medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-9-39-43medalphabet-2037Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУЭффективность и безопасность дупилумаба в комплексном лечении пациентов с тяжелым атопическим дерматитомEfficacy and safety of dupilumab in complex treatment of patients with severe atopic dermatitishttps://orcid.org/0000-0002-5044-5265КругловаЛ. С.KruglovaL. S.

Круглова Лариса Сергеевна, д. м. н., проф., зав. кафедрой дерматовенерологии и косметологии, проректор по учебной работе

Kruglova Larisa S.,DM Sci, prof., head of Dept of Dermatovenereology and Cosmetology

kruglovals@mail.ruhttps://orcid.org/0000-0002-0238-6563ШатохинаЕ. А.ShatohinaЕ. А.

Шатохина Евгения Афанасьевна,д. м. н., доцент кафедры дерматовенерологии и косметологии

Shatokhina Evgenia A.,PhD, associate professor at Dept of Dermatovenereology and Cosmetology

sh.77@mail.ruhttps://orcid.org/0000-0001-9638-2290РудневаН. C.RudnevаN. S.

Руднева Наталья Сергеевна, к. м. н., гл. врач, гл.внештатный специалист –дерматовенеролог, косметолог Минздрава Тульской области

Rudneva Natalia S., PhD Med,chief doctor², chief freelance specialist –dermatologist, cosmetologist of Ministryof Health of Tula Region

rudneva@tularegion.ruФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РоссииРоссияCentral State Medical Academy of the Administrative Department of the President of RussiaRussian FederationГУЗ «Тульский областной клинический кожно-венерологический диспансер» Минздрава Тульской областиРоссияTula Regional Clinical Skin and Venereological DispensaryRussian Federation20212406202109Дерматология (1)3943Copyright © Круглова Л.С., Шатохина Е.А., Руднева Н.C., 20212021Круглова Л.С., Шатохина Е.А., Руднева Н.C.Kruglova L.S., Shatohina Е.А., Rudnevа N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2037

По современным представлениям, в патогенезе АтД играет роль повышенное содержание в области кожных поражений интерлейкинов ИЛ-4 и ИЛ-13, которые секретируются Т-хелперами второго типа, эозинофилами и другими иммунокомпетентными клетками. Генно-инженерный препарат Дупилумаб избирательно связывается с субъединицей IL-4Rα рецепторных комплексов для ИЛ-4 и ИЛ-13 и ингибирует сигнальную функцию этих цитокинов. Препарат одобрен для лечения пациентов со среднетяжелым и тяжелым АтД, у которых есть показания для системной терапии, независимо от применения местных кортикостероидов, с 6-летнего возраста. Эффективность и безопасность дупилумаба в лечении пациентов с атопическим дерматитом подтверждены результатами многочисленных клинических исследований. Материал и методы. Под наблюдением находилось 11 пациентов со средним и тяжелым течением АтД в возрасте 18–48 лет. Все пациенты получали системное лечение препаратом дупилумаб, наружно использовали метилпреднизолона ацепонат (два раза в день на протяжении 4 первых недель, затем ингибитор кальциневрина два раза в день до конца периода наблюдения), эмоленты (два раза в день). Начальная доза дупилумаба составила 600 мг (две инъекции по 300 мг в разные места для инъекций), далее по 300 мг каждые 2 недели. Результаты исследования. Через 6 месяцев комплексной терапии у 73 % пациентов был достигнут IGA = 0/1. Индекс SCORAD через 6 месяцев снизился в среднем на 71,7 %. Среднее значение шкалы NRS через 6 месяцев снизилось на 63,2 %. Не было зарегистрировано нежелательных явлений, которые приводили бы к отмене препарата. У 2 (18,2 %) пациентов отмечался коньюктивит. Выводы. Отмечалось выраженное снижение интенсивности основных клинических симптомов (SCORAD), в том числе зуда (NRS), значительно снизились проявления тревожности и депрессии (PROMIS).

The increased level of interleukins IL-4 and IL-13 in the area of skin lesions, which are secreted by type 2 T-helpers, eosinophils and other immunocompetent cells, plays a main role in the pathogenesis of AD according to modern concepts. The genetically engineered drug dupilumab selectively binds to the subunit of IL-4Rα receptor complexes for IL-4 and IL-13 and inhibits the signaling function of these cytokines. The drug is approved for the treatment of patients with moderate to severe AD who have indications for systemic therapy, regardless of the use of topical corticosteroids from 6 years age. The efficacy and safety of dupilumab in the treatment of patients with atopic dermatitis has been confirmed by the results of numerous clinical studies. Material and methods.The study included 11 patients with moderate and severe AD at the age from 18 to 48 years. All patients received systemic treatment with dupilumab, topically used methylprednisolone aceponate (two times a day for the first 4 weeks, then a calcineurin inhibitor two times a day until the end of the observation period), emollients (two times a day). The initial dose of dupilumab was 600 mg (two injections of 300 mg at different injection sites), then 300 mg every 2 weeks. Results. After 6 months of complex therapy 73 % of patients achieved IGA 0/1. The SCORAD index decreased by an average of 71.7 % after 6 months. The mean value of the NRS scale decreased by 63.2 %. There were no adverse events reported that would lead to drug withdrawal. Conjunctivitis was noted in 2 (18.2 %) patients. Conclusion. There was a marked decrease in the intensity of the main clinical symptoms (SCORAD), including pruritus (NRS), a significant decrease in the manifestations of anxiety and depression (PROMIS).

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The authors declare that there are no conflicts of interest present.