Оценка эффективности генно-инженерной биологической терапии у детей с ювенильными артритами с системным началом

Аннотация

The article presents the results of evaluating the effectiveness of a genetically engineered biological drug (tocilizumab) in children with juvenile arthritis with a systemic onset. Analysis of the results of the study showed that the use of a genetically engineered biological drug (tocilizumab) in the treatment of patients with juvenile arthritis with systemic onset contributes to a decrease in disease activity, regression of systemic signs and normalization of laboratory parameters in a significantly short time and improves the prognosis of the disease in these children. Keywords: children, juvenile arthritis with systemic onset, tocilizumab. Among the various variants of the course of juvenile arthritis, arthritis with systemic onset (JASCH) is characterized by a pronounced severity of the general inflammatory response, pronounced polysyndromicity, severe functional insufficiency in the acute period, and is distinguished by its various forms of course and outcomes, from favorable to extremely severe. The disease is characterized by an undulating course and damage to internal organs, the complexity of determining the period of remission of the disease [2, 8, 9, 10]. The protracted process of diagnosis and improper treatment at the initial stage leads to aggravation of the further course of the disease and response to therapy. The overall strategy for the treatment of systemic arthritis, aimed at the rapid and aggressive arrest of inflammatory activity, is the most important in therapy and may include various medical therapeutic agents. High disease activity and unfavorable prognosis in relation to deforming complications require the earliest possible appointment of basic therapy [1, 3, 4]. Recently, a lot of evidence has been accumulated about the leading role of inflammatory mediators, namely pro-inflammatory cytokines - interlekin-1 (IL-1) and interlekin-6 (IL-6), in the pathogenesis of this disease [2, 5, 6, 7]. Accumulated knowledge about the influence of pro-inflammatory cytokines distinguishes JAcCH with its pronounced activity of the laboratory inflammatory response and pronounced polysyndromicity from other JA variants. They cause a spectrum of various multi- organ extra-articular clinical manifestations [7, 10]. In addition, the local effects of IL-6, manifested in muscular-articular symptoms, are very diverse and are associated with its influence on the pathogenetic mechanisms of sinusitis and destructive joint damage [8, 9, 10]. A large evidence base created in the last decade has made it possible to revise the tactics of treating JAHF, according to which it is necessary to suppress the cytokine cascade at the earliest stages of pathology development through the use of basic immunobiological preparations. 204 Art of Medicine Volume-2 International Medical Scientific Journal Issue-1 10.5281/zenodo.6556141 In this regard, the use of a recombinant humanized monoclonal antibody to the human interleukin-6 receptor (IL-6) from the IgG immunoglobulin subclass, which selectively binds and suppresses both soluble and membrane IL-6 receptors (sIL-6R and mIL-6R), in the form of the drug tocilizumab is currently the standard in the treatment of JASHF [5]. In addition, the effectiveness of NSAIDs and basal immunosuppressive therapy in JASHF, the short-term effectiveness of glucocorticoid drugs (GCS), and a large number of side effects have led to the widespread use of genetically engineered biological drugs (GEBDs) [9, 10]. Purpose of the study. To evaluate the effectiveness of genetically engineered biological therapy in children with juvenile arthritis with systemic onset. Materials and research methods. We examined 32 patients with JASHF aged 1 to 18 years, hospitalized in the cardio-rheumatology department of the Republican Specialized Scientific and Practical Medical Center for Pediatrics from the beginning of 2017 to the present. The diagnosis was made according to the ILAR Edmonton criteria (2001). All patients underwent general clinical, biochemical and instrumental research methods. Immunological studies included the determination of interleukin-6 (IL-6) and antibodies to modified citrullinated vimentin (anti-MCV/AMCV). Out of 32 patients, in addition to complex treatment, 12 (31.2%) patients received a genetically engineered biological drug (GIBP) - tocilizumab (Actemra), which made up the 1st main group. The comparison group 2 consisted of 20 (68.8%) patients who received complex treatment, including immunosuppressant, corticosteroids and NSAIDs. Patients of the 1st group included in the study received tocilizumab therapy at a dose of 12 mg/kg of body weight (weighing < 30 kg) or 8 mg/kg (weighing 30 kg) intravenously every 4 weeks. Clinical, instrumental and laboratory assessment of the disease dynamics was carried out immediately before the start of therapy with tocilizumab and then every 3 months. Statistical analysis of the obtained results was carried out using the software package "SPSS for