medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-055medsovet-8129Research ArticleЗАБОЛЕВАНИЯ КОЖИDERMAL DISEASESИнгибиторы янус-киназ в терапии коморбидных заболеваний – атопического дерматита и гнездной алопеции: обзор литературы и опыт клинической практикиJAK-inhibitors in the therapy of comorbid diseases – atopic dermatitis and alopecia areata: literature review and experience of clinical practicehttps://orcid.org/0000-0002-9578-5490ПотекаевН. Н.PotekaevN. N.

Потекаев Николай Николаевич - д.м.н., профессор, заведующий кафедрой кожных болезней и косметологии факультета дополнительного профессионального образования, РНИМУ им. Н.И. Пирогова; директор, МНПЦДК.

117997, Москва, ул. Островитянова, д. 1; 119071, Москва, Ленинский проспект, д. 17

Nikolay N. Potekaev - Dr. Sci. (Med.), Professor, Head of the Department of Skin Diseases and Cosmetology of the Faculty of Further Professional Education, Pirogov Russian National Research Medical University; Director, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology.

1, Ostrovityanov St., Moscow, 117997; 17, Leninsky Ave., Moscow, 119071

klinderma@mail.ruhttps://orcid.org/0000-0001-9643-0440ТерещенкоГ. П.TereshchenkoG. P.

Терещенко Галина Павловна - к.м.н., заведующая консультативно-диагностическим центром, МНПЦДК; доцент кафедры дерматовенерологии, аллергологии и косметологии Медицинского института, РУДН им. Патриса Лумумбы.

119071, Москва, Ленинский проспект, д. 17; 117198, Москва, ул. Миклухо-Маклая, д. 6

Galina P. Tereshchenko - Cand. Sci (Med.), Head of the Consultative and Diagnostic Center, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology; Associate Professor of the Department of Dermatovenerology, Allergology and Cosmetology at the Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba.

17, Leninsky Ave., Moscow, 119071; 6, Miklukho-Maklai St., Moscow, 117198

gala_ter@mail.ruhttps://orcid.org/0000-0003-0489-0576ГаджигороеваА. Г.GadzhigoroevaA. G.

Гаджигороева Аида Гусейхановна - д.м.н., руководитель научного отдела клинической дерматовенерологии и косметологии.

119071, Москва, Ленинский проспект, д. 17

Aida G. Gadzhigoroeva - Dr. Sci. (Med.), Head of the Scientific Department of Clinical Dermatovenerology and Cosmetology, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology.

17, Leninsky Ave., Moscow, 119071

aida2010@mail.ruМосковский научно-практический центр дерматовенерологии и косметологии; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияMoscow Scientific and Practical Center of Dermatovenereology and Cosmetology; Pirogov Russian National Research Medical UniversityRussian FederationМосковский научно-практический центр дерматовенерологии и косметологии; Российский университет дружбы народов имени Патриса ЛумумбыРоссияMoscow Scientific and Practical Center of Dermatovenereology and Cosmetology; Peoples’ Friendship University of Russia named after Patrice LumumbaRussian FederationМосковский научно-практический центр дерматовенерологии и косметологииРоссияMoscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian Federation202407032024024453Copyright © Потекаев Н.Н., Терещенко Г.П., Гаджигороева А.Г., 20242024Потекаев Н.Н., Терещенко Г.П., Гаджигороева А.Г.Potekaev N.N., Tereshchenko G.P., Gadzhigoroeva A.G.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/8129

В настоящее время атопический дерматит (АтД) рассматривается как системное заболевание в связи с тем что нарушения врожденного и адаптивного иммунного ответа, особенно выраженные при тяжелом течении, проявляются не только в воспалении на коже, но и могут реализоваться в развитии других хронических заболеваний, в т. ч. аутоиммунного профиля. Одним из аутоиммунных коморбидных заболеваний при АтД является гнездная алопеция (ГА), что подтверждается эпидемиологическими данными, а также клиническими особенностями и выявлением общих иммунных звеньев патогенеза при ассоциации этих заболеваний. Ингибиторы янус-киназ (JAK), которые представляют собой новый класс таргетных синтетических базисных противовоспалительных препаратов, в настоящее время являются основным патогенетическим методом лечения тяжелых форм АтД и ГА. Воздействуя на несколько иммунных осей, эти препараты избирательно и обратимо модулируют сигнальную активность ключевых воспалительных цитокинов, что делает их наиболее перспективной стратегией системной терапии указанных дерматозов, в т. ч. в случаях их сочетания. В статье представлен обзор патофизиологии и применения ингибиторов JAK первого и второго поколения при АтД и ГА, проанализированы данные об их эффективности при одновременном наличии этих патологических состояний. Представлены собственные наблюдения двух пациентов с тяжелыми коморбидными заболеваниями АтД и ГА, получающих лечение JAK-ингибиторами аброцитинибом и упадацитинибом. В данных примерах подтверждается эффективность ингибиторов янус-киназ при АтД и ГА в реальной клинической практике, описывается опыт перехода с одного JAK-ингибитора первого поколения на другой селективный JAK-ингибитор, а также эффект влияния этих препаратов на течение обеих патологий. Учитывая необходимость длительного применения ингибиторов JAK, сохраняет актуальность дальнейшее изучение их долгосрочной эффективности и безопасности.

Atopic dermatitis (AtD) is currently considered as a systemic disease due to the fact, that disorders of innate and adaptive immune response, especially pronounced in severe course, are manifested not only in skin inflammation, but also can be realized in the development of other chronic diseases, including autoimmune profile. One of the autoimmune comorbid diseases in AtD is alopecia areata (AA), which is confirmed by epidemiologic data, clinical features and identification of common immune links of pathogenesis in the case of association of these diseases. Janus-kinase inhibitors, which represent a new class of targeted synthetic basic anti-inflammatory drugs, are currently the main pathogenetic treatments for severe forms of AtD and AA. Acting on several immune axes, these drugs selectively and reversibly modulate the signaling activity of key inflammatory cytokines, which makes them the most promising strategy for systemic therapy of these dermatoses, including in cases of their combination. The article covers the review of pathophysiology and application of first and second generation JAK-inhibitors in AtD and AA, including the analysis of their efficacy in the simultaneous presence of these pathological conditions. We present own observations of two patients with severe comorbid conditions AtD and AA, treated with the JAK-inhibitors abrocitinib and upadacitinib. These examples confirm the efficacy of Janus-kinase inhibitors in AtD and AA in real clinical practice and describe the experience of switching from one JAK-inhibitor of the first generation to another, selective JAK-inhibitor, as well as the effect of of these drugs on the course of both pathologies. Taking into account the necessity of long-term use of JAK-inhibitors, further study of their long-term efficacy and safety remains relevant.

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