Ингибиторы янус-киназ в терапии коморбидных заболеваний – атопического дерматита и гнездной алопеции: обзор литературы и опыт клинической практики

В настоящее время атопический дерматит (АтД) рассматривается как системное заболевание в связи с тем что нарушения врожденного и адаптивного иммунного ответа, особенно выраженные при тяжелом течении, проявляются не только в воспалении на коже, но и могут реализоваться в развитии других хронических заболеваний, в т. ч. аутоиммунного профиля. Одним из аутоиммунных коморбидных заболеваний при АтД является гнездная алопеция (ГА), что подтверждается эпидемиологическими данными, а также клиническими особенностями и выявлением общих иммунных звеньев патогенеза при ассоциации этих заболеваний. Ингибиторы янус-киназ (JAK), которые представляют собой новый класс таргетных синтетических базисных противовоспалительных препаратов, в настоящее время являются основным патогенетическим методом лечения тяжелых форм АтД и ГА. Воздействуя на несколько иммунных осей, эти препараты избирательно и обратимо модулируют сигнальную активность ключевых воспалительных цитокинов, что делает их наиболее перспективной стратегией системной терапии указанных дерматозов, в т. ч. в случаях их сочетания. В статье представлен обзор патофизиологии и применения ингибиторов JAK первого и второго поколения при АтД и ГА, проанализированы данные об их эффективности при одновременном наличии этих патологических состояний. Представлены собственные наблюдения двух пациентов с тяжелыми коморбидными заболеваниями АтД и ГА, получающих лечение JAK-ингибиторами аброцитинибом и упадацитинибом. В данных примерах подтверждается эффективность ингибиторов янус-киназ при АтД и ГА в реальной клинической практике, описывается опыт перехода с одного JAK-ингибитора первого поколения на другой селективный JAK-ингибитор, а также эффект влияния этих препаратов на течение обеих патологий. Учитывая необходимость длительного применения ингибиторов JAK, сохраняет актуальность дальнейшее изучение их долгосрочной эффективности и безопасности.

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