Выбор нестероидных противовоспалительных препаратов для рациональной фармакотерапии хронической скелетно-мышечной боли: взгляд клинического фармаколога

Хроническая скелетно-мышечная боль (ХСМБ) – одно из наиболее распространенных патологических состояний, ограничивающих физическую активность пациентов и снижающих качество жизни. Обезболивающее и противовоспалительное действие нестероидных противовоспалительных препаратов (НПВП) делает их основой фармакотерапии пациентов с хроническими заболеваниями, вовлекающими различные отделы опорно-двигательного аппарата. Основная мишень НПВП – циклооксигеназа (ЦОГ) – существует в виде двух основных изоформ, ЦОГ-1 и ЦОГ-2, ингибирование каждой из которых приводит к каскаду реакций на уровне клеток и тканей, ведущих к развитию как целевых фармакологических эффектов, так и побочных. Разнообразие химических структур представителей НПВП опосредует различия их фармакодинамических и фармакокинетических параметров и, соответственно, различия в профилях эффективности и безопасности. Селективные ингибиторы ЦОГ-2, коксибы, продемонстрировали повышенный риск развития побочных эффектов со стороны сердечно-сосудистой системы, что привело к значимому ограничению их использования. Неселективные ингибиторы ЦОГ не имеют столь выраженных проявлений кардиотоксичности, однако спектр их побочных эффектов чрезвычайно широк. Они имеют дозозависимый характер и свойственны, в первую очередь, системным НПВП. Комбинация системных и топических НПВП позволяет снизить дозу первых и повысить профиль безопасности противовоспалительной терапии. Среди неселективных ингибиторов ЦОГ с удовлетворительным профилем безопасности и высокой противовоспалительной активностью следует отметить группу оксикамов и, в частности, теноксикам, характеризующийся максимальной длительностью действия, что является преимуществом при ведении пациентов с ХСМБ. Данный обзор посвящен вопросам рационального выбора НПВП на основе сравнительных данных фармакодинамики, фармакокинетики и результатов клинических исследований.

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