medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-16-47-52medalphabet-2152Research ArticleСтатьиЭффективность ингибиторов фактора некроза опухоли – и их концентрация и иммуногенность: особенности при различных иммуноопосредованных заболеванияхEffectiveness of tumor necrosis factor α inhibitors and their concentration and immunogenicity: features in various immune-mediated diseaseshttps://orcid.org/0000-0002-1902-4964НуриахметоваТ. Ю.NuriakhmetovaT. Yu.

Нуриахметова Татьяна Юрьевна, ассистент кафедры госпитальной терапии

Nuriakhmetova Tatiana Yu., assistant at Dept of Hospital Therapy

https://orcid.org/0000-0003-3707-6511ВалееваИ. Х.ValeevaI. Kh.

Валеева Ильдария Хайрулловна, д.б.н., старший научный сотрудник Центральной научно-исследовательской лаборатории

Valeeva Ildaria Kh., DBio Sci, senior researcher at Central Research Laboratory

https://orcid.org/0000-0003-0497-4630ШевнинаЯ. О.ShevninaYa. O.

Шевнина Яна Олеговна, врач-ревматолог консультативной поликлиники

Shevnina Yana O., rheumatologist at Consultative Polyclinic

janashevnina1@gmail.comhttps://orcid.org/0000-0002-5856-5050ЧереминаН. А.ChereminaN. A.

Черемина Наталья Александровна, врач-гастроэнтеролог отделения гастроэнтерологии

Cheremina Natalia A., gastroenterologist at Dept of Gastroenterology

https://orcid.org/0000-0001-6274-4636СухоруковаЕ. В.SukhorukovaE. V.

Сухорукова Елена Васильевна, врач-ревматолог отделения ревматологии

Sukhorukova Elena V., rheumatologist at Dept of Rheumatology

https://orcid.org/0000-0002-8898-3165СибгатуллинТ. Б.SibgatullinT. B.

Сибгатуллин Тимур Булатович, зав. ревматологическим отделением медико-санитарной части 

Sibgatullin Timur B., head of Rheumatology Dept of Medical and Sanitary Unit

https://orcid.org/0000-0002-8686-6184ВасильевА. Г.VasilievA. G.

Васильев Артем Геннадьевич, врач-ревматолог ревматологического отделения

Vasiliev Artem G., rheumatologist at Rheumatology Dept

https://orcid.org/0000-0001-7069-2725АбдулганиеваД. И.AbdulganievaD. I.

Абдулганиева Диана Ильдаровна, д.м.н, проф., проректор, зав. кафедрой госпитальной терапии

Abdulganieva Diana I., DM Sci, professor, vice-rector, head of Dept of Hospital Therapy

ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical UniversityRussian FederationГБУЗ РК «Республиканская клиническая больница имени Н.А. Семашко»РоссияRepublican Clinical Hospital n.a. N.A. SemashkoRussian FederationГАУЗ «Республиканская клиническая больница Минздрава Республики Татарстан»РоссияRepublican Clinical HospitalRussian FederationФГАОУ ВО «Казанский (Приволжский) федеральный университет»РоссияKazan (Volga Region) Federal University, Medical and Sanitary UnitRussian FederationГАУЗ «Городская клиническая больница № 7»РоссияCity Clinical Hospital No. 7Russian Federation202119082021016Ревматология в общей врачебной практике4752Copyright © Нуриахметова Т.Ю., Валеева И.Х., Шевнина Я.О., Черемина Н.А., Сухорукова Е.В., Сибгатуллин Т.Б., Васильев А.Г., Абдулганиева Д.И., 20212021Нуриахметова Т.Ю., Валеева И.Х., Шевнина Я.О., Черемина Н.А., Сухорукова Е.В., Сибгатуллин Т.Б., Васильев А.Г., Абдулганиева Д.И.Nuriakhmetova T.Y., Valeeva I.K., Shevnina Y.O., Cheremina N.A., Sukhorukova E.V., Sibgatullin T.B., Vasiliev A.G., Abdulganieva D.I.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/2152Цель исследования

Цель исследования. Сравнить концентрацию и иммуногенность ингибиторов ФНО-α и их связь с эффективностью у пациентов с ревматическими заболеваниями (РЗ) и воспалительными заболеваниями кишечника (ВЗК).

