Ритуксимаб в лечении миастении гравис: обзор современных данных

Миастения гравис — аутоиммунное заболевание нервно-мышечного синапса, обусловленное продукцией патогенных антител к ацетилхолиновым рецепторам (AChR), мышечно-специфической тирозинкиназе (MuSK) или другим компонентам постсинаптической мембраны, проявляющееся развитием патологической мышечной утомляемости и слабости. Ритуксимаб, моноклональное антитело против CD20, вызывающее деплецию В-клеток, демонстрирует дифференцированную эффективность в зависимости от серологического подтипа заболевания. При MuSK-миастении ритуксимаб обеспечивает выраженный и устойчивый терапевтический ответ благодаря элиминации клеток-предшественников короткоживущих плазмобластов, вырабатывающих патогенные IgG4-антитела. При AChR-позитивной миастении эффективность ритуксимаба более вариабельна, а ответ нередко отсрочен, поскольку значительная часть антител продуцируется долгоживущими CD20-негативными плазматическими клетками костного мозга, способными поддерживать продукцию антител независимо от В-клеток-предшественников. Раннее назначение препарата при недавней генерализации тем не менее будет способствовать минимальным проявлениям заболевания и снижению потребности в интенсивной терапии. В педиатрической практике ритуксимаб представляет ценную терапевтическую опцию при тяжёлом и рефрактерном течении ювенильной миастении.

В настоящем обзоре мы систематизируем данные рандомизированных и наблюдательных исследований, обсуждаем режимы дозирования, профиль безопасности и место ритуксимаба в современном терапевтическом алгоритме.

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