Перспективы применения ритуксимаба при аутоиммунных заболеваниях человека

Обновлено: 22.05.2024

В последние годы ритуксимаб стал применяться при аутоиммунных процессах: ревматоидном артрите, болезни Шёгрена, системной красной волчанке (СКВ), антифосфолипидном синдроме, аутоиммунных цитопениях и т.д. Механизм действия ритуксимаба при аутоиммунных болезнях основан не только на уменьшении количества В-лимфоцитов и уровня IgG, но и на снижении экспрессии CD40 и CD80 на В-лимфоцитах, что тормозит активацию Т-лимфоцитов. Ритуксимаб может индуцировать элиминацию аутореактивных Т-лимфоцитов и восстанавливать аутотолерантность.

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Об авторах

Л Б Филатов

А В Пивник

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Эта статья доступна по лицензии Creative Commons Attribution-NonCommercial 4.0 International License.

Для цитирования: Насонов Е.Л. Перспективы применения ритуксимаба при аутоиммунных заболеваниях человека. РМЖ. 2007;26:1958.

Аутоиммунные заболевания включают более 80 нозологических форм и относятся к числу наиболее распространенных и тяжелых болезней человека, частота которых в популяции составляет 5-8%. Для лечения аутоиммунных заболеваний используется широкий спектр препаратов, обладающих противовоспалительной (глюкокортикоиды - ГК), цитотоксической или иммуносупрессивной (в низких дозах) активностью, большая часть из которых создавалась для лечения злокачественных новообразований или подавления отторжения трансплантата. Рациональное применение этих препаратов на ранних этапах болезни, в сочетании с экстракорпоральными методами очищения крови в период обострения, позволило существенно улучшить непосредственный и отдаленный прогноз, однако во многих случаях не позволяет контролировать прогрессирование заболевания, развитие угрожающих для жизни осложнений или ассоциируется с тяжелыми побочными эффектами.

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Отмечено, что широчайший спектр показаний (пока off label) для ритуксимаба (РТМ) в ревматологии, несомненно, требует подтверждения с помощью рандомизированных клинических исследований. К расширению показаний для терапии любыми генно-инженерными биологическими препаратами следует подходить с особой осторожностью из-за сложности и взаимовлияния различных иммунорегуляторных механизмов. Тем не менее указано, что большой клинический опыт применения РТМ у самых тяжелых, резистентных к терапии пациентов может служить основанием для его назначения при ряде наиболее сложных воспалительных ревматических заболеваний (РЗ). Приведены новые данные о применении РТМ при самых разных по клинической картине, течению и патогенезу РЗ - спондилоартритах, системной красной волчанке, системных васкулитах и воспалительных миопатиях

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