pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-2-227-244pulmo-1349Research ArticleОБЗОРЫREVIEWПрактические рекомендации по выбору иммунобиологического препарата для лечения тяжелой бронхиальной астмы Т2-эндотипаPractical recommendations for choosing an immunobiological preparation for the treatment of severe bronchial asthma of T2-endotypeНенашеваН. М.NenashevaN. M.

д. м. н., профессор, заведующая кафедрой аллергологии и иммунологии,

125993, Москва, ул. Баррикадная, 2 / 1, стр. 1

Doctor of Medicine, Professor, Head of Department of Clinical Allergology,

ul. Barrikadnaya 2/1, build. 1, Moscow, 123995

1444031@gmail.comКурбачеваО. М.KurbachevaO. M.

д. м. н., профессор, заведующая отделением бронхиальной астмы,

115478, Москва, Каширское шоссе, 24, корп. 2

Doctor of Medicine, Professor, Head of Division Federal Academic Center "Institute of Immunology",

Kashirskoe shosse 24, build. 2, Moscow, 115478

kurbacheva@gmail.comАвдеевС. Н.AvdeevS. N.

д. м. н., член-корр. Российской академии наук, профессор, заведующий кафедрой пульмонологии,

119991, Москва, ул. Трубецкая, 8, стр. 2

Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Department of Pulmonology,

ul. Trubetskaya 8, build. 2, Moscow, 119991

serg_avdeev@list.ruФедосенкоС. В.FedosenkoS. V.

д. м. н., профессор кафедры общей врачебной практики и поликлинической терапии, 634050, Сибирский федеральный округ, Томская область, Томск, Московский тракт, 2;

медицинский научный эксперт, 125167, Москва, Ленинградский проспект, 37А, корп. 4

Doctor of Medicine, Associate Professor, Department of General Medical Practice and Outpatient Therapy, Moskovskiy tract 2, Tomsk, 634050;

Medical Scientific Expert, Leningradskiy pr. 37A, build. 4, Moscow, 125167

s-fedosenko@mail.ruЕмельяновА. В.Emel’yanovA. V.

д. м. н., профессор, заведующий кафедрой пульмонологии,

191015, Санкт-Петербург, ул. Кирочная, 41

Doctor of Medicine, Professor, Head of Department of Pulmonology,

ul. Kirochnaya 41, Saint Petersburg, 191015

emelav@inbox.ruБелевскийА. С.BelevskiyA. S.

д. м. н., профессор, заведующий кафедрой пульмонологии,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Head of Department of Pulmonology, Faculty of Postgraduate Physician Training,

ul. Ostrovityanova 1, Moscow, 117997

pulmobas@yandex.ruИльинаН. И.Il'inaN. I.

д. м. н., профессор, заместитель директора, главный врач,

115478, Москва, Каширское шоссе, 24, корп. 2

Doctor of Medicine, Professor, Deputy Director – Hospital Chief Executive Officer, 

Kashirskoe shosse 24, build. 2, Moscow, 115478

instimmun@yandex.ruКняжескаяН. П.KnyazheskayaN. P.

к. м. н., доцент кафедры пульмонологии,

117997, Москва, ул. Островитянова, 1

Candidate of Medicine, Associate Professor at Department of Pulmonology, Faculty of Postgraduate Physician Training,

ul. Ostrovityanova 1, Moscow, 117997

kniajeskaia@mail.ruЗыряновС. К.ZyryanovS. K.

д. м. н., профессор, заведующий кафедрой клинической фармакологии,

117997, Москва, ул. Островитянова, 1

Doctor of Medicine, Professor, Head of Clinical Pharmacology Department,

ul. Ostrovityanova 1, Moscow, 117997

sergey.k.zyryanov@gmail.comИгнатоваГ. Л.IgnatovaG. L.

д. м. н., профессор, заведующая кафедрой терапии Института дополнительного профессионального образования,

454092, Челябинск, Воровского, 64

Doctor of Medicine, Professor, Head of Department of Therapy, Institute of Postgraduate Physician Training,

ul. Vorovskogo 64, Chelyabinsk, 454092

iglign@mail.ruДемкоИ. В.DemkoI. V.

