Расширение показаний кладрибина в таблетках при рассеянном склерозе: от раннего назначения наивным пациентам к возможности проведения повторных курсов терапии спустя 4 года инициации лечения кладрибином

Аутоиммунные заболевания являются распространенными клиническими состояниями, возникающими в результате аномального иммунного ответа на собственные структуры организма. Большинство существующих иммуномодулирующих препаратов способно подавлять аутоиммунные реакции до тех пор, пока они применяются, но они не нацелены на аутореактивную иммунологическую память и не могут отключить лежащие в основе механизмы, чтобы вызвать ремиссию без терапии. За последнее десятилетие возрос интерес к высокоэффективной терапии иммунной реконституции, с помощью которой возможно транзиторно или стойко провоцировать ре-программирование иммунной системы. Кладрибин (2-хлоро-дезоксиаденозин) в таблетках относится к группе препаратов ТИР при рецидивирующем рассеянном склерозе, терапия которым включает в себя два коротких курса лечения в течение 1-го и 2-го года. Большинство пациентов достигают устойчивой эффективности при применении кладрибина, но у небольшой части пациентов может наблюдаться новая активность заболевания, требующая от лечащего врача принятия решения в отношении ранее выбранной стратегии терапии. С тех пор, как более 5 лет назад кладрибин в таблетках был одобрен Европейским союзом, в США и России, число публикаций, посвященных анализу данных рутинной практики, неуклонно возрастает. Целью публикации является представление результатов работы экспертного совета, проведенного в феврале 2026 г. Участниками совета экспертов выработаны дальнейшие рекомендации по назначению препарата терапевтически наивным пациентам с рецидивирующим рассеянным склерозом, применению при вторично-прогрессирующем рассеянном склерозе с обострениями, алгоритмы ведения пациентов с рецидивирующим рассеянным склерозом с возобновлением активности заболевания после стартовых 2 курсов терапии кладрибином при последующем наблюдении, обсуждены профили пациентов, у которых смена терапии на кладрибин в таблетках рассматривается в качестве опции, снижающей риски постоянной иммуносупрессии.

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