vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i4.729vsp-303Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESРЕТРОСПЕКТИВНЫЙ АНАЛИЗ ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ МЕТОТРЕКСАТА ДЛЯ ПОДКОЖНОГО ВВЕДЕНИЯ У БОЛЬНЫХ ЮВЕНИЛЬНЫМ ИДИОПАТИЧЕСКИМ АРТРИТОМRETROSPECTIVE ANALYSIS OF EFFICACY AND SAFETY OF HYPODERMIC METHOTREXATE INJECTIONS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITISАлексееваЕ. И.AlexeevaE. I.

Alekseeva Ekaterina Iosifovna, PhD, professor, Head of Rheumatologic Department of RAMS, Head of the Faculty of Pediatrics

alekatya@ya.ruСлепцоваТ. В.SleptsovaT. V.alekatya@ya.ruВалиеваС. И.ValievaS. I.alekatya@ya.ruБзароваТ. М.BzarovaT. M.alekatya@ya.ruДенисоваР. В.DenisovaR. V.alekatya@ya.ruИсаеваК. Б.IsaevaK. B.alekatya@ya.ruМитенкоЕ. В.MitenkoE. V.alekatya@ya.ruЧистяковаЕ. Г.ChistyakovaE. G.alekatya@ya.ruФетисоваА. Н.FetisovaA. N.alekatya@ya.ruТайбулатовН. И.TaibulatovN. I.alekatya@ya.ruНаучный центр здоровья детей РАМН, Москва; Первый Московский медицинский государственный университет им. И.М. СеченоваРоссияScientific Centre of Children Health of RAMS,; I.M. Sechenov First Moscow Medical State University,Russian FederationНаучный центр здоровья детей РАМН, МоскваРоссияScientific Centre of Children Health of RAMS,Russian FederationНаучный центр здоровья детей РАМН, МоскваРоссияScientific Centre of Children Health of RAMS, MoscowRussian FederationНаучный центр здоровья детей РАМН, Москва, Российская ФедерацияРоссияScientific Centre of Children Health of RAMS, MoscowRussian FederationНаучный центр здоровья детей РАМН, Москва;Первый Московский медицинский государственный университет им. И.М. Сеченова,РоссияScientific Centre of Children Health of RAMS, Moscow; I.M. Sechenov First Moscow Medical State UniversityRussian Federation201312072013124Вопросы современной педиатрии3846Copyright © Алексеева Е.И., Слепцова Т.В., Валиева С.И., Бзарова Т.М., Денисова Р.В., Исаева К.Б., Митенко Е.В., Чистякова Е.Г., Фетисова А.Н., Тайбулатов Н.И., 20132013Алексеева Е.И., Слепцова Т.В., Валиева С.И., Бзарова Т.М., Денисова Р.В., Исаева К.Б., Митенко Е.В., Чистякова Е.Г., Фетисова А.Н., Тайбулатов Н.И.Alexeeva E.I., Sleptsova T.V., Valieva S.I., Bzarova T.M., Denisova R.V., Isaeva K.B., Mitenko E.V., Chistyakova E.G., Fetisova A.N., Taibulatov N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/303(Авторы

(Авторы: Е.И. Алексеева, Т.В. Слепцова, С.И. Валиева, Т.М. Бзарова, Р.В. Денисова, К.Б. Исаева, Е.В. Митенко, Е.Г. Чистякова, А.Н. Фетисова)

Цель исследования

Цель исследования: оценить эффективность и безопасность метотрексата для подкожного введения в клинической практике у детей в возрасте 1,5–16 лет с ювенильным идиопатическим артритом (ЮИА) без внесуставных проявлений. Пациенты и методы: проанализированы результаты лечения 104 пациентов с ЮИА без системных проявлений (61 девочка и 43 мальчиков) в возрасте 5,0 (1,5–16) лет, наблюдавшихся в ревматологическом отделении ФГБУ «НЦЗД» РАМН. Длительность болезни на момент назначения метотрексата в среднем составила 6 мес. Эффективность терапии метотрексатом оценивали по педиатрическим критериям улучшения Американской коллегии ревматологов. Целевыми показателями эффективности считали частоту достижения стадии неактивной болезни и лекарственной ремиссии заболевания. Результаты: в течение года исследование продолжил 61 (59%) пациент. Через 12 мес терапии препарат индуцировал ремиссию по критериям С. Wallace у 39 из 104 (38%) пациентов. У 22 (21%) больных, не достигших ремиссии через год, было зафиксировано 70% улучшение. Нежелательные явления зарегистрированы у 45 (43%) детей: у 33 (32%) — нетяжелые, у 12 (12%) — тяжелые. Метотрексат был отменен 9 (9%) пациентам в связи с непереносимостью. Этим больным и 34 пациентам с неэффективностью препарата были назначены генно-инженерные биологические препараты. Выводы: метотрексат для подкожного введения высокоэффективен у больных ЮИА без внесуставных проявлений. Раннее назначение препарата в дозе 15 мг/м2 поверхности тела, а также правильный выбор формы введения обеспечили ремиссию болезни и позволили предотвратить инвалидизацию у 38% детей.

 

 

Aim: to assess efficacy and safety of hypodermic methotrexate injections in children aged from 1,5 to 16 years old with juvenile idiopathic arthritis (JIA) without extra-articular manifestations. Patients and methods: the results of treatment of 104 patients with JIA without systemic manifestations (61 girls and 43 boys) aged 5,0 (1,5–16) years old being followed-up in the rheumatology department of FSFI «SCCH» of RAMS were analyzed. The mean duration of the disease at the moment of methotrexate first administration was 6 months. Efficacy of methotrexate therapy was assessed according to the pediatric criteria for improvement of the American College of Rheumatology. The percentage of non-active stage and medicinal remission achievement were considered to be the target characteristics of therapy efficacy. Results: 61 patients (59%) were maintained in the study during 1 year. In 12 months of treatment remission according to C. Wallace criteria was induced in 39 of 104 (38%) children. In 22 (21%) of patients who failed to achieve remission in 1 year of treatment, 70% improvement was observed. Side effects were found in 45 (43%) of children: mild and moderate — in 33 (32%), severe — in 12 (12%) of patients. In 9 patients methotrexate was withdrawn due to intolerance of the drug. These patients as well as 34 children with resistance to performed treatment were administered genetically engineered biological agents. Conclusions: hypodermic injections of methotrexate are highly efficient in patients with JIA without extra-articular manifestations. Early administration at the dose of 15 mg/m2 of body surface as well as appropriate selection of administration form induced remission and allowed to prevent of disability development in 38% of children.

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