Противовоспалительные препараты и иммуногенность вакцин у пациентов с ревматическими заболеваниями

Проблема коморбидных инфекций в ревматологии представляется весьма актуальной в связи с активным внедрением в клиническую практику инновационных базисных противовоспалительных препаратов (БПВП), т. н. таргетных БПВП (тБПВП), а также генно-инженерных биологических препаратов (ГИБП), действие которых направлено на специфические звенья патогенеза иммуновоспалительных ревматических заболеваний. По мере накопления мирового клинического опыта стала четко прослеживаться ассоциация применения указанных препаратов с нарастающим риском развития коморбидных инфекций различной природы и локализации. Реальным выходом из этой ситуации представляется создание, совершенствование и внедрение в клиническую практику различных вакцин. В то же время ряд антиревматических препаратов может оказывать определенное негативное влияние на иммуногенность некоторых вакцин, что может повлечь за собой снижение профилактической эффективности последних. В настоящем обзоре представлены новые данные о влиянии различных антиревматических препаратов на иммуногенность вакцин против гриппа, пневмококковой и герпес- вирусной инфекций, вирусного гепатита В, желтой лихорадки и COVID-19, применяемых у ревматологических больных. Показано, что анти-В-клеточный препарат ритуксимаб оказывает значимое негативное влияние на иммуногенность вакцин, которое нарастает при сокращении сроков между иммунизацией и применением препарата. Метотрексат также отрицательно влияет на иммуногенность большинства вакцин, но в меньшей степени. Абатацепт, вероятно, снижает иммуногенность вакцин, хотя исследования выполнялись при отсутствии адекватных контрольных групп. Ингибиторы фактора некроза опухоли-α и тБПВП (ингибиторы янус-киназ) снижают абсолютные значения концентраций антител для многих вакцин, но, по-видимому, не оказывают значимого влияния на частоту пациентов, достигших серопротекции. Ингибиторы интерлейкина-6 (ИЛ-6), ИЛ-12/ИЛ-23 и ИЛ-17 практически не влияют на иммуногенность вакцин. Накапливаемые данные о влиянии вышеуказанных препаратов на иммуногенность вакцины против SARS-CoV-2, вероятно, схожи с таковыми, полученными в исследованиях по вакцинопрофилактике других инфекций у больных иммуновоспалительными ревматическими заболеваниями. Необходимы дальнейшие клинические исследования с целью оценки влияния иммуносупрессивной терапии на вакцинальный ответ и отработки методик для его оптимизации.

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