medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-281medsovet-8506Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYПрименение упадацитиниба у ребенка с рефрактерным течением язвенного колитаUse of upadacitinib in a child with refractory ulcerative colitishttps://orcid.org/0000-0003-4905-2373ПотаповА. С.PotapovA. S.

Потапов Александр Сергеевич - д.м.н., профессор, начальник центра воспалительных заболеваний кишечника у детей, заведующий гастро-энтерологическим отделением, НМИЦ здоровья детей; профессор кафедры педиатрии и детской ревматологии Клинического института детского здоровья имени Н.Ф. Филатова, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

119296, Москва, Ломоносовский проспект, д. 2, стр. 1; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Alexander S. Potapov - Dr. Sci. (Med.), Professor, Head of the Center for Inflammatory Bowel Diseases in Children, Head of the Gastroenterology Department, National Medical Research Center for Children's Health; Professor of the Department of Pediatrics and Pediatric Rheumatology, Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

2, Bldg. 1, Lomonosovsky Ave., Moscow, 119296; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

potapov@nczd.ruhttps://orcid.org/0000-0002-0661-2556ПушкареваА. Е.PushkarevaA. E.

Пушкарева Анна Евгеньевна - врач-педиатр, ординатор, старший лаборант кафедры педиатрии и детской ревматологии Клинического института детского здоровья имени Н.Ф. Филатова.

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

Anna E. Pushkareva - Pediatrician, Resident, Senior Laboratory Assistant of the Department of Pediatrics and Pediatric Rheumatology, Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

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

annpushka1243@mail.ruhttps://orcid.org/0000-0002-3977-0657ВинокуроваА. В.VinokurovaA. V.

Винокурова Анна Валерьевна - врач-педиатр, врач-гастроэнтеролог гастроэнтерологического отделения, аспирант.

119296, Москва, Ломоносовский проспект, д. 2, стр. 1

Anna V. Vinokurova - Pediatrician, Gastroenterologist of the Gastroenterology Department, Postgraduate Student, National Medical Research Center for Children's Health.

2, Bldg. 1, Lomonosovsky Ave., Moscow, 119296

vinokurova.av@nczd.ruhttps://orcid.org/0000-0002-1198-0396ПрохоренковаМ. О.ProkhorenkovaM. O.

Прохоренкова Марина Олеговна - врач-педиатр, аспирант, ассистент кафедры педиатрии и детской ревматологии Клинического института детского здоровья имени Н.Ф. Филатова.

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

Marina O. Prokhorenkova - Pediatrician, Postgraduate Student, Assistant of the Department of Pediatrics and Pediatric Rheumatology, Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

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

mo.ostrovskaya@gmail.comhttps://orcid.org/0000-0003-0250-343XКрасновидоваА. Е.KrasnovidovaA. E.

Красновидова Анастасия Евгеньевна - врач-педиатр, аспирант, ассистент кафедры педиатрии и детской ревматологии Клинического института детского здоровья имени Н.Ф. Филатова.

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

Anastasia E. Krasnovidova - Pediatrician, Postgraduate Student, Assistant of the Department of Pediatrics and Pediatric Rheumatology, Filatov Clinical Institute of Child Health, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

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

krasnovidova_a_e@staff.sechenov.ruНациональный медицинский исследовательский центр здоровья детей; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияNational Medical Research Center for Children's Health; Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationНациональный медицинский исследовательский центр здоровья детейРоссияNational Medical Research Center for Children's HealthRussian Federation202402092024013124129Copyright © Потапов А.С., Пушкарева А.Е., Винокурова А.В., Прохоренкова М.О., Красновидова А.Е., 20242024Потапов А.С., Пушкарева А.Е., Винокурова А.В., Прохоренкова М.О., Красновидова А.Е.Potapov A.S., Pushkareva A.E., Vinokurova A.V., Prokhorenkova M.O., Krasnovidova A.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8506

Упадацитиниб - селективный ингибитор янус-киназ, относящийся к группе таргетных иммуносупрессоров или селективных иммунодепрессантов, который стал новой стратегией при иммуноопосредованных заболеваниях. Ранее в литературе встречались в основном клинические примеры и исследования на взрослых пациентах с воспалительными заболеваниями кишечника, в педиатрической практике данный опыт крайне мал. Препарат зарегистрирован на территории России для лечения язвенного колита и болезни Крона у взрослых. Применение у детей все еще остается off-label из-за отсутствия рандомизированных исследований. В представленном клиническом случае данный препарат назначался мальчику 15 лет при рефрактерном течении язвенного колита, который ранее потерял ответ на ингибитор фактора некроза опухоли. Терапия ведолизумабом и тофацитинибом также не была успешной. Учитывая предыдущий неудачный опыт, ребенку с рефрактерным течением язвенного колита был назначен упадацитиниб в дозе 45 мг 1 раз в сутки в течение 8 нед., далее предлагалось переходить на поддерживающую дозировку - 15 мг 1 раз в сутки. Без системного применения глюкокортикоидов у пациента сохранялись жалобы, клинико-лабораторные и эндоскопические изменения, но на терапии упадацитинибом мальчик смог от них отказаться. Данный пример демонстрирует положительную динамику по данным клинической, лабораторной и эндоскопической картины на фоне применения селективного ингибитора янус-киназ. Все больше клинических примеров с применением ингибиторов янус-киназ демонстрируют необходимость проведения клинических исследований в педиатрической группе пациентов с рефрактерным течением воспалительных заболеваний кишечника.

Upadacitinib a selective Janus kinase inhibitor that belongs to the group of targeted immunosuppressors or selective immu-nosuppressants, has emerged as a new strategy for immune-mediated diseases. Previously, clinical cases and studies on adult patients with inflammatory bowel disease were mostly found in the literature; in paediatric practice, this experience is very limited. Use in children is still off-label due to the lack of randomized trials. In the presented clinical case, this drug was prescribed to a 15-year-old boy for a refractory course of ulcerative colitis that had previously lost response to anti-TNF, therapy with vedolizumab and tofacitinib was also failed. Given the unsuccessful previous treatment experience, a child with refractory ulcerative colitis was prescribed upadacitinib. The drug was prescribed at a dose of 45 mg once a day for 8 weeks, then it was suggested to switch to a maintenance dose of 15 mg once a day. Without systemic glucocorticosteroid use, the patient's complaints, clinical, laboratory, and endoscopic changes persisted, but on upadacitinib therapy the boy was able to discontinue glucocorticosteroid. This example illustrates the positive dynamics according to clinical, laboratory and endoscopic data on the background of selective inhibitor of Janus kinases. A growing number of clinical cases using Janus kinase inhibitors show the need for clinical trials in a pediatric group of patients with refractory inflammatory bowel disease.

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