Антифибротическая терапия идиопатического легочного фиброза: соотношение эффективности и безопасности


Антифибротическая терапия идиопатического легочного фиброза: соотношение эффективности и безопасности

 349

Антифибротическая терапия идиопатического легочного фиброза: соотношение эффективности и безопасности

Журнал "Медицинский совет. Пульмонология" №15, 2018

DOI: https://doi.org/10.21518/2079-701X-2018-15-131-136

С.Н. Авдеев1, Н.В. Трушенко2 1 ФГБОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России, Москва 2 ФГБУ «НИИ пульмонологии» ФМБА России, Москва 

Идиопатический легочный фиброз (ИЛФ) – наиболее распространенная форма идиопатической интерстициальной пневмонии, характеризующаяся неуклонно прогрессирующим течением и плохим прогнозом. В основе ухудшения клинической симптоматики и функционального статуса у больных ИЛФ лежит нарастающий фиброз легких, заканчивающийся изменениями по типу «сотового легкого». На сегодняшний день в качестве лекарственной терапии ИЛФ рекомендуют препараты с антифибротическими свойствами. В представленной статье приведены сведения об эффективности и безопасности данной терапии, даны практические рекомендации по ведению больных ИЛФ, получающих ее.

Antifibrotic therapy of idiopathic pulmonary fibrosis: efficiency / safety ratio 

S.N. Avdeev1, N.V. Trushenko2 1 Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia 2 Research Institute of Pulmonology of the Federal Medical-Biological Agency of Russia, Moscow

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonia that is characterized by a steadily progressive course and poor prognosis. The worsening pulmonary fibrosis resulting in honeycomb lungs accounts for the deterioration of clinical symptoms and functional status in patients with IPF. Today, the drugs with anti-fibrotic properties are recommend as a drug therapy for IPF. The article provides information on the efficacy and safety of this therapy as well as practical guidelines on the management of patients with IPF receiving such therapy.