Материалы и методы

Материалы и методы. В исследование включено 104 пациента с РЗ (48,1%) и ВЗК (51,9%), получавших инфликсимаб (ИНФ, 30,8%), адалимумаб (АДА, 38,5%) и цертолизумаб пэгол (ЦЗП, 30,8%). Оценивалась эффективность препарата, измерялись минимальная остаточная концентрация иФНО-α и уровень антител к ним. У 30 пациентов оценка концентрации иФНО-α и уровня антител производилась дважды с интервалом 15 [13; 17] месяцев.

Результаты

Результаты. Ингибиторы ФНО-α были эффективны у 77 (74%) пациентов. В группе ВЗК и РЗ частота развития неэффективности составила 33,3 и 18,0%, неэффективность ЦЗП встречалась только в группе ВЗК (p = 0,024). Низкая концентрация иФНО-α выявлена на первом визите у 29 (53,7%) пациентов с ВЗК и 24 (48,0%) с РЗ, на втором визите – у 4 (36,4%) пациентов с ВЗК и 9 (47,4%) с РЗ. У всех пациентов с РЗ, не отвечавших на терапию ИНФ и ЦЗП, определялась субтерапевтическая концентрация (p = 0,047), в группе ВЗК – лишь в 64,3% случаев (p > 0,050). На первом визите АТ к иФНО-α обнаружены у 24 (23,1%) пациентов, на втором визите – у 7 (23,3%) исключительно в группе РЗ (p = 0,019), у 5 из них повторно. Формирование АТ было ассоциировано с 27,8% случаев ускользания эффекта иФНО-α при ВЗК и 22,2% случаев неэффективности при РЗ (p > 0,050).

Выводы

Выводы. Частота эффективности иФНО-α не различалась между РЗ и ВЗК, неэффективность ЦЗП наблюдалась исключительно у пациентов с ВЗК. У пациентов с РЗ выявлена достоверная связь между неэффективностью и низкой концентрацией иФНО-α. Частота формирования АТ не различалась между группами заболеваний.

Aim

Aim. To compare the concentration and immunogenicity of TNF-α inhibitors (TNFi) and their relationship with efficacy in patients with rheumatic diseases (RD) and inflammatory bowel diseases (IBD).

Materials and methods

Materials and methods. The study included 104 patients with RD (48.1%) and IBD (51.9%) who received infliximab (INF, 30.8%), adalimumab (ADA, 38.5%) and certolizumab pegol (CZP, 30.8%). We assessed the efficacy of the drug, trough concentration of TNFi and the level of antibodies. In 30 patients, the concentration of TNFi and the level of antibodies were assessed twice with an interval of 15 [13; 17] months.

Results

Results. TNF-α inhibitors were effective in 77 (74%) patients. In the group of IBD and RD, the incidence of inefficiency was 33.3% and 18.0%, the ineffectiveness of CZP was found only in IBD group (p = 0.024). A low concentration of TNFi was detected at the first visit in 29 (53.7%) patients with IBD and 24 (48.0%) with RD, at the second visit in 4 (36.4%) patients with IBD and 9 (47.4%) with RD. In all patients with RD who did not respond to IFN and CZP, the subtherapeutic concentration was determined (p = 0.047), in the IBD group – only in 64.3% cases (p > 0.050). At the first visit, antibodies to TNFi were found in 24 (23.1%) patients, at the second visit in 7 (23.3%) exclusively in the RD group (p = 0.019), in 5 of them repeatedly. The formation of Ab was associated with 27.8% of cases of escape of the effect of TNF-α in IBD and 22.2% of cases of ineffectiveness in RD (p > 0.050).

Conclusions

Conclusions. The incidence of TNF-α efficacy did not differ between RD and IBD, CZP ineffectiveness was observed exclusively in patients with IBD. In patients with RD, a significant relationship was found between ineffectiveness and low concentration of TNFi. The frequency of Ab formation did not differ between the groups of diseases.

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