Безопасность фармакотерапии у пациентов с COVID-19: обзор литературы

Актуальность проблемы безопасности фармакотерапии COVID-19 связана в первую очередь с малым опытом использования отдельных препаратов и с использованием препаратов вне показаний. Цель работы: анализ информации о предикторах и возможных нежелательных реакциях (НР) при применении этиотропной и патогенетической терапии COVID-19. По данным литературы, основными клинически значимыми факторами риска развития НР у пациентов с COVID-19 являются длительность пребывания в стационаре, комбинированное использование противовирусных препаратов, полипрагмазия и наличие лекарственной аллергии в анамнезе. Показано, что наиболее частыми НР при применении противовирусных препаратов являются нарушения со стороны желудочно-кишечного тракта и гепатобилиарной системы, вирус-нейтрализующих антител — нарушения со стороны желудочно-кишечного тракта, аллергические реакции и неврологические нарушения. При использовании иммуноглобулина человека против COVID-19 и плазмы реконвалесцентов наиболее часто развиваются трансфузионные реакции (лихорадка, озноб и другие). При проведении патогенетической терапии системными глюкокортикостероидами самой характерной НР является гипергликемия. Применение ингибиторов янус-киназ и ингибиторов интерлейкинов чаще всего сопряжено с желудочно-кишечными нарушениями и гипертрансаминаземией, для ряда ингибиторов интерлейкинов также характерна нейтропения. НР при использовании антикоагулянтов со стороны системы гемостаза зависят от режима дозирования и тяжести состояния пациента. Лекарственные взаимодействия являются распространенной проблемой при терапии COVID-19, наибольшее количество значимых лекарственных взаимодействий отмечается при применении препарата нирматрелвир+ритонавир, что обусловлено его фармакокинетическими особенностями. В настоящий момент есть данные о влиянии фармакогенетических биомаркеров на безопасность и клинический исход терапии COVID-19. Таким образом, для повышения безопасности фармакотерапии COVID-19 необходим комплексный подход, при котором будут учитываться клинико-демографические и фармакогенетические предикторы развития НР, а также риски лекарственных взаимодействий.

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