д. м. н., профессор, заведующая кафедрой внутренних болезней № 2 с курсом последипломного образования,

660022, Красноярск, ул. Партизана Железняка, 1

Doctor of Medicine, Professor, Head of Department of Internal Medicine No.2 and Postgraduate Physician Training Course, 

ul. Partizana Zheleznyaka 1, Krasnoyarsk, 660022

demko64@mail.ruШульженкоЛ. В.Shul'zhenkoL. V.

д. м. н., профессор, заведующая кафедрой пульмонологии факультета повышения квалификации и профессиональной переподготовки специалистов,

350063, Краснодар, ул. М.Седина, 4

Doctor of Medicine, Professor, Head of Department of Pulmonology, Faculty of Postgraduate Physician Training,

ul. Sedina 4, Krasnodar, 350063

larisa_shulzhenk@mail.ruЛещенкоИ. В.LeshchenkoI. V.

д. м. н., профессор кафедры фтизиатрии и пульмонологии,

620028, Екатеринбург, ул. Репина, 3

Doctor of Medicine, Professor, Department of Phthisiology and Pulmonology, 

ul. Repina 3, Ekaterinburg, 620028

leshchenkoiv@mail.ruФассаховР. С.FassakhovR. S.

д. м. н., профессор кафедры фундаментальных основ клинической медицины,

420008, Казань, ул. Кремлевская, 18

Doctor of Medicine, Professor, Department of Basic Clinical Medicine,

nab. Kremlevskaya 18, Kazan', Tatarstan Republic, 420008

farrus@mail.ruЧернякБ. А.ChernyakB. A.

д. м. н., профессор, заведующий кафедрой клинической аллергологии и пульмонологии,

664049, Иркутск, мкр Юбилейный, 100

Doctor of Medicine, Professor, Head of Department of Clinical Allergology and Pulmonology,

mkr Yubileynyy 100, Irkutsk, 664079

ba.chernyak@gmail.comНедашковскаяН. Г.NedashkovskayaN. G.

заведующая отделением пульмонологии и аллергологии,

344029, Ростов-на-Дону, ул. 1-й Конной Армии, 33

Chief of the Division of Pulmonology and Allergy, 

ul. 1-y Konnoy Armii 33, Rostov-na-Donu, 344029

nenagen@mail.ruБобриковаЕ. Н.BobrikovaE. N.

заведующая консультативно-диагностическим отделением центра аллергологии и иммунологии,

123182, Москва, ул. Пехотная, 3

Chief of the diagnostic Division of Allergology аnd Immunology Center,

ul.Pekhotnaya 3, Moscow, 123182

elena.bobrikova.69@mail.ruДеминаД. В.DeminaD. V.

к. м. н., заведующая аллергологическим отделением клиники иммунопатологии,

630099, Новосибирск, ул. Ядринцевская, 14

Candidate of Medicine, Head of the Allergology Division of the Immunopathology Clinic, 

