Иммуномодулирующая медикаментозная терапия при заболевании, вызванном инфекцией SARS-CoV-2 (COVID-19)

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Настоящий систематический обзор посвящен современному состоянию фармакотерапии иммунных нарушений при новой коронавирусной инфекции (COVID-19), приводящих к «цитокиновому шторму» и неконтролируемой воспалительной реакции, которая служит причиной серьезного повреждения тканей и полиорганной недостаточности. Множество теоретических, экспериментальных и клинических данных подтверждают необходимость проведения иммуномодулирующей (иммуносупрессивной) терапии при этом заболевании. Подчеркнем: все иммуномодулирующие препараты при COVID-19 назначаются вне официально зарегистрированных показаний (англ. off-label), а доказательная база в виде результатов рандомизированных исследований только создается. Рассмотрена иммуномодулирующая терапия COVID-19 следующими препаратами: глюкокортикоиды, ги-дроксихлорохин и хлорохин, интерфероны 1-го типа, антагонисты интерлейкина-6 (тоцилизумаб, сарилумаб, олокизумаб), ингибитор интерлейкина-ip канакинумаб, ингибиторы фактора некроза опухоли-альфа (инфликсимаб), ингибиторы янус-киназ (тофацитиниб, барицитиниб, руксолитиниб), а также препаратами с другими механизмами действия (абатацепт, ниволумаб, такролимус, сиролимус, финголимод, мелфалан, циклоспорин, метотрексат). На данный момент наиболее целесообразным можно признать применение ингибиторов рецепторов интерлейкина-6, глюкокортикоидов в средних и высоких дозах, ингибиторов янус-киназ. Применение гидроксихлорохина и хлорохина в свете последних данных клинических исследований, особенно исследования "Solidarity”, представляется недостаточно обоснованным. Имеется значительное патогенетическое сходство в развитии иммунопатологии при COVID-19 и ревматических заболеваниях, а стратегия ранней агрессивной иммуносупрессивной терапии, предлагаемая рядом исследователей для терапии новой коронавирусной инфекции, практически полностью совпадает с современной стратегией лечения ревматоидного артрита.

Об авторах

Д. Е. Каратеев

ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского

Автор, ответственный за переписку.
Email: dekar@inbox.ru
ORCID iD: 0000-0002-2352-4080

Каратеев Дмитрий Евгеньевич - доктор медицинских наук, заведующий отделением ревматологии, профессор кафедры терапии факультета усовершенствования врачей.

129110, Москва, ул. Щепкина, 61/2, Тел.: +7 (495) 631 74 16

Россия

Е. Л. Лучихина

ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского

Email: eleluch@yandex.ru
ORCID iD: 0000-0002-6519-1106

Лучихина Елена Львовна - кандидат медицинских наук, ведущий научный сотрудник отделения ревматологии, доцент кафедры терапии факультета усовершенствования врачей.

129110, Москва, ул. Щепкина, 61/2

Россия

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