НОВЫЕ ПОДХОДЫ К ТЕРАПИИ КЛАССИЧЕСКИХ PH-НЕГАТИВНЫХ МИЕЛОПРОЛИФЕРАТИВНЫХ НОВООБРАЗОВАНИЙ: ОПЫТ РАННЕГО ПРИМЕНЕНИЯ ЦЕПЭГИНТЕРФЕРОНА АЛЬФ А-2B

Введение. Даже спустя 100 лет после первых попыток внедрения в практику химиотерапевтических подходов (1918 г.) и несмотря на окончательно сформировавшиеся представления о миелопролиферативных заболеваниях как о группе злокачественных новообразований, в отношении большинства пациентов с Ph-негативными миелопролиферативными новообразованиями (МПН) допускается, по сути, симптоматический подход к терапии – воздействие на показатели периферической крови и неспецифическая тромбопрофилактика. Ограничения классической циторедукции и современной таргетной терапии, а также убежденность большинства специалистов в невозможности адекватного сдерживания прогрессирования заболевания остаются основными факторами, удерживающими врачей от раннего назначения патогенетической терапии.

 Цель исследования – изучение эффективности и безопасности цепэгинтерферона альфа-2b (цеПЭГ-ИФН α-2b) в ранней (не рискадаптированной) терапии классических Ph-негативных МПН при инициальном назначении и при переходе с терапии другими пегилированными интерферонами.

Материалы и методы. Пациентам (n = 27) с истинной полицитемией или эссенциальной тромбоцитемией без учета риска назначен цеПЭГ-ИФН α-2b: инициально или после 6 либо 12 мес терапии другими пегилированными интерферонами в дозе 200 мкг в неделю со снижением до 100 мкг в неделю при развитии гематологической токсичности II степени. Оценивали гематологический и молекулярный ответ. Время наблюдения – от 20 до 46 мес.

 Результаты. Во всех группах достигнут сопоставимый по глубине и динамике гематологический ответ со стойкой нормализацией показателей, а также молекулярный ответ в виде устойчивого снижения уровня аллельной нагрузки JAK2V617F. Влияние на результаты фактора переключения на терапию цеПЭГ-ИФН α-2b отсутствовало. ЦеПЭГ-ИФН α-2b показал меньшую дозолимитирующую токсичность по нейтропении и лучшую фармакоэкономическую целесообразность.

Обсуждение. Новые данные о механизмах антипролиферативного действия препаратов интерферона α позволяют говорить о фармакологических преимуществах цеПЭГ-ИФН α-2b по фармакокинетическим показателям; отмечены наличие одного позиционного изомера, чистота лекарственной субстанции, удобство самостоятельного применения.

 Заключение. Раннее назначение эффективной патогенетической терапии является самостоятельной превентивной мерой в профилактике развития осложнений МПН. Внедрение цеПЭГ-ИФН α-2b может способствовать совершенствованию помощи пациентам с МПН.

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