Инновационные противоревматические препараты и инфекции: проблемы и пути их решения

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.

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