pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-5-584-601pulmo-1058Research ArticleОБЗОРЫREVIEWГенно-инженерно-биологические препараты в терапии бронхиальной астмы: современные достиженияGenetically engineered drugs for treatment of bronchial asthma: recent achievementsЗыряновС. К.ZyryanovS. K.

Зырянов Сергей Кенсаринович – доктор медицинских наук, профессор, заведующий кафедрой общей и клинической фармакологии Федерального государственного автономного образовательного учреждения высшего образования «Российский университет дружбы народов», заместитель главного врача Государственного бюджетного учреждения здравоохранения «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»

117198, Москва, ул. Миклухо-Маклая, 6, 

127015, Москва, Писцовая, 10

Sergey K. Zyryanov – Doctor of Medicine, Professor, Head of Department of General and Clinical Pharmacology, The Peoples' Friendship University of Russia, Deputy Chief Physician, State Educational Government-Financed Institution City Clinical Hospital No.24 of Department of Health Care of the City of Moscow

ul. Miklukho-Maklaya 6, Moscow, 117198, 

ul. Pistsovaya 10, Moscow, 127015

zyryanov_sk@rudn.universityБутрановаО. И.ButranovaO. I.

Бутранова Ольга Игоревна – кандидат медицинских наук, ассистент кафедры общей и клинической фармакологии Медицинского института Федерального государственного автономного образовательного учреждения высшего образования «Российский университет дружбы народов», заместитель главного врача Государственного бюджетного учреждения здравоохранения «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»

117198, Москва, ул. Миклухо-Маклая, 6, 

127015, Москва, Писцовая, 10

Olga I. Butranova – Candidate of Medicine, Assistant Professor of Chair of General and Clinical Pharmacology, Medical Institute, Federal State Autonomous Educational Institution for Higher Education Peoples' Friendship University of Russia, Deputy Chief Physician, State Educational Government-Financed Institution City Clinical Hospital No.24 of Department of Health Care of the City of Moscow

ul. Miklukho-Maklaya 6, Moscow, 117198, 

ul. Pistsovaya 10, Moscow, 127015

butranovaolga@mail.ruФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов» (Медицинский институт); Государственное бюджетное учреждение города Москвы «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»РоссияThe Peoples' Friendship University of Russia (Medical University); Moscow State Educational Government-Financed Institution City Clinical Hospital No.24 of Department of Health Care of the City of MoscowRussian Federation201824122018285584601Copyright © Зырянов С.К., Бутранова О.И., 20182018Зырянов С.К., Бутранова О.И.Zyryanov S.K., Butranova O.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1058

Согласно международным статистическим данным, в современной популяции пациентов с бронхиальной астмой (БА) отмечается тенденция по увеличению резистентности к таким стандартным инструментам базисной фармакотерапии, как ингаляционные глюкокортикостероиды, антилейкотриеновые препараты и антииммуноглобулин (Ig)-E-препараты, что указывает на их недостаточную эффективность. Определенное значение в характере ответа на терапию имеет фенотип заболевания, подразумевающий вовлеченность определенных биомаркеров в патогенез воспалительного процесса на уровне бронхов. Прямое воздействие на модуляторы и медиаторы воспаления и бронхоконстрикции, которое могут обеспечить генно-инженерно-биологические препараты (ГИБП), является одним из наиболее перспективных направлений современной фармакотерапии БА, особенно в отношении популяции пациентов с тяжелой БА, резистентной к стандартным методам лечения. В статье приведен сравнительный анализ эффективности и безопасности, согласно данным рандомизированных контролируемых исследований (РКИ), основных групп ГИБП, существующих на сегодняшний день – препараты моноклональных антител к IgE, препараты моноклональных антител к интерлейкинам (IL)-4 / IL-13, IL-5 и препараты антагонистов к рецепторам простагландина-D2, По данным РКИ, омализумаб сохраняет свои лидирующие позиции в ряду активно развивающихся ГИБП, при этом в ряду новых представителей ГИБП обнаружены доказательства эффективности и безопасности их применения, позволяющие им занять свою нишу в терапевтическом арсенале врача-пульмонолога, в частности для лечения пациентов с тяжелой эозинофильной БА.

Current population of patients with asthma is characterized by increasing resistance to standard pharmacotherapeutic agents such as inhaled corticosteroids, antileukotriene agents and anti-IgE antibodies. These findings were confirmed by international statistic data and indicate insufficient efficacy of the treatment. Asthma phenotyping encompassing a role of certain biomarkers for bronchial inflammation could contribute to achieving better response to treatment. Genetically engineered drugs could directly impact on mediators and modulators involved in the inflammation and bronchoconstriction. This is one of the most promising directions of the modern pharmacotherapy, particularly considering severe and difficult-to-treat asthma. A comparative analysis of efficacy and safety of currently available genetically engineered drug groups (monoclonal anti-IgE antibodies, monoclonal antibodies against interleukin (IL)-4/IL-13 and IL-5, and prostaglandin D2 receptor antagonists) was performed by the authors of this article on the basis of results of randomized controlled clinical trials (RCT). According to RCT results, omalizumab is still the leading genetically engineered drug. Moreover, evidence of efficacy and safety of novel agents has been published that allowed implementation these drugs in the routine clinical practice for treatment of severe eosinophilic asthma.

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