Клиническое применение новых таргетных препаратов для профилактического лечения мигрени

Мигрень – распространенное в клинической практике неврологическое заболевание. Бремя его во многом определяется наличием хронических дезадаптирующих форм, часто имеющих резистентность к традиционным терапевтическим подходам. Прогрессирование мигрени связано со многими негативными исходами: увеличением количества сопутствующих заболеваний, прежде всего тревоги и депрессии, потенциалом злоупотребления анальгетиками, а также нарастанием нарушений функциональной активности и снижением качества жизни пациентов. Профилактическая терапия мигрени – ключевая стратегия ведения пациентов, способная изменить дезадаптирующий характер течения заболевания, в которой нуждаются около 40% пациентов. Эволюция превентивных подходов позволила осуществить качественный переход от эмпирических методов к использованию таргетных стратегий лечения. Профилактический эффект многих традиционно используемых при мигрени лекарственных средств был открыт случайно, поскольку они разрабатывались для лечения других заболеваний. В последние годы арсенал фармакологических подходов, используемых для профилактики мигрени, пополнился таргетными препаратами, направленными на кальцитонин-ген-родственный пептид (CGRP), играющий ключевую роль в патофизиологии мигрени. Анти-CGRP моноклональные антитела (мАТ), которые воздействуют на лиганд CGRP или его рецептор, используются для профилактики мигрени с 2018 г. В отличие от традиционных пероральных средств, новый класс таргетной терапии обладает существенными преимуществами в практическом использовании: высокой эффективностью, быстрым наступлением профилактического эффекта и хорошей переносимостью. Определенные преимущества связаны также с длительным периодом полувыведения и отсутствием необходимости титрации препарата. Результаты клинических исследований эффективности и безопасности анти-CGRP мАТ демонстрируют их высокую эффективность при эпизодической и хронической мигрени, у пациентов с чрезмерным потреблением анальгетиков, с неудачным опытом предшествующей профилактической терапии, а также у пациентов с коморбидными эмоционально-аффективными расстройствами. При длительном применении превентивный эффект анти-CGRP мАТ проявляется благоприятным модифицирующим влиянием на течение заболевания.

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