Псориаз и воспалительные заболевания кишечника: пути патогенеза и вопросы выбора генно-инженерных препаратов (обзор литературы)

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Альманах клинической медицины. 2019; 47: 568-578

Псориаз и воспалительные заболевания кишечника: пути патогенеза и вопросы выбора генно-инженерных препаратов (обзор литературы)

Круглова Л. С., Львов А. Н., Каграманова А. В., Князев О. В.

https://doi.org/10.18786/2072-0505-2019-47-062

Аннотация

Псориаз и воспалительные заболевания кишечника (ВЗК) относятся к многофакторным хроническим иммуновоспалительным потенциально инвалидизирующим заболеваниям, при которых выявляют сходные генетические факторы и иммунологические пути развития, в частности генетический полиморфизм ИЛ-23R (IL-23R), определяющий сигнальный ИЛ-12/23 путь иммунопатогенеза. Появление генно-инженерных биологических препаратов изменило прогноз как при псориазе, так и при ВЗК. Пересечение терапевтического спектра при псориазе и ВЗК – важный аспект, который необходимо учитывать, выбирая тактику ведения пациентов с данными заболеваниями. Инфликсимаб и адалимумаб демонстрируют эффективность в лечении псориаза, псориатического артрита, болезни Крона, язвенного колита (уровень доказательности 1А). Устекинумаб эффективен в терапии псориаза, псориатического артрита (уровень доказательности 1А) и болезни Крона (уровень доказательности 1В). Для этанерцепта и секукинумаба показана эффективность в отношении псориаза, псориатического артрита (уровень доказательности 1А) и отсутствие эффективности и потенциальный риск обострения при болезни Крона и язвенном колите. Ингибирование регуляторных цитокинов ИЛ-12/23 также имеет ряд преимуществ в сравнении с блокированием эффекторных цитокинов (фактор некроза опухоли-α, ИЛ-17) за счет потенциально долгосрочного устойчивого результата терапии и более редкого режима введения препарата.

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Almanac of Clinical Medicine. 2019; 47: 568-578

Psoriasis and inflammatory bowel diseases: pathogenetic pathways and the choice of biologic therapy (a literature review)

Kruglova L. S., Lvov A. N., Kagramanova A. V., Knyazev O. V.

https://doi.org/10.18786/2072-0505-2019-47-062

Abstract

Psoriasis and inflammatory bowel disease (IBD) are multifactorial chronic immuno-inflammatory potentially disabling disorders with similar genetic factors and immunological pathways, in particular, genetic polymorphisms of IL-23R, which determines the signal IL-12/23-mediated pathway of immunopathogenesis. The emergence of genetically engineered biological agents has changed the prognosis for both psoriasis and IBD. The intersection of the therapeutic spectrum in psoriasis and IBD is a very important point when choosing the management strategy for these patients. Infliximab and adalimumab are effective in the treatment of psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis (evidence level 1A). Ustekinumab demonstrates effectiveness in the treatment of psoriasis, psoriatic arthritis (evidence level 1A) and Crohn's disease (evidence level 1B). Etanercept and secukinumab have been shown to be effective against psoriasis, psoriatic arthritis (evidence level 1A) and ineffective and even associated with exacerbation risk in Crohn's disease and ulcerative colitis. Inhibition of regulatory cytokines IL-12/23 also has a number of advantages compared to the blockade of effector cytokines (TNF-α, IL-17) due to potentially long-term and stable treatment results and less frequent administration.

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