ul. Yadrintsevskaya 14, Novosibirsk, 630099

immunology@mail.ruФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Federal Academy of Continued Medical Education, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное учреждение «Государственный научный центр "Институт иммунологии"» Федерального медико-биологического агентстваРоссияFederal Research Center "Institute of Immunology", Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M.Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Сибирский государственный медицинский университет» Министерства здравоохранения Российской Федерации; 5 – Акционерное общество «ГлаксоСмитКляйн Трейдинг»РоссияFederal Siberian State Medical University, Healthcare Ministry of Russia; GlaxoSmithKline Trading CompanyRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Министерства здравоохранения Российской ФедерацииРоссияI.I.Mechnikov State North-West Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской ФедерацииРоссияN.I.Pirogov Federal Russian National Research Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Южно-Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSouth Ural State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Красноярский государственный медицинский университет имени профессора В.Ф.Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияV.F.Voyno-Yasenetskiy Krasnoyarsk State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKuban State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Уральский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияUral Federal State Medical University, Healthcare Ministry of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Казанский (Приволжский) федеральный университет»РоссияFederal State Autonomous Educational Institution of Higher Education "Kazan (Privolzhsky) Federal University"Russian FederationИркутская государственная медицинская академия последипломного образования – филиал Федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of Irkutsk State Medical Academy of Postgraduate TrainingRussian FederationГосударственное бюджетное учреждение Ростовской области «Областная клиническая больница № 2»РоссияRostov region State Institution Regional Clinical Hospital No.2Russian FederationГосударственное бюджетное учреждение здравоохранения «Городская больница № 52» Департамента здравоохранения МосквыРоссияState Institution "City Hospital No.52", Moscow Health DepartmentRussian FederationФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт фундаментальной и клинической иммунологии»РоссияState Institution "Federal Fundamental аnd Clinical Immunology Research Institute"Russian Federation202021062020302227244Copyright © Ненашева Н.М., Курбачева О.М., Авдеев С.Н., Федосенко С.В., Емельянов А.В., Белевский А.С., Ильина Н.И., Княжеская Н.П., Зырянов С.К., Игнатова Г.Л., Демко И.В., Шульженко Л.В., Лещенко И.В., Фассахов Р.С., Черняк Б.А., Недашковская Н.Г., Бобрикова Е.Н., Демина Д.В., 20202020Ненашева Н.М., Курбачева О.М., Авдеев С.Н., Федосенко С.В., Емельянов А.В., Белевский А.С., Ильина Н.И., Княжеская Н.П., Зырянов С.К., Игнатова Г.Л., Демко И.В., Шульженко Л.В., Лещенко И.В., Фассахов Р.С., Черняк Б.А., Недашковская Н.Г., Бобрикова Е.Н., Демина Д.В.Nenasheva N.M., Kurbacheva O.M., Avdeev S.N., Fedosenko S.V., Emel’yanov A.V., Belevskiy A.S., Il'ina N.I., Knyazheskaya N.P., Zyryanov S.K., Ignatova G.L., Demko I.V., Shul'zhenko L.V., Leshchenko I.V., Fassakhov R.S., Chernyak B.A., Nedashkovskaya N.G., Bobrikova E.N., Demina D.V.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/1349

Биологическая терапия бронхиальной астмы (БА) представляет собой современный метод лечения тяжелых форм заболевания, неконтролируемых при помощи традиционных фармакотерапевтических подходамов. В настоящее время в мире зарегистрированы 5 препаратов моноклональных антител (АТ) для лечения тяжелой бронхиальной астмы (ТБА) Т2-эндотипа (Т2-ТБА) – АТ, связывающие иммуноглобулин (Ig) Е (анти-IgE – омализумаб), антагонисты интерлейкина (IL)-5 (анти-IL-5 – меполизумаб, реслизумаб) и его рецептора (анти-IL-5Rα – бенрализумаб), а также АТ, избирательно связывающиеся с рецептором IL-4 и -13 (анти-IL-4/13Rα – дупилумаб). В статье приведены данные об эффективности указанных препаратов в отношении ключевых характеристик ТБА, сформулированы клинико-лабораторные критерии, при исследовании которых в реальной практике потенциально может быть предсказана вероятность клинического ответа на тот или иной вид биологической терапии. Предложен алгоритм выбора стратегии таргетной терапии для пациентов с ТБА, клинически ассоциированной с аллергией, для больных тяжелой неаллергической эозинофильной БА и для страдающих эозинофильной БА сочетанного фенотипа.

Biological therapy of bronchial asthma (BA) is a modern method of treating severe forms of the disease, that are uncontrolled by traditional pharmacotherapeutic approaches. Currently, 5 monoclonal antibody (AT) preparations are registered in the world for the treatment of severe bronchial asthma (SBA) of the T2 endotype (T2-SBA) – antibodies, binding to immunoglobulin (Ig) E (anti-IgE – omalizumab), interleukin antagonists (IL)-5 (anti-IL-5 – mepolizumab, resizumab) and its receptor (anti-IL-5Rα – benralizumab), as well as antibodies, that selectively bind to the IL-4 and -13 receptor (anti-IL-4 /13Rα – dupilumab). The article presents data on the effectiveness of these drugs in relation to the key characteristics of SBA, formulates clinical and laboratory criteria, the study of which in real practice can potentially predict the likelihood of a clinical response to a particular type of biological therapy. An algorithm is proposed for choosing a targeted therapy strategy for patients with SBA, clinically associated with allergies, for patients with severe non-allergic eosinophilic BA and for patients with eosinophilic BA of a combined phenotype.

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