medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-123medsovet-7527Research ArticleПРАКТИКАPRACTICEПрименение дупилумаба в комплексной терапии полипозного риносинусита и бронхиальной астмыDupilumab in complex therapy for chronic rhinosinusitis with nasal polyps and asthmahttps://orcid.org/0000-0001-7341-1167СивохинД. А.SivokhinD. A.

Сивохин Дмитрий Алексеевич, аспирант кафедры болезней уха, горла и носа 

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

Dmitrii A. Sivokhin, Postgraduate Student of the Department of Ear, Nose and Throat Diseases

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia 

dr.sivokhin@gmail.comhttps://orcid.org/0000-0003-4755-0205ЩенниковаЕ. С.ShchennikovaE. S.

Щенникова Екатерина Сергеевна, врач-оториноларинголог отделения оториноларингологии Университетской клинической больницы №1 

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

Ekaterina S. Shchennikova, Otorhinolaryngologist, Department of Otorhinolaryngology, University Clinical Hospital No1 

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

katt-she@yandex.ruhttps://orcid.org/0000-0002-4966-3767РоюкВ. В.RoyukV. V.

Роюк Валерий Валерьевич, к.м.н., главный врач Университетской клинической больницы №1 

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

Valeriy V. Royuk, Cand. Sci. (Med.), head of University Clinical Hospital No1 

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

royuk_v_v@staff.sechenov.ruhttps://orcid.org/0000-0002-1562-6386КняжескаяН. П.KniajeskaiaN. P.

Княжеская Надежда Павловна, к.м.н., доцент кафедры пульмонологии 

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.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20231205202307203208Copyright © Сивохин Д.А., Щенникова Е.С., Роюк В.В., Княжеская Н.П., 20232023Сивохин Д.А., Щенникова Е.С., Роюк В.В., Княжеская Н.П.Sivokhin D.A., Shchennikova E.S., Royuk V.V., Kniajeskaia N.P.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/7527

Полипозный риносинусит (ПРС), вызванный T2-воспалением, отличается сложным патогенезом, трудно поддается методам медикаментозного (топические и системные глюкокортикостероиды, ингибиторы лейкотриенов и др.) и хирургического лечения, часто рецидивирует и значительно снижает качество жизни пациентов. Зачастую ПРС ассоциирован с бронхиальной астмой и аллергической реакцией на аспирин-содержащие препараты (триада Самтера). Данные состояния в большинстве случаев связаны общим патогенезом, включающим иммунный ответ II типа, при котором происходит гиперпродукция интерлейкинов (ИЛ) 4, 5 и 13, активация эозинофилов и ремоделирование тканей. Биологические препараты, блокирующие воздействие данных ИЛ, позволяют значительно улучшать состояние таких пациентов. Одним из наиболее эффективных препаратов для ПРС и бронхиальной астмы является дупилумаб, являющийся полностью человеческим моноклональным антителом, которое действует на альфа-субъединицу рецептора интерлейкина-4 (IL-4Rα), благодаря чему блокируется действие ИЛ-4 и ИЛ-13. В настоящее время данный препарат одобрен для лечения бронхиальной астмы, полипозного риносинусита и атопического дерматита. Применение дупилумаба позволяет снизить количество обострений, потребность в применении системных глюкокортикостероидных препаратов, улучшить состояние верхних и нижних дыхательных путей и добиться прироста ОФВ1 на 0,2–0,3 л, что приводит к значимому контролю данных заболеваний. Одним из актуальных вопросов является выбор тактики лечения пациентов, имеющих ПРС, бронхиальную астму и выраженное искривление перегородки носа. В рамках данной статьи представлен клинический случай пациента с бронхиальной астмой тяжелой степени тяжести, полипозным риносинуситом и искривлением перегородки носа, получающего дупилумаб на протяжении 4 мес.

Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.

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