medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-16-17-25medsovet-6455Research ArticleАКТУАЛЬНОЕ В ПУЛЬМОНОЛОГИИОмализумаб и модификация естественного течения бронхиальной астмыOmalizumab and modification of bronchial asthma natural coursehttps://orcid.org/0000-0002-1562-6386КняжескаяН. П.KniajeskaiaN. P.

Княжеская Надежда Павловна, к.м.н., доцент, доцент кафедры пульмонологии дополнительного профессионального образования

117997, Россия, Москва, ул. Островитянова, д. 1

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

1, Ostrovityanov St., Moscow, 117997, Russia

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

Анаев Эльдар Хусеевич, д.м.н., профессор кафедры пульмонологии факультета дополнительного профессионального образования

117997, Россия, Москва, ул. Островитянова, д. 1

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

1, Ostrovityanov St., Moscow, 117997, Russia

el_anaev@hotmail.comhttps://orcid.org/0000-0001-6050-724XБелевскийА. С.BelevskiyA. S.

Белевский Андрей Станиславович, д.м.н., профессор, заведующий кафедрой пульмонологии факультета дополнительного профессионального образования

117997, Россия, Москва, ул. Островитянова, д. 1

Andrey S. Belevskiy, Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997, Russia

pulmobas@yandex.ruhttps://orcid.org/0000-0002-5895-2982КамелеваА. А.KamelevaA. A.

Камелева Анастасия Андреевна, к.м.н., врач – аллерголог-иммунолог

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

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

32, 11th Parkovaya St., Moscow, 105077, Russia

yurenkova@mail.ruhttps://orcid.org/0000-0002-7709-6579СафошкинаЕ. В.SafoshkinaE. V.

Сафошкина Елена Викторовна, врач-пульмонолог, соискатель кафедры пульмонологии факультета дополнительного профессионального образования

117997, Россия, Москва, ул. Островитянова, д. 1

Elena V. Safoshkina, Pulmonologist, Applicant for the Department of Pulmonology of the Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997, Russia

safelena@yandex.ruhttps://orcid.org/0000-0002-6547-8553КириченкоН. Д.KirichenkoN. D.

Кириченко Наталья Дмитриевна, врач-пульмонолог

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

Natalia D. Kirichenko, Pulmonologist

32, 11th Parkovaya St., Moscow, 105077, Russia

loskutova83@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница имени Д.Д. ПлетневаРоссияPletnev City Clinical HospitalRussian Federation2021291020210161725Copyright © Княжеская Н.П., Анаев Э.Х., Белевский А.С., Камелева А.А., Сафошкина Е.В., Кириченко Н.Д., 20212021Княжеская Н.П., Анаев Э.Х., Белевский А.С., Камелева А.А., Сафошкина Е.В., Кириченко Н.Д.Kniajeskaia N.P., Anaev E.H., Belevskiy A.S., 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/6455

Клиническая и молекулярная неоднородность бронхиальной астмы (БА) к настоящему времени документально подтверждена. Поиск новых путей повышения эффективности терапии связан прежде всего с изучением ее гетерогенной природы, что в свою очередь позволяет индивидуализировать лечение каждого пациента. Применение биологической терапии может способствовать достижению хорошего контроля у пациентов с тяжелой БА. В настоящее время в России зарегистрировано 5 иммунобиологических препаратов для фенотип-обусловленных методов терапии тяжелой БА: анти-IgE-терапии, анти-IL-4/- 13-терапии и анти-IL-5-терапии. Первым таргетным (целевым) препаратом, который применяется у пациентов с тяжелой БА в качестве анти-IgE-терапии, является омализумаб. Этот препарат назначается пациентам со среднетяжелой и тяжелой аллергической (атопической) БА, которая не контролируется базисной терапией, соответствующей 4-й ступени (уровень доказательности А). Клинические исследования продемонстрировали, что у пациентов с хронической тяжелой БА, требующей терапии высокими дозами ингаляционных или пероральных глюкокортикостероидов, лечение омализумабом снижает частоту обострений, уменьшает степень тяжести астмы и позволяет при стероидозависимой БА отменять или значительно снижать дозы системных препаратов. Кроме того, доказан противовоспалительный эффект препарата. Особое внимание привлекают исследования последних лет, которые демонстрируют положительное влияние омализумаба на ремоделирование дыхательных путей, способствующее модификации естественного течения БА у взрослых и детей. Доказан противовоспалительный эффект препарата. Омализумаб уменьшает эозинофильную инфильтрацию подслизистого слоя бронхов у пациентов с атопической БА, эозинофилию в мокроте, что коррелирует со снижением фракции выдыхаемого оксида азота на фоне биологической терапии. Омализумаб уменьшает толщину стенки бронхов, увеличивает просвет бронхов (положительная динамика КТ-параметров), что клинически проявляется увеличением ОФВ1.

Clinical and molecular heterogeneity of bronchial asthma has been documented in recent years. The search for novel solutions to enhance efficient patient support related first of all to understanding of asthma heterogenic nature and allows to personalize each patient treatment. Biological therapy application can influence to achieve better control at greater extent for patients with severe uncontrolled asthma. Nowadays 5 biological drugs are registered on Russian Federation territory and implemented according to severe asthma phenotypes: anti-IgE, anti-IL-4,13 and anti-IL-5 class therapies. Omalizumab become the first target drug for uncontrolled allergic asthma patients (monoclonal antibody against IgE). This medication is prescribed for uncontrolled moderate and severe allergic (atopic) asthma in patients on basic asthma therapy according GINA step 4 and 5 (Level of evidence A). Clinical trials confidently reported that anti- IgE-therapy reduces the rate of asthma exacerbations, severity of disease in patients with chronic severe asthma on high doses of inhaled steroids or systemic steroids and allows to reduce or withdraw systemic steroids doses in case of steroid-dependent asthma. For the last years special attention led to and demonstrated omalizumab positive effect on airways remodeling and modification of bronchial asthma natural course in adults and children. Antiinflammatory effect of omalizumab is documented. Omalizumab significantly reduces eosinophilic infiltration of submucosal bronchi layer among patients with atopic asthma, sputum eosinophilia, which correlates with reduction of FeNO during biologic treatment, reduces mast cells infiltration of smooth muscle cells in bronchi. Omalizumab significantly reduces the thickness of the bronchial wall, increases the lumen of the bronchi (positive dynamics of CT-scan parameters), which is clinically manifested by increased of FEV1.

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