medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-7-116-122medsovet-6869Research ArticleЗаболевания кишечникаBowel diseaseРеальная клиническая практика лечения осложненной болезни Крона устекинумабом. Описание клинического случаяReal clinical practice of complicated Crohn’s disease treatment with ustekinumab: clinical case presentationhttps://orcid.org/0000-0001-8053-8764МакарчукП. А.MakarchukP. A.

Макарчук Павел Александрович - кандидат медицинских наук, старший научный сотрудник отделения гастроэнтерологии.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1.

Pavel A. Makarchuk - Cand. Sci. (Med.), Senior Researcher, Department of Gastroenterology, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

61/2, Bldg. 1, Schepkin St., Moscow, 129110.

pashka_m79@mail.ruhttps://orcid.org/0000-0002-7703-8328ЛомакинаЕ. Ю.LomakinaE. Yu.

Ломакина Екатерина Юрьевна - научный сотрудник отделения гастроэнтерологии.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1.

Ekaterina Yu. Lomakina - Researcher, Department of Gastroenterology and Hepatology, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

61/2, Bldg. 1, Schepkin St., Moscow, 129110.

Kate-den@yandex.ruhttps://orcid.org/0000-0003-4523-3337БелоусоваЕ. А.BelousovaE. A.

Белоусова Елена Александровна - доктор медицинских наук, профессор, руководитель отделения гастроэнтерологии.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1.

Elena A. Belousova - Dr. Sci. (Med.), Professor, Head of Department of Gastroenterology, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

61/2, Bldg. 1, Schepkin St., Moscow, 129110.

eabelous@yandex.ruhttps://orcid.org/0000-0001-8809-1629ДуброваС. Э.DubrovaS. E.

Дуброва Софья Эриковна - кандидат медицинских наук, врач отделения лучевой диагностики.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1.

Sofya E. Dubrova - Cand. Sci. (Med.), Radiologist of the X-ray Department, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

61/2, Bldg. 1, Schepkin St., Moscow, 129110.

Dubrova.sofya@gmail.comМосковский областной научно-исследовательский клинический институт имени М.Ф. ВладимирскогоРоссияMoscow Regional Research Clinical Institute named after M.F. VladimirskyRussian Federation20221405202207116122Copyright © Макарчук П.А., Ломакина Е.Ю., Белоусова Е.А., Дуброва С.Э., 20222022Макарчук П.А., Ломакина Е.Ю., Белоусова Е.А., Дуброва С.Э.Makarchuk P.A., Lomakina E.Y., Belousova E.A., Dubrova S.E.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/6869

Болезнь Крона (БК) является тяжелым иммуноопосредованным заболеванием с сегментарным трансмуральным воспалением желудочно-кишечного тракта преимущественно в подвздошной и толстой кишке и развитием тяжелых кишечных осложнений. Болезнь имеет прогрессирующее течение, требующее агрессивной терапии или хирургического лечения. Лечение БК остается пока одной из нерешенных и наиболее острых проблем гастроэнтерологии. Базисными средствами для лечения БК в течение многих лет остаются глюкокортикостероиды (ГКС), однако отмечается постоянное увеличение доли больных со стероидорезистентными и стероидозависимыми формами заболевания. При неэффективности базисной терапии и рефрактерности к ГКС схемы терапии БК предусматривают применение генно-инженерных биологических препаратов (ГИБП) разных классов: ингибиторов фактора некроза опухоли альфа (иФНО-α), ингибитора интегрина α4β7 (ведолизумаб), ингибитора интерлейкинов 12/23 (ИЛ 12/23) (устекинумаб). Любой из указанных препаратов может быть использован у бионаивных пациентов c БК в качестве первой линии терапии, однако на все ГИБП со временем отмечается вторичная потеря ответа. При потере ответа на ГИБП в первой линии терапии возникает вопрос о правильном выборе препарата второй и последующих линий, поскольку во второй линии ГИБП могут демонстрировать более низкую эффективность. Расширение арсенала ГИБП и данные реальной клинической практики позволяют сделать более правильный выбор следующего лекарственного препарата. Одним из ГИБП, имеющим высокую эффективность в первой линии терапии БК и сохраняющим эффективность в последующих линиях терапии, является устекинумаб – лекарственное средство на основе человеческих моноклональных антител к ИЛ 12/23. В работе представлено клиническое наблюдение, демонстрирующее эффективность устекинумаба при осложненном течении БК у молодой пациентки с негативным прогнозом заболевания при потере ответа на три иФНО-α.

Crohn’s disease (CD) is a severe immune-mediated disease with segmental transmural inflammation and ulcers in gastrointestinal tract most often in terminal ileum and colon. The disease is often associated with severe complications such as fistulas and strictures that require aggressive treatment or surgery. CD treatment remains the unresolved and one of the most serious problems in gastroenterology. Glucocorticosteroids (GCS) are the essential treatment options for many years but unfortunately the frequency of steroid resistance and steroid dependence are constantly increasing. In the cases of steroid refractory CD treatment options include biologics of different classes: tumour necrosis factor alfa - inhibitors (iTNF-α), α4β7 integrin inhibitor (vedolizumab), IL-12/23 inhibitor (ustekinumab). Any of these drugs can be used in bio-naïve CD patients, however secondary loss of response was noted for all biologics over time.

In the cases of the first line treatment failure the problem of correct choice of the second and subsequent lines of biologics appears, since some biologics may show lower efficacy in the second line of treatment. Real clinical practice will allow us to make a more correct choice of next biologic. Ustekinumab, a human interleukin -12/23 monoclonal antibody is one of biologics that is highly effective in the first-line CD therapy and remains effective in the subsequent lines of treatment. We present a clinical case of complicated CD in young female with negative disease prognosis and loss of response to three iTNF-α. In this case the high efficacy of ustekinumab after multiple iTNF-α failure was demonstrated.

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