Загрузить файл статьи в формате PDF



Список литературы

1. Авдеев С.Н. Идиопатический легочный фиброз. Пульмонология, 2015, 25 (5): 600-612.
2. Авдеев С.Н. Идиопатический фиброз легких: новая парадигма. Тер архив, 2017, 89(1): 112122.
3. Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Белевский А.С., Демура С.А., Илькович М.М., Коган Е.А. и др. Диагностика и лечение идиопатического легочного фиброза. Федеральные клинические рекомендации. Пульмонология, 2016, 26(4): 399-419.
4. Raghu G, Collard H, Egan JJ, Martinez FJ, Behr J, Brown KK An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. Am J Respir Crit Care Med, 2011, 183: 788-824. https://doi.org/10.1164/rccm.2009-040GL.
5. Raghu G, Anstrom KJ, King TE Jr, Lasky JA, Martinez FJ, Idiopathic Pulmonary Fibrosis Clinical Research Network. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fbrosis. N Engl J Med, 2012, 366(21): 1968-1977.
6. Richeldi L, Costabel U, Selman M, Kim DS, Hansell DM, Nicholson AG, Brown KK, Flaherty KR, Noble PW, Raghu G, et al. Efficacy of a tyrosine kinase inhibitor in idiopathic pulmonary fibrosis. N Engl J Med, 2011, 365: 1079- 1087.
7. Richeldi L, du Bois RM, Raghu G, Azuma A, Brown KK, Costabel U, Cottin V, Flaherty KR, Hansell DM, Inoue Y, et al, INPULSIS Trial Investigators. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med, 2014, 370: 2071-2082.
8. Lyer SN, Hyde DM, Giri SN. Anti-inflammatory effect of pirfenidone in the bleomycin-hamster model of lung inflammation. Inflammation, 2000, 24(5): 477-91.
9. Fernandez IE, Eickelberg O. The impact of TGF-β on lung fibrosis: from targeting to biomarkers. Proc Am Thorac Soc, 2012, 9(3): 111-6.
10. Card JW, Racz WJ, Brien JF, Margolin SB, Massey TE. Differential effects of pirfenidone on acute pulmonary injury and ensuing fibrosis in the hamster model of amiodarone-induced pulmonary toxicity. Toxicol Sci, 2003; 75(1): 169-80.
11. Togami K, Kanehira Y, Tada H. Possible involvement of pirfenidone metabolites in the antifibrotic action of a therapy for idiopathic pulmonary fibrosis. Biol Pharm Bull, 2013, 36(10): 1525-7.
12. Kakugawa T, Mukae H, Hayashi T, et al. Pirfenidone attenuates expression of HSP47 in murine bleomycin-induced pulmonary fibrosis. Eur Respir J, 2004, 24(1): 57-65.
13. Shi S, Wu J, Chen H, Zeng F. Single- and multiple-dose pharmacokinetics of pirfenidone, an antifibrotic agent, in healthy Chinese volunteers. J Clin Pharmacol, 2007, 47(10): 1268-76.
14. King CS, Nathan SD. Practical considerations in the pharmacologic treatment of idiopathic pulmonary fbrosis. Curr Opin Pulm Med, 2015, 21(5): 479-489.
15. Meyer KC, Decker CA. Role of pirfenidone in the management of pulmonary fibrosis. Therapeutics and Clinical Risk Management, 2017, 13: 427-437.
16. Noble PW, Albera C, Bradford WZ, et al. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPATY): two randomised trials. Lancet, 2011, 377(9779): 1760-9.
17. King TE, Bradford WZ, Castro-Bernardini S, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med, 2014, 370(22): 2083-92.
18. George PM, Wells AU. Pirfenidone for the treatment of Idiopathic Pulmonary Fibrosis. Expert Review of Clinical Pharmacology, 2017. https://doi.org/10.1080/17512433.2017.1295846.
19. Costabel U, Albera C, Bradford WZ, Hormel P et al. Analysis of lung function and survival in RECAP: an open-label extension study of pirfenidone in patients with idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis, 2014, 31(3): 198-205.
20. Визель А.А, Белевский А.С. Современные аспекты лечения идиопатического легочного фиброза. Практическая пульмонология, 2017, 2: 93-98. /Wiesel AA, Belevsky AS. Modern aspects of the treatment of idiopathic pulmonary fibrosis. Prakticheskaya Pulmonologiya, 2017, 2: 93-98.
21. Ley B, Swigris J, Day BM, Stauffer JL, Raimundo K, Chou W, et al. Pirfenidone reduces respiratory-related hospitalizations in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med, 2017, 196: 756-61. https://doi.org/10.1164/rccm.2017010091OC.
22. Noble PW, Albera C, Bradford WZ, et al. Pirfenidone for idiopathic pulmonary fbrosis: analysis of pooled data from three multinational phase 3 trials. Eur Respir J, 2016, 47(1): 243-253.
23. Bargagli E, Piccioli C, Rosi E, Torricelli E, Turi L, Piccioli E et al. Pirfenidone and Nintedanib in idiopathic pulmonary fibrosis: Real-life experience in an Italian referral centre. Pulmonology, 2018 Sep 17. pii:S2531-0437(18)30099-0.
24. Yan YJ, Fan YL, Yu SW, Ye Q Real-life experience with pirfenidone in idiopathic pulmonary fibrosis. Zhonghua Jie He He Hu Xi Za Zhi, 2018 May 12, 41(5): 327-332.
25. Ogawa K, Miyamoto A, Hanada S, Takahashi Y, Murase K, Mochizuki S The efficiacy and safety of long-term pirfenidone therapy in patients with idiopathic pulmonary fibrosis. Intern Med, 2018 May 18. https://doi.org/10.2169/internalmedicine.0559-17.
26. Tzouvelekis A, Ntolios P, Karampitsakos T, Tzilas V, Anevlavis S, Bouros E, et al. Safety and efficacy of pirfenidone in severe idiopathic pulmonary fibrosis: a real-world observational study. Pulm Pharmacol The, 2017, 46: 48-53. https://doi.org/10.1016/j.pupt.2017.08.011.
27. Vancheri C, Kreuter M, Richeldi L, Ryerson CJ, Valeyre D, Grutters JC, Wiebe S, Stansen W, Quaresma M, Stowasser S, et al. Nintedanib with Add-on Pirfenidone in Idiopathic Pulmonary Fibrosis. Results of the INJOURNEY Trial. Am J Respir Crit Care Med, 2018, 197: 356- 363. https://doi.org/10.1164/rccm.201706-1301OC.
28. Ogura T, Taniguchi H, Azuma A, Inoue Y, Kondoh Y, Hasegawa Y, Bando M, Abe S, Mochizuki Y, Chida K, et al. Safety and pharmacokinetics of nintedanib and pirfenidone in idiopathic pulmonary fibrosis. Eur Respir J, 2015, 45: 1382-1392. https://doi.org/10.1183/09031936.00198013.
29. Behr J, Bendstrup E, Crestani B, et al. Safety and tolerability of acetylcysteine and pirfenidone combination therapy in idiopathic pulmonary fibrosis: a randomised, double-blind, placebocontrolled, phase 2 trial. Lancet Respir Med, 2016, 4(6): 445-453.
30. Azuma A, Nukiwa T, Tsuboi E, et al. Doubleblind, placebo-controlled trial of pirfenidone in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med, 2005, 171(9): 1040-7.
31. Taniguchi H, Ebina M, Kondoh Y, et al. Pirfenidone in idiopathic pulmonary fibrosis. Eur Respir J, 2010, 35(4): 821-9.
32. Glassberg M, Nathan SD, Lin CY, Lew C, Raimun do K, Stauffer J, Chou W, Noble PW. Cardiovascular Events in Phase 3 Trials of Pirfenidone in Idiopathic Pulmonary Fibrosis (IPF). Am J Respir Crit Care Med, 2016, 193: A4980.
33. Valeyre D, Albera C, Bradford WZ, et al. Comprehensive assessment of the long-term safety of pirfenidone in patients with idiopathic pulmonary fibrosis. Respirology, 2014, 19(5): 740-7.


Пульмонология