medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-138medsovet-7569Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESТеоретические аспекты назначения устекинумаба в качестве первой линии терапии болезни КронаTheoretical aspects of prescribing ustekinumab as first-line therapy for Crohn’s diseasehttps://orcid.org/0000-0003-1172-6221ШапинаМ. В.ShapinaM. V.

Шапина Марина Владимировна, к.м.н., руководитель отдела функциональных и  воспалительных заболеваний кишечника 

123423, Москва, ул. Саляма Адиля, д. 2

Marina V. Shapina, Cand. Sci. (Med.), Head of the Department of Functional and Inflammatory Bowel Diseases 

2, Salyam Adil St., Moscow, 123423

shapina.mv@yandex.ruНациональный медицинский исследовательский центр колопроктологии имени А.Н. РыжихРоссияRyzhikh State Scientific Center of ColoproctologyRussian Federation20232505202308175180Copyright © Шапина М.В., 20232023Шапина М.В.Shapina M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7569

Лечение болезни Крона является сложным процессом, в котором необходимо учитывать не только текущее состояние пациента и риски прогрессирования заболевания, но и последовательность назначения терапии. На сегодняшний день только биологические препараты могут изменить течение заболевания, но их число ограничено, и назначать их следует с учетом выбора оптимальной последовательности у каждого пациента, так как на эффективность любого биологического препарата влияет предшествующее лечение. К сожалению, универсальных рекомендаций по последовательности выбора биологических препаратов нет, и актуальным является вопрос выбора препарата первой линии. Устекинумаб (торговое наименование – Стелара®) является биологическим препаратом, направленным на интерлейкин-12 и 23, который показал себя эффективным и  безопасным в  лечении как пациентов после ингибиторов фактора некроза опухоли альфа, так и  бионаивных пациентов. Его эффективность также показана в  лечении стриктур и  перианальных проявлений БК. Также устекинумаб является эффективным в отношении суставных внекишечных проявлений, таких как артралгии и псориатический артрит. Высокая частота ответа на устекинумаб была также обнаружена у пациентов с дерматологическими проявлениями (псориаз, гангренозная пиодермия и узловатая эритема). Кроме того, хороший профиль безопасности позволяет применять его у пожилых пациентов. Особый интерес представляет прямое сравнение биологических препаратов. В настоящий момент проведено только одно рандомизированное исследование прямого сравнения устекинумаба с адалимумабом у пациентов с болезнью Крона, где показаны сопоставимые по эффективности результаты. Также есть данные post hoc анализа рандомизированных исследований, где его эффективность сопоставима с инфликсимабом. Таким образом, данный препарат может назначаться для лечения болезни Крона, в том числе в первой линии терапии.

The treatment of Crohn’s disease is a complex process in which it is necessary to take into account not only the current condition of the patient and the risks of disease progression, but also the sequence of therapy. To date, only biological drugs can change the course of the disease, but their number is limited and they should be prescribed taking into account the choice of the optimal sequence for each patient, since the effectiveness of any biological drug is affected by previous treatment. Unfortunately, there are no common recommendations on the sequence of choosing biological drugs, and the issue of choosing a first-line drug is relevant. Ustekinumab is a biologic agent targeting interleukin-12 and 23 that has been shown to be effective and safe in the treatment of both patients after TNF-alpha inhibitors and bionaive patients. It has also been shown to be effective in the treatment of strictures and perianal manifestations of Crohn’s disease. Ustekinumab is also effective against articular extraintestinal manifestations such as arthralgia and psoriatic arthritis. A high response rate to ustekinumab was also found in patients with dermatological manifestations – psoriasis, pyoderma gangrenosum, and erythema nodosum. In addition, a good safety profile allows its use in elderly patients. Of particular interest is the direct comparison of biologics. To date, there is only one randomized head-to-head trial of ustekinumab and adalimumab showing comparable efficacy results. And there is also data from a post hoc analysis of randomized trials, where its effectiveness is comparable to infliximab. Thus, ustekinumab can be prescribed for the treatment of Crohn’s disease, including in the first line of therapy.

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