Новые возможности терапии тяжелой бронхиальной астмы

В обзоре приведены современные данные о новых возможностях терапии тяжелой бронхиальной астмы (БА). Распространенность тяжелой астмы составляет от 3 до 10%, но именно для лечения данной группы пациентов расходуется более 80% средств, выделяемых на лечение заболевания в целом. Пациенты c тяжелой БА составляют особую категорию, так как традиционная терапия, эффективная у большинства больных БА, не позволяет контролировать заболевание. Гетерогенность и многоликость заболевания диктуют необходимость разработки персонифицированного подхода, который невозможен без значительных финансовых и кадровых вложений. Понимание патогенетических путей, лежащих в основе развития воспаления при астме, явилось толчком к разработке таргетной терапии. Было разработано и одобрено пять генноинженерных иммунобиологических препаратов для пациентов с тяжелой аллергической и (или) эозинофильной БА. Выбор правильного лекарства должен зависеть от правильного диагноза тяжелой астмы, понимания эндотипа пациента и учета специфических для него факторов. Стоит отметить, что все одобренные биопрепараты и большинство находящихся в настоящее время в разработке сосредоточены на Т2-иммунном ответе. Безусловно, существует огромный пул пациентов, у которых регистрируется другой тип воспаления. И поэтому, несмотря на быстрое развитие знаний в области таргетной терапии БА, необходимы дальнейшая расшифровка и углубление знаний о патофизиологических механизмах, в частности не Т2-воспаления, а также анализ опыта применения существующих препаратов для четкого понимания показаний и оценки эффективности и безопасности существующих методов лечения.

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