mesЭкстремальная биомедицинаExtreme Medicine3033-89643033-8972Centre for Strategic Planning of the Federal Medical and Biological Agency10.47183/mes.2025-27-2-213-219mes-249Research ArticleПУЛЬМОНОЛОГИЯPULMONOLOGYВозможности переключения биологического препарата при лечении бронхиальной астмы у детей. Клиническое наблюдениеPossibility of switching of a biological drug when treating childhood asthma (A clinical case)https://orcid.org/0000-0003-1649-5493ПыжьяноваП. А.PyzhyanovaP. A.

Пыжьянова Полина Александровна  

Москва

Polina A. Pyzhyanova

Moscow

polinapzh@mail.ruhttps://orcid.org/0000-0003-1685-234XЗайцеваС. В.ZaytsevaS. V.

Зайцева Светлана Владимировна, канд. мед. наук

Москва

 

Svetlana V. Zaytseva, Cand. Sci. (Med.)

Moscow

zcv16@mail.ruhttps://orcid.org/0009-0003-8895-262XТомиловаА. Ю.TomilovaA. U.

Томилова Анна Юрьевна, канд. мед. наук  

Москва

Anna U. Tomilova, Cand. Sci. (Med.)

Moscow

anhen_lily@mail.ruhttps://orcid.org/0009-0000-1577-4728ИбрагимоваА. А.IbragimovaA. A.

Ибрагимова Анисахон Алихоновна  

Москва

Anisakhon A. Ibragimova

Moscow

anisaibragimova32@gmail.comРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationФедеральный научно-клинический центр детей и подростков Федерального медико-биологического агентства; Российский университет медициныРоссияFederal Scientific and Clinical Center for Children and Adolescents; Russian University of MedicineRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова;  Федеральный научно-клинический центр детей и подростков Федерального медико-биологического агентстваРоссияPirogov Russian National Research Medical University; Federal Scientific and Clinical Center for Children and AdolescentsRussian Federation202526062025272213219Copyright © Пыжьянова П.А., Зайцева С.В., Томилова А.Ю., Ибрагимова А.А., 20252025Пыжьянова П.А., Зайцева С.В., Томилова А.Ю., Ибрагимова А.А.Pyzhyanova P.A., Zaytseva S.V., Tomilova A.U., Ibragimova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.extrememedicine.ru/jour/article/view/249Введение

Введение. В терапии детей с неконтролируемой бронхиальной астмой (БА) активно используются генно-инженерные биологические препараты (ГИБП). В России для лечения детей и подростков с БА зарегистрировано несколько ГИБП: антииммуноглобулин Е (IgE) (омализумаб), антиинтерлейкин 5 (IL-5/анти-IL-5Rα) (Меполизумаб®) и анти-IL-4Rα (Дупилумаб®). Выбор ГИБП зависит от фенотипа и эндотипа БА. Однако в педиатрической практике определение эндотипа БА затруднительно, в связи с чем поиск эффективного препарата остается непростой задачей. По этой причине существует вероятность недостаточной эффективности рекомендованной дорогостоящей терапии и необходимости пересмотра лечения ГИБП в соответствии с фенотипическими особенностями заболевания.

Описание клинического случая. В работе представлено динамическое наблюдение за ребенком 7 лет с тяжелым течением БА и сопутствующим атопическим дерматитом (АтД), получающим в терапии ГИБП. Исходным биологическим препаратом был омализумаб. В последующем в связи с недостаточным контролем симптомов заболевания и обострением тяжелого атопического дерматита проведено переключение на Дупилумаб®. Смена ГИБП способствовала достижению контроля симптомов БА и купированию кожного синдрома.

Выводы

Выводы. Наше наблюдение показывает эффективность и безопасность переключения с биологического препарата омализумаб на препарат Дупилумаб® у детей с тяжелым течением БА и сопутствующим АтД. Необходимы дальнейшие исследования для уточнения клинического профиля пациентов с целью определения предикторов эффективного выбора биологической терапии и решения вопроса о переходе на различные моноклональные антитела.

Introduction

Introduction. Genetically engineered biological drugs (GEBD) are widely used in the treatment of children with uncontrolled bronchial asthma (BA). In Russia, several GEBD have been registered for the treatment of children and adolescents with asthma, including anti-immunoglobulin E/anti-IgE (omalizumab), anti-interleukin 5/anti-IL-5Ra (mepolizumab), and anti-IL-4Ra (dupilumab). The choice of GEBD depends on the BA phenotype and genotype. However, in pediatric practice, the difficulty of determining a BA endotype complicates the search for an effective drug. For this reason, there is a possibility of insufficient effectiveness of the recommended expensive therapy and the need to revise the treatment of GEBD in accordance with the phenotypic features of the disease.

Clinical case description. The paper presents a dynamic follow-up of a 7-year-old child with severe asthma and concomitant atopic dermatitis (AD) receiving GEBD therapy. The initial biological drug was omalizumab. Subsequently, due to insufficient control of the symptoms of the disease and exacerbation of severe atopic dermatitis, a switch to dupilumab was performed. The change in GEBD contributed to achieving control over BA symptoms and a relief of the skin condition.

Conclusions

Conclusions. Our observation shows the effectiveness and safety of switching between omalizumab to dupilumab in children with severe asthma and concomitant AD. Further research is needed to clarify the clinical profile of patients in order to determine predictors of an effective choice of biotherapy and resolve the issue of switching to various monoclonal antibodies.

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