pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.34215/1609-1175-2026-2-33-40pmj-3138Research ArticleОБЗОРЫREVIEWSКлеточный иммунный ответ на вакцинацию против пневмококка у больных ревматоидным артритом, получающих метотрексат и ритуксимаб (обзор литературы)Cellular immune response to pneumococcal vaccination in patients with rheumatoid arthritis receiving methotrexate and rituximab (Literature review)https://orcid.org/0000-0002-7280-6877ШмитькоА. Д.ShmitkoA. D.

Шмитько Анна Дмитриевна – к.м.н., старший научный сотрудник лаборатории вакцинопрофилактики и иммунотерапии аллергических заболеваний.

105064, Москва, пер. Малый Казенный, 5а; тел.: +8 (926) 374-45-25

Anna D. Shmitko - Cand. Sci. (Med.), Senior Research, Laboratory of Vaccination and Immunotherapy of Allergic Diseases.

5A Maly Kazenny per., Moscow 105064

violadellanna@gmail.comТарасоваА. А.TarasovaA. A.

Нижний Новгород

Nizhny Novgorod

БатожаргаловаБ. Ц.BatozhargalovaB. Ts.

Москва

Moscow

КостиновМ. П.KostinovM. P.

Москва

Moscow

Научно-исследовательский институт вакцин и сывороток им. И.И. МечниковаРоссияI. Mechnikov Scientific Research Institute of Vaccines and SerumsRussian FederationПриволжский исследовательский медицинский университетРоссияPrivolzhsky Research Medical UniversityRussian FederationНаучно-исследовательский институт вакцин и сывороток им. И.И. Мечникова; Первый Московский государственный медицинский университет имени И.М. СеченоваРоссияI. Mechnikov Scientific Research Institute of Vaccines and Serums; I.M. Sechenov First Moscow State Medical UniversityRussian Federation202619072026023340Copyright © Шмитько А.Д., Тарасова А.А., Батожаргалова Б.Ц., Костинов М.П., 20262026Шмитько А.Д., Тарасова А.А., Батожаргалова Б.Ц., Костинов М.П.Shmitko A.D., Tarasova A.A., Batozhargalova B.T., Kostinov M.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/3138

Пациенты с ревматоидным артритом (РА) подвергаются повышенному риску инвазивных пневмококковых инфекций из-за особенностей иммунитета, как связанных с заболеванием, так и вследствие проводимой терапии, в том числе базисным противоревматическим препаратом метотрексат (МТ), а также препаратом анти-B-клеточной терапии – ритуксимаб (РТМ). В связи с этим вакцинация имеет большое профилактическое значение. Установлено, что РТМ ухудшал клеточный и гуморальный ответ на ППВ23 у пациентов с РА. МТ у больных РА приводил к снижению ответа вакциноспецифичных антител и их функциональности, а также уменьшению количества Th17-клеток, блокировал активацию плазмобластов и переключенных В-клеток памяти после введения ПКВ13. Супрессивное действие МТ на концентрацию моноцитов в периферической крови, вероятно, может выступать в качестве биомаркера для выявления будущих не восприимчивых к ПКВ13 больных с РА.

Patients with rheumatoid arthritis (RA) are at an increased risk for invasive pneumococcal infections due to immune system characteristics related to the disease and its treatment. Treatment options include disease-modifying antirheumatic drugs, such as methotrexate (MTX), and anti-B-cell therapy drugs, such as rituximab (RTX). Therefore, vaccination holds significant preventive value. Previous studies indicate that RTX impairs the cellular and humoral response to PPV23 in patients with RA. In RA patients, MTX led to decreased vaccine-specific antibody response and functionality, reduced Th17 cell numbers, and blocked plasma cell activation and switched memory B cell activation following PCV13 administration. Due to its ability to suppress peripheral blood monocyte concentration, MTX may serve as a biomarker for identifying RA patients who will be resistant to PKV13.

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