vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v14i2.1292vsp-64Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESТОЦИЛИЗУМАБ В ЛЕЧЕНИИ ДЕТЕЙ С СИСТЕМНЫМ ВАРИАНТОМ ЮВЕНИЛЬНОГО АРТРИТА: АНАЛИЗ ФАКТОРОВ, ВЛИЯЮЩИХ НА ЭФФЕКТИВНОСТЬ ТЕРАПИИ В ДОЛГОСРОЧНОМ ПЕРИОДЕTOCILIZUMAB IN THE TREATMENT OF CHILDREN WITH SYSTEMIC JUVENILE ARTHRITIS: ANALYSIS OF FACTORS INFLUENCING THE THERAPY EFFICIENCY IN THE LONG TERMКаледаМ. И.KaledaM. I.

врач-ревматолог детского ревматологического отделения НИИ ревматологии им. В.А. Насоновой Адрес: 115522, Москва, Каширское шоссе, д. 34А, тел.: +7 (499) 614-44-64

kaleda-mi@yandex.ruНикишинаИ. П.NikishinaI. P.kaleda-mi@yandex.ruНаучно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Российская ФедерацияРоссияV.A. Nasonova Research Institute of Rheumatology, Moscow, Russian FederationRussian Federation201517042015142Вопросы современной педиатрии236245Copyright © Каледа М.И., Никишина И.П., 20152015Каледа М.И., Никишина И.П.Kaleda M.I., Nikishina I.P.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/64

Внедрение в практику педиатров-ревматологов тоцилизумаба — препарата, блокирующего интерлейкин 6 — стало важным достижением в терапии системного варианта ювенильного артрита (сЮА). Цель исследования: выявить факторы, связанные с уровнем терапевтического ответа и безопасностью тоцилизумаба при лечении детей с сЮА. Методы: обследованы дети с сЮА (n =49), получавшие тоцилизумаб в период с ноября 2009 по июнь 2014 г. Эффективность терапии оценивали по критериям ACRpedi. Результаты: первоначальный положительный ответ на терапию тоцилизумабом зарегистрирован у 100% пациентов. По итогам пятилетнего наблюдения терапию препаратом продолжают 38 пациентов с ответом более 50% по педиатрическим критериям Американской коллегии ревматологов. Устойчивое улучшение позволило снизить дозу глюкокортикоидов у всех пациентов, отменить — у 11%, отменить нестероидные противовоспалительные препараты у 14% пациентов. На момент завершения исследования 10 пациентов имели статус неактивной болезни. Более низкий ответ на терапию зафиксирован при дебюте заболевания в возрасте до 3 лет, у пациентов с большей продолжительностью заболевания, при нарушении сроков введения и дозирования тоцилизумаба, при несвоевременной коррекции сопутствующей терапии. Не выявлено различий в ответе на терапию в зависимости от предшествующего применения генно-инженерных биологических препаратов. Наиболее частыми нежелательными явлениями были нейтропении и инфекции. Причинами отмены тоцилизумаба стали серьезные неблагоприятные реакции (n =6), отсутствие продолжения терапии в региональных центрах по месту жительства по организационным причинам (n =5). Заключение: при наличии факторов неблагоприятного прогноза (дебют в возрасте до 3 лет, раннее формирование полиартрита, полисерозит) необходимо назначение тоцилизумаба на более ранних сроках сЮА. Нарушение сроков введения препарата и несвоевременная коррекция сопутствующей терапии снижают эффективность препарата.

 

The introduction of tocilizumab — a drug that blocks interleukin 6 — into the practice of pediatric rheumatologists is an important achievement in the treatment of systemic juvenile arthritis (SJA). Objective: Our aim was to identify factors associated with the level of treatment response and safety of tocilizumab in the treatment of children with SJA. Methods: We examined children with SJA (n =49) who received tocilizumab from November 2009 to June 2014. The therapy efficiency was evaluated according to the ACRpedi criteria. Results: The initial positive response to the tocilizumab therapy was found in 100% of patients. At the end of the five-year monitoring period, 38 patients were still treated with tocilizumab with the response of more than 50% according to the pediatric criteria of the American College of Rheumatology. Steady improvement reduced the dose of corticosteroids in all patients. The dose of corticoids was cancelled in 11% of patients and non-steroidal anti-inflammatory drugs were cancelled in 14% of patients. At the end of the study, 10 patients had an inactive disease status. The lower response to the treatment was recorded at the onset of the disease in children at the age of 3 and below and in patients with longer duration of disease due to the violation of the tocilizumab administration and dosing terms and late correction of the concomitant therapy. There were no differences in response to the therapy depending on the previous use of genetically engineered biological agents. The most common adverse effects were neutropenia and infections. The reasons for the withdrawal of tocilizumab were serious adverse responses (n =6) and termination of the therapy in regional centers at the place of residence for organizational reasons (n=5). Conclusion: If there are unfavorable prognosis factors (onset at the age of 3, formation of early polyarthritis, and polyserositis), tocilizumab should be appointed at earlier dates. Violation of the terms for the drug administration and late correction of the concomitant therapy reduce the efficiency of the drug.

 

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