medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-471medsovet-8011Research ArticleПУЛЬМОНОЛОГИЯ, ОТОЛАРИНГОЛОГИЯPULMONOLOGY, OTORHINOLARYNGOLOGYПроблема выбора генно-инженерного биологического препарата у пациента с тяжелой бронхиальной астмойThe problem of choosing a genetically engineered biological drug in a patient with severe bronchial asthmahttps://orcid.org/0000-0003-4678-3904ТитоваО. Н.TitovaO. N.

Титова Ольга Николаевна - д.м.н., профессор, директор НИИ пульмонологии.

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Olga N. Titova - Dr. Sci. (Med.), Professor, Director of Research Institute of Pulmonology.

6–8, Lev Tolstoy St., St Petersburg, 197022

titovaon@spb-gmu.ruhttps://orcid.org/0000-0002-5664-7386ВолчковВ. А.VolchkovV. A.

Волчков Владимир Анатольевич - д.м.н., заведующий кафедрой анестезиологии и реаниматологии медицинского факультета.

199034, Санкт-Петербург, Университетская наб., д. 7/9

Vladimir A. Volchkov - Dr. Sci. (Med.), Head of the Department of Anesthesiology and Reanimatology.

7/9, Universitetskaya Emb., St Petersburg, 199034

https://orcid.org/0000-0002-1166-9717КузубоваН. А.KuzubovaN. A.

Кузубова Наталия Анатольевна - д.м.н., начальник Экспертного центра по профилю «Пульмонология».

194354, Санкт-Петербург, Учебный переулок, д. 5

Natalia A. Kuzubova - Dr. Sci. (Med.), Head of the expert center on the profile of "Pulmonology".

5, Uchebnyy Lane, St Petersburg, 194354

kuzubova@mail.ruhttps://orcid.org/0000-0001-7052-6903СкляроваД. Б.SklyarovaD. B.

Склярова Дарья Борисовна - к.м.н., заведующая амбулаторно-консультативным отделением № 2 Экспертного центра по профилю «Пульмонология».

194354, Санкт-Петербург, Учебный переулок, д. 5

Daria B. Sklyarova - Cand. Sci. (Med.), Head of Outpatient Department No. 2 of the Expert Center on the profile "Pulmonology".

5, Uchebnyy Lane, St Petersburg, 194354

darya_sklyarova@mail.ruПервый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаРоссияPavlov First Saint Petersburg State Medical UniversityRussian FederationСанкт-Петербургский государственный университетРоссияSt Petersburg State UniversityRussian FederationГородская многопрофильная больница № 2РоссияCity Multidisciplinary Hospital No. 2Russian Federation202319012024023128132Copyright © Титова О.Н., Волчков В.А., Кузубова Н.А., Склярова Д.Б., 20242024Титова О.Н., Волчков В.А., Кузубова Н.А., Склярова Д.Б.Titova O.N., Volchkov V.A., Kuzubova N.A., Sklyarova D.B.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/8011

Тяжелая бронхиальная астма (ТБА) – это астма, симптомы которой не контролируются с помощью высоких доз ингаляционных глюкокортикостероидов, основного лекарственного средства при лечении астмы. ТБА связана с высоким экономическим бременем и остается серьезной проблемой общественного здравоохранения. Современные достижения в понимании молекулярных механизмов, лежащих в основе воспаления дыхательных путей, привели к разработке терапии моноклональными антителами. За последние годы подход к лечению пациентов с ТБА претерпел значительные изменения: 6 биологических препаратов показали свою эффективность в исследованиях фазы 3, особенно в уменьшении обострений, улучшении контроля астмы, качества жизни, функции легких и отмене системных кортикостероидов или, по крайней мере, снижении их суточной дозы, с некоторыми различиями между ними. Выбор таргетного препарата всегда является сложной задачей, предполагающей тщательную оценку клинико-анамнестических и лабораторных показателей. Биологические препараты имеют разные мишени воздействия и, следовательно, следует ожидать различных терапевтических показаний; однако некоторым пациентам может быть показано более одного препарата, что затрудняет выбор. Анализ маркеров эозинофильного воспаления позволяет определить механизмы патогенеза, прогнозировать ответ на лечение, проводить мониторинг его эффективности или прогрессирования заболевания. Другими факторами, которые необходимо анализировать, являются частота симптомов, триггеры астмы, исходная спирометрия, статус приема пероральных кортикостероидов, частота обострений и сопутствующие заболевания. Назначение таргетной терапии без тщательной оценки клинико-функциональных и лабораторных показателей, а также отсутствие контроля этих показателей во время терапии может привести к недостаточной эффективности лечения.

Severe bronchial asthma (SA) is asthma whose symptoms are not controlled by high doses of inhaled glucocorticosteroids, the main drug in the treatment of asthma. SA is associated with a high economic burden and remains a serious public health problem. Modern advances in understanding the molecular mechanisms underlying respiratory tract inflammation have led to the development of monoclonal antibody therapy. In recent years, the approach to the treatment of patients with SA has undergone significant changes: six biological drugs have shown their effectiveness in phase 3 studies, especially in reducing exacerbations, improving asthma control, quality of life, lung function and the abolition of systemic corticosteroids or at least reducing their daily dose, with some differences between them. Choosing a targeted drug is always a difficult task, involving a thorough assessment of clinical, anamnestic and laboratory parameters. Biologics have different targets of exposure and, therefore, different therapeutic indications should be expected; however, some patients may be shown more than one drug, which makes it difficult to choose. The analysis of markers of eosinophilic inflammation makes it possible to determine the mechanisms of pathogenesis, predict the response to treatment, monitor its effectiveness or disease progression. Other factors that need to be analyzed are the frequency of symptoms, asthma triggers, baseline spirometry, oral corticosteroid intake status, frequency of exacerbations and concomitant diseases. The appointment of targeted therapy without a thorough assessment of clinical, functional and laboratory parameters, as well as the lack of control of these indicators during therapy can lead to insufficient effectiveness of treatment.

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