medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-070medsovet-9977Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYИнновационные противоревматические препараты и инфекции: проблемы и пути их решенияInnovative antirheumatic drugs and infections: Problems and solutionshttps://orcid.org/0000-0001-7091-2054БеловБ. С.BelovB. S.

Белов Борис Сергеевич - д.м.н., заведующий лабораторией ревматоидного артрита и коморбидных инфекций.

115522, Москва, Каширское шоссе, д. 34а

Boris S. Belov - Dr. Sci. (Med.), Head of the Laboratory of Rheumatoid Arthritis and Comorbid Infections, Nasonova Research Institute of Rheumatology.

34а, Kashirskoe Shosse, Moscow, 115522

belovbor@yandex.ruhttps://orcid.org/0000-0003-4327-6720МуравьеваН. В.MuravievaN. V.

Муравьева Наталья Валерьевна - к.м.н., старший научный сотрудник лаборатории ревматоидного артрита и коморбидных инфекций.

115522, Москва, Каширское шоссе, д. 34а

Natalia V. Muravieva - Cand. Sci. (Med.), Senior Researcher of the Laboratory of Comorbid Infections and Vaccine Prevention, Nasonova Research Institute of Rheumatology.

34а, Kashirskoe Shosse, Moscow, 115522

nmuravjeva@mail.ruhttps://orcid.org/0000-0002-5264-337XБарановаМ. М.BaranovaM. M.

Баранова Марина Михайловна - к.м.н., научный сотрудник лаборатории ревматоидного артрита и коморбидных инфекций.

115522, Москва, Каширское шоссе, д. 34а

Marina M. Baranova - Cand. Sci. (Med.), Researcher of the Laboratory of Comorbid Infections and Vaccine Prevention, Nasonova Research Institute of Rheumatology.

34а, Kashirskoe Shosse, Moscow, 115522

baranovamarina103@gmail.comНаучно-исследовательский институт ревматологии имени В.А. НасоновойРоссияNasonova Research Institute of RheumatologyRussian Federation20261904202603164174Copyright © Белов Б.С., Муравьева Н.В., Баранова М.М., 20262026Белов Б.С., Муравьева Н.В., Баранова М.М.Belov B.S., Muravieva N.V., Baranova M.M.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/9977

В последние десятилетия в ревматологии отмечается явный прогресс, связанный с внедрением в практику генно-инженерных биологических препаратов (ГИБП) и таргетных базисных противовоспалительных препаратов (тБПВП). В то же время применение этих препаратов ассоциируется с нарастающим риском развития инфекций разнообразной природы и локализации, включая оппортунистические, а также повышенный риск реактивации латентной инфекции, в первую очередь туберкулеза (ТБ). Помимо этого, регистрируются случаи тяжелых инфекций (пневмония, сепсис, бактериальный артрит, поражение кожи и мягких тканей и др.), в т. ч. с летальным исходом. На сегодняшний день полностью не распознаны механизмы, лежащие в основе нарастающего риска инфекционных осложнений, связанных с применением ГИБП/тБПВП. В рамках настоящего нарративного (несистематического) обзора представлены современные данные о частоте и локализации основных инфекций у больных ревматологического профиля при лечении различными ГИБП/тБПВП. Подчеркнута необходимость более широкого применения иммунизации различными вакцинами (в первую очередь против гриппа и пневмококковой инфекции) пациентов с иммуновоспалительными ревматическими заболеваниями. При подготовке обзора авторами проведен исчерпывающий поиск литературы (преимущественно англоязычной) в базах данных MEDLINE (через PubMed) по следующим ключевым словам: “biologics/rheumatic diseases AND infection”, “tumor necrosis factor-α antagonists/ rheumatic diseases AND infection”, “targeted synthetic disease modifying antirheumatic drugs/rheumatic diseases AND infection” с преимущественным отбором национальных и международных регистров, систематических обзоров и метаанализов. Также были рассмотрены материалы двух крупных ежегодных международных ревматологических форумов, проводимых под эгидой Европейского альянса ревматологических ассоциаций (EULAR) и Американской коллегии ревматологов (ACR, American College of Rheumatology). После исключения дублирующих материалов для дальнейшего анализа было отобрано 168 источников, имеющих отношение к данной проблеме.

In recent decades, there has been clear progress in rheumatology related to the introduction of genetically engineered biological disease-modifying antirheumatic drugs (bDMARDs) and targeted disease-modifying antirheumatic drugs (tDMARDs) into practice. At the same time, the use of these drugs is associated with an increasing risk of developing infections of a diverse nature and localization, including opportunistic ones, as well as an increased risk of reactivation of latent infection, primarily tuberculosis (TB). In addition, cases of severe infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissue lesions, etc.), including fatal ones, have been reported. To date, the mechanisms underlying the increasing risk of infectious complications associated with the use of b/tDMARDs have not been fully recognized. Within the framework of this narrative (non-systematic) review, modern data on the frequency and localization of major infections in rheumatological patients treated with various b/tDMARDs are presented. The need for wider use of immunization with various vaccines (primarily against influenza and pneumococcal infection) in patients with immuno-inflammatory rheumatic diseases is emphasized. In preparing the review, the authors conducted an exhaustive literature search (mainly in English) in MEDLINE databases (via PubMed) for the following keywords: “biologics/rheumatic diseases AND infection”, “tumor necrosis factor-α antagonists/rheumatic diseases AND infection”, “targeted synthetic disease modifying antirheumatic drugs/rheumatic diseases AND infection” with preferential selection of national and international registers, systematic reviews and meta-analyses. The materials of two major annual international rheumatological forums held under the auspices of the European Alliance of Rheumatology Associations (EULAR) and the American College of Rheumatology (ACR) were also reviewed. After eliminating duplicate materials, 168 relevant sources were selected for further analysis.

иммуновоспалительные ревматические заболеваниягенно-инженерные биологические препаратытаргетные базисные противовоспалительные препаратыинфекциивакцинацияimmuno-inflammatory rheumatic diseasesbiological disease-modifying antirheumatic drugstargeted disease-modifying antirheumatic drugsinfectionsvaccinationСтатья подготовлена в рамках научно-исследовательской работы ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой», номер государственного задания РК 125020301268-4.This article has been prepared as part of the research work of Nasonova Research Institute of Reumatology under State Assignment No. RK 125020301268-4.ReferencesKrabbe S, Grøn KL, Glintborg B, Nørgaard M, Mehnert F, Jarbøl DE et al.. Risk of serious infections in arthritis patients treated with biological drugs: a matched cohort study and development of prediction model. 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The authors declare that there are no conflicts of interest present.