fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2022-7-3-74-84fcmedicine-575Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESВозможности использования иммуносупрессоров и их аэрозольной доставки в легкие при лечении COVID-19 (аналитический обзор)Immunosuppressive drugs and their aerosol delivery for COVID-19 treatmenthttps://orcid.org/0000-0002-1523-9669КобылянскийВ. И.KobylyanskyV. I.

Кобылянский Вячеслав Иванович, доктор медицинских наук, профессор образовательного центра

115682, Россия, г. Москва, Ореховый б-р, д. 28

Prof. Vyacheslav I. Kobylyansky, MD, DSc, Professor, Educational Centre

28, Orekhovy Boulevard, Moscow, 115682, Russian Federation 

kobylyansky@mail.ruФГБУ «Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства России»РоссияResearch Institute of Pulmonology, Federal Medical and Biological Agency of Russian FederationRussian Federation202230092022737484Copyright © Кобылянский В.И., 20222022Кобылянский В.И.Kobylyansky V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/575

Одним из приоритетных направлений современной медицины является повышение эффективности лечения COVID-19, являющегося причиной тяжелых осложнений, часто обусловливающих летальный исход. С учетом патофизиологических особенностей заболевания, характеризующегося частым наличием гипериммунного ответа на патоген, определённый потенциал в этом плане заложен в средствах иммуносупрессивного действия (СИСД). Наиболее перспективными из них признаны иммунобиологические препараты, обладающие прецизионным иммуносупрессивным действием, к которым относятся моноклональные антитела (МКАТ). Однако появились единичные работы, предлагающие использование цитостатиков, в том числе и в ингаляционном виде, от применения которых с целью лечения воспаления дыхательных путей (ДП), как хорошо известно, отказались еще в 1990-е годы в силу их малой эффективности и сопряженности с целым рядом грозных побочных эффектов. Определение целесообразности использования данной группы препаратов с современных позиций – цель обзора. Рассмотрены возможности и некоторых других СИСД, в том числе и иммунобиологических препаратов, составляющих тренд в современной медицине. Дан анализ эффективности воздействия различных подгрупп СИСД, в том числе и при ингаляционном их введении в ДП. Отражены методы и подходы их использования, преимущества и недостатки, оценка целесообразности и перспективы их применения. Эффективность цитостатиков и ингибиторов кальциневрина при лечении воспаления ДП при COVID-19 остаётся не подтвержденной и бесперспективной. Перспективными средствами в этом плане являются биологические препараты, включая моноклональные антитела и средства пуринергической регуляции.

Despite numerous efforts of healthcare, the incidence of COVID-19 and its fatal complications remains unacceptably high. As COVID-19 pathophysiology is notable for an uncurbed immune response, its treatment protocols routinely include immunosuppressive drugs such as corticosteroids, cytostatic drugs, calcineurin inhibitors, and monoclonal antibodies. Here we review the efficacy of the latter 3 drug classes, in particular inhalation preparations, in COVID-19 treatment and SARSCoV-2 elimination as well as their potential advantages and drawbacks. Efficacy of cytostatic drugs and calcineurin inhibitors in the treatment of airway inflammation in COVID-19 remains unconfirmed. Promising agents in this regard are biologics, including monoclonal antibodies and purinergic agents.

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The authors declare that there are no conflicts of interest present.