medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-446medsovet-8586Research ArticleЗАБОЛЕВАНИЯ КИШЕЧНИКАBOWEL DISEASESЛечение легких и среднетяжелых форм язвенного колита: возможности месалазинаTreatment of mildandmoderateforms of ulcerativecolitis: the possibilities of mesalazinehttps://orcid.org/0000-0002-7703-8328ЛомакинаЕ. Ю.LomakinaE. Yu.

Ломакина Екатерина Юрьевна, научный сотрудник отделения гастроэнтерологии

129110, Москва, ул. Щепкина, д. 61/2

Ekaterina Yu. Lomakina, Researcher, Department of Gastroenterology

61/2, Schepkin St., Moscow, 129110

kate-den@bk.ruhttps://orcid.org/0000-0001-9083-2617ТебердиеваМ. В.TeberdievaM. V.

Тебердиева Марьяна Вячеславовна, младший научный сотрудник отделения гастроэнтерологии

129110, Москва, ул. Щепкина, д. 61/2

Maryana V. Teberdieva, Junior Researcher, Department of Gastroenterology

61/2, Schepkin St., Moscow, 129110

mteberdieva96@mail.ruhttps://orcid.org/0009-0005-4316-8086БузуноваЮ. М.BuzunovaYu. M.

Бузунова Юлия Михайловна, младший научный сотрудник отделения гастроэнтерологии

129110, Москва, ул. Щепкина, д. 61/2

Yulia M. Buzunova, Junior Researcher, Department of Gastroenterology

61/2, Schepkin St., Moscow, 129110

krasnovaulia@mail.ruhttps://orcid.org/0000-0003-4523-3337БелоусоваЕ. А.BelousovaE. A.

Белоусова Елена Александровна, д.м.н., профессор, руководитель отделения гастроэнтерологии

129110, Москва, ул. Щепкина, д. 61/2

Elena A. Belousova, Dr. Sci. (Med.), Professor, Head of Department of Gastroenterology

61/2, Schepkin St., Moscow, 129110

eabelous@yandex.ruМосковский областной научно-исследовательский клинический институт имени М.Ф. ВладимирскогоРоссияMoscow Regional Research Clinical Institute named after M.F. VladimirskyRussian Federation202417102024015182–189Copyright © Ломакина Е.Ю., Тебердиева М.В., Бузунова Ю.М., Белоусова Е.А., 20242024Ломакина Е.Ю., Тебердиева М.В., Бузунова Ю.М., Белоусова Е.А.Lomakina E.Y., Teberdieva M.V., Buzunova Y.M., Belousova E.A.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/8586

В статье уточняется ниша и принципы выбора препаратов месалазина, а также подбор дозы препарата при лечении легкого и среднетяжелого распространенного (левостороннего и тотального) язвенного колита (ЯК). Тактика лечения более тяжелых форм ЯК и лечение дистальных форм (проктита) здесь не рассматриваются. Изложены современные представления по использованию препаратов 5-аминосалициловой кислоты (5-АСК) при легком и среднетяжелом активном ЯК для индукции и поддержания ремиссии. Приводятся принципы использования препарата, сравниваются отечественные и международные клинические рекомендации по дозам месалазина. Сделан акцент на важности высокодозной терапии месалазином (≥4 г/ день), что позволяет достичь целей, поставленных стратегией Treat-to-Target (T2T) с достижением клинической и эндоскопической ремиссии. Приводятся данные метаанализов и сравнительных исследований, демонстрирующих одинаковую эффективность разных форм месалазина в лечении ЯК. Обращено внимание на выбор оптимального препарата, энтеросолюбидное покрытие которого состоит из двух типов эудрагита (L + S-эудрагит), в отличие от месалазинов с однотипным покрытием (только L или только S). Двойное эудрагитное (L + S) рН-зависимое покрытие таблеток месалазина растворяется в терминальном отделе подвздошной кишки, в слепой и частично в правой половине ободочной кишки при значениях рН = 6–7,5, тогда как препараты с покрытием только L или только S действуют в более узком интервале рН. Клиническая эффективность месалазина напрямую зависит от его внутрипросветной концентрации, определяющейся количеством высвободившегося препарата в соответствии с уровнем рН в просвете кишки. Двойное эудрагитное покрытие позволяет перекрыть весь спектр рН в подвздошной и толстой кишке. В работе приведены данные из отечественной клинической практики, подтверждающие положения Кокрейновского метаанализа о сопоставимой эффективности разных месалазинов в отношении поставленных целей: достижения ремиссии и снижения уровня фекального кальпротектина. Кроме того, демонстрируется высокая частота достижения клинической ремиссии (более 80% через 48 нед. лечения) при применении месалазина с двойным покрытием (L + S). 

The article indicates the specific niche and principles for choosing mesalazine formulations, and the selection of a dose for the treatment of mild to moderate extensive (left-sided and total) ulcerative colitis (UC). It doesn’t consider any approaches to the treatment of more severe UC or distal UC (proctitis). The current concepts on the use of 5-aminosalicylic acid (5-ASA) formulations to induce and maintain remission in mild to moderate active UC are discussed. The principles for drug administration and a comparative analysis of domestic and international mesalazine dosing recommendations are provided. The guidelines place special emphasis on the importance of high-dose mesalazine therapy (≥4 g/day), which allows to achieve the targets set by the Treat-to-target (T2T) strategy and to reach the clinical and endoscopic remission. The evidence from meta-analyses and comparative studies demonstrating the same efficacy of different forms of mesalazine in the treatment of UC are presented. Attention is drawn to the choice of the optimal drug with enteric coating that consists of two types of Eudragit (Eudragit L and Eudragit S) in contrast to mesalazine formulations with one and the same type of coating (only L or only S). The double Eudragit (L + S) pH-dependent coating of mesalazine tablets dissolves in the terminal ileum, cecum and partially in the right half of the colon at pH 6–7.5, while formulations coated with only L or S dissolve at a narrower pH range. The clinical efficacy of mesalazine directly depends on its intraluminal concentration that is determined by the amount of the released drug according to the pH level in the intestinal lumen. The double Eudragit coating allows to cover the entire pH range in the ileum and colon. The paper presents evidence from the domestic clinical practice that confirms the Cochrane meta-analysis statements on the comparable efficacy of different mesalazine formulations concerning the targets to reach remission and reduce the level of fecal calprotectin. In addition, a high incidence of clinical remissions (more than 80% at 48 weeks of treatment) on double coated (L + S) mesalazine is demonstrated.

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