps://orcid.org/0000-0002-1562-6386КняжескаяН. П.KniajeskaiaN. P.

Княжеская Надежда Павловна, кандидат медицинских наук, доцент кафедры пульмонологии

117997, Москва, ул. Островитянова, д. 1

Nadezhda P. Kniajeskaia, Cand. of Sci. (Med.), Associate Professor of the Department of Pulmonology

1, Ostrovityanov St., Moscow, 117997

kniajeskaia@mail.ruhttps://orcid.org/0000-0003-3672-9242АнаевЭ. Х.AnaevE. Kh.

Анаев Эльдар Хусеевич, доктор медицинских наук, профессор кафедры пульмонологии факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, д. 1

Eldar Kh. Anaev, Dr. of Sci. (Med.), Professor of the Department of Pulmonology, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997

el_anaev@hotmail.comhttps://orcid.org/0000-0002-5895-2982КамелеваА. А.KamelevaA. A.

Камелева Анастасия Андреевна, кандидат медицинских наук, врач аллерголог-иммунолог

105077, Москва, ул. 11-я Парковая, д. 32

Anastasia A. Kameleva, Cand. of Sci. (Med.), Allergologist-Immunologist

32, 11ya Parkovaya St., Moscow, 105077

СафошкинаЕ. В.SafoshkinaE. V.

Сафошкина Елена Викторовна, врач-терапевт

127018, Москва, 2-й Вышеславцев переулок, д. 7

Elena V. Safoshkina, General Practitioner

7, 2nd Vysheslavtsev Lane, Moscow, 127018

https://orcid.org/0000-0002-6547-8553КириченкоН. Д.KirichenkoN. D.

Кириченко Наталья Дмитриевна, врач-пульмонолог

105077, Москва, ул. 11-я Парковая, д. 32

Natalia D. Kirichenko, Pulmonologis

32, 11ya Parkovaya St., Moscow, 105077

Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница им. Д.Д. ПлетнёваРоссияCity Clinical Hospital named after D.D. PletnevRussian FederationПоликлиника №1РоссияOutpatient Clinic No. 1Russian Federation202020112020017916Copyright © Княжеская Н.П., Анаев Э.Х., Камелева А.А., Сафошкина Е.В., Кириченко Н.Д., 20202020Княжеская Н.П., Анаев Э.Х., Камелева А.А., Сафошкина Е.В., Кириченко Н.Д.Kniajeskaia N.P., Anaev E.K., Kameleva A.A., Safoshkina E.V., Kirichenko N.D.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/5871

Тяжелое течение бронхиальной астмы встречается у 5–20% больных бронхиальной астмой. Использование основных базисных препаратов в терапии тяжелой бронхиальной астмы (ТБА) не всегда эффективно ввиду возможного неконтролируемого течения заболевания и сохранения признаков эозинофильного воспаления дыхательных путей. Поэтому выделение фенотипов/эндотипов важно для индивидуального подхода к лечению таких пациентов. Это позволяет добиться лучшего контроля над заболеванием и снизить риски развития обострений, ремоделирования дыхательных путей и нежелательных побочных эффектов лечения, особенно системными глюкокортикостероидами. Применение биологической терапии в т. ч. может в значительной степени способствовать достижению хорошего контроля в лечении пациентов с неконтролируемой тяжелой астмой. В настоящее время в России зарегистрировано 5 иммунобиологических препаратов, относящихся к группе фенотип-обусловленных методов терапии ТБА: анти-IgE-терапия, анти-IL-4/13-терапия, анти-IL-5-терапия и антиIL5Rα-терапия. В зависимости от анамнеза, клинических особенностей течения бронхиальной астмы, наличия гиперчувствительности к одному из круглогодичных аллергенов и значения лабораторных маркеров, врач-специалист определяет точный диагноз с указанием фенотипа заболевания (аллергическая БА, эозинофильная или неаллергическая БА) и решает вопрос о назначении соответствующего препарата для пациента с БА. Значительный интерес представляет препарат бенрализумаб (Фазенра), который является гуманизированным моноклональным антителом. Бенрализумаб имеет несколько иной принцип действия: он блокирует не собственно интерлейкин-5, а альфа-субъединицу рецептора к интерлейкину-5 (IL-5Rα), запускает активный апоптоз эозинофилов, снижая их уровень в мокроте и крови. Проведенные клинические исследования подтвердили эффективность препарата в значительном уменьшении количества обострений бронхиальной астмы и снижении дозы системных глюкокортикостероидов.

A severe course of bronchial asthma develops in 5–20% of patients with bronchial asthma. The use of key disease-modifying agents for the treatment of severe bronchial asthma (SBA) is not always effective due to the possible uncontrolled course of the disease and persistence of signs of eosinophilic airway inflammation. Therefore, the isolation of phenotypes/ endotypes is important for an individual approach to the treatment of such patients. This method permits to get better control over the disease and reduces the risks of exacerbations, airway remodelling and unwanted adverse reactions to the therapy particularly with systemic glucocorticosteroids. The use of biological therapy among other drugs can greatly contribute to the achievement of good control over management of patients with uncontrolled severe asthma. There are currently 5 registered immunobiological drugs in Russia that belong to the group of SBA phenotype-based treatment modalities: anti-IgE therapy, anti-IL-4/13 therapy, anti-IL-5 therapy and anti-IL5Rα therapy. Depending on the disease history, clinical features of bronchial asthma course, the presence of hypersensitivity to one of the year-round allergens and the levels of laboratory markers, the medical professional establishes the exact diagnosis indicating a disease phenotype (allergic BA, eosinophilic or non-allergic BA) and addresses an issue of an appropriate drug for a patient with BA. Benralizumab (Fazenra), a humanized monoclonal antibody, generates considerable interest. Benralizumab has a slightly different principle of action: it blocks not interleukin-5 itself, but the alpha subunit of the interleukin-5 receptor (IL-5Rα), triggers active apoptosis of eosinophils, reducing their level in sputum and blood. The results of clinical studies showed the efficacy of the drug, which resulted in the significant reduction of bronchial asthma exacerbations and a dose of systemic glucocorticosteroids.

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