pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-5-629-644pulmo-1377Research ArticleОБЗОРЫREVIEWКоронавирусная болезнь-2019 (COVID-19): значение ингибиторов IL-6Coronavirus disease-2019 (COVID-19): value of IL-6 inhibitorshttps://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

Насонов Евгений Львович – д. м. н., профессор, академик Российской академии наук, президент Общероссийской общественной организации «Ассоциация ревматологов России»; научный руководитель Федерального государственного бюджетного научного учреждения «Научно-исследовательский институт ревматологии им. В.А.Насоновой»; главный внештатный специалист-ревматолог Министерства здравоохранения Российской Федерации; профессор кафедры внутренних, профессиональных болезней и ревматологии Федерального государственного автономного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет им. И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); главный редактор журнала «Научно-практическая ревматология»

115522, Москва, Каширское шоссе, 34а119991, Москва, ул. Трубецкая, 8, стр. 2тел.: (495) 109-29-11 

Evgeny L. Nasonov – Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, President of the Association of Rheumatologists of Russia; Scientific Director, V.A.Nasonova Federal Research Rheumatology Institute; Chief Specialist-Rheumatologist of Healthcare Ministry of Russia; Professor of the Department of Internal, Occupational Diseases and Rheumatology, I.M.Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia; Chief Editor of the Journal “Scientific and Practical Rheumatology”

Kashirskoe shosse 34A, Moscow, 115522ul. Trubetskaya 8, build. 2, Moscow, 119991tel.: (495) 109-29-11 

nasonov@irramn.ruФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт ревматологии им. В.А.Насоновой»; Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет им. И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияV.A.Nasonova Federal Research Rheumatology Institute; I.M.Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of RussiaRussian Federation202026102020305629644Copyright © Насонов Е.Л., 20202020Насонов Е.Л.Nasonov E.L.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/1377

Пандемия коронавирусной болезни-2019 (COVID-19) привлекла внимание к новым клиническим и фундаментальным проблемам иммунопатологии заболеваний человека. Поскольку при COVID-19 именно гипериммунный ответ, получивший наименование синдром «цитокинового шторма», составляет основу патогенеза острого респираторного дистресс-синдрома и мультиорганной дисфункции при COVID-19. При этом особенно привлекательной является возможность репозиционирования (drug repurposing) некоторых широкоприменяемых для лечения иммуновоспалительных ревматических заболеваний (ИВРЗ) противовоспалительных лекарственных препаратов, включая глюкокортикостероиды, базисные противовоспалительные препараты, генно-инженерные биологические препараты и таргетные базисные противовоспалительные препараты. В спектре цитокинов, принимающих участие в патогенезе синдрома «цитокинового шторма» при ИВРЗ и COVID-19, большое значение придается провоспалительному цитокину интерлейкину (IL)-6. Разработка и внедрение в клиническую практику моноклональных антител (мАТ), ингибирующих активность IL-6, относится к числу крупных достижений в лечении ИВРЗ, а в последние годы – критических состояний в рамках синдрома «цитокинового шторма», в т. ч. при COVID-19. В обзоре обсуждаются материалы многочисленных исследований, посвященных проблемам эффективности и безопасности мАТ к рецептору IL-6 (тоцилизумаб) и других мАТ, ингибирующих активность этого цитокина при COVID-19. Несмотря на эффективность ингибирования IL-6 у пациентов с тяжелым течением COVID-19, требуется дальнейшее изучение многих теоретических и клинических проблем иммунопатологии и фармакотерапии этого заболевания.

The coronavirus disease 2019 (COVID-19) pandemic has drawn attention to new clinical and fundamental issues in the immunopathology of human diseases. Since in COVID-19 it is the ‘‘hyperimmune’’ response, called cytokine storm syndrome, which forms the basis of the pathogenesis of acute respiratory distress syndrome (ARDS) and multiorgan dysfunction in COVID-19, special attention is drawn to the possibility of “repurposing” (drug repurposing) of some widely used for treatment immune-mediated inflammatory rheumatic diseases (IMIRDs) anti-inflammatory drugs, including glucocorticoids (GC), disease-modified anti-rheumatic drugs (DMARDs), biologic agents and ‘‘targeted’’ DMARDs. In the spectrum of cytokines involved in the pathogenesis of cytokine storm syndrome in IMIRDs and COVID-19, great importance is attached to the pro-inflammatory cytokine, interleukin IL-6. The development and introduction into clinical practice of monoclonal antibodies (mAbs) that inhibit the activity of IL-6 are among the major advances in the treatment of IMIRDs, and in recent years, critical conditions within the framework of the cytokine storm syndrome, including in COVID-19. The review discusses the materials of numerous studies devoted to the problems of the efficacy and safety of mAbs to the IL-6 receptor (tocilizumab) and other mAbs that inhibit the activity of this cytokine in COVID-19. Despite the effectiveness of inhibiting IL-6 in patients with severe COVID-19, many theoretical and clinical problems of immunopathology and pharmacotherapy of this disease require further study.

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