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Статья
Иммуномодулирующая медикаментозная терапия при заболевании, вызванном инфекцией SARS-CoV-2 (COVID-19)
2020
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.
Цитирование
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- 1. Version of Record от 2020-09-18
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Предметная рубрика
- COVID-19
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- Almanac of Clinical Medicine
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- 51-67
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- elpub
