Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media24933710.18565/aig.2021.7.53-60ArticlesСтатьиReview ArticleImpact of therapy for autoimmune rheumatic diseases on reproductive functionВлияние терапии иммунно-воспалительных ревматических заболеваний на репродуктивную функциюVlasovaGalina A.ВласоваГалина Алексеевна

graduate student of Reproductology Department

аспирант НКО ВРТ им. Ф. Паулсена

galinavlasova089@gmail.comPerminovaSvetlana G.ПерминоваСветлана Григорьевна

Dr. Med. Sci., Leading Researcher of Reproductology Department

д.м.н., в.н.с. НКО ВРТ им. Ф. Паулсена

perisvet@list.ruKoshelevaNadezhda M.КошелеваНадежда Михайловна

PhD, Senior Researcher of the Laboratory of Vascular Rheumatology

к.м.н., с.н.с. лаборатории сосудистой ревматологии

nadkosheleva@yandex.ruVeyukovaMaria A.ВеюковаМария Александровна

PhD (Bio), Senior embriologist of Reproductology Department

к.б.н., старший эмбриолог НКО ВРТ им. Ф. Паулсена

veymary@gmail.comAcademician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииV.A. Nasonova Research Institute of Rheumatology, Ministry of Science and Higher Education of the Russian FederationФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой» Министерства науки и высшего образования Российской Федерации150720217NO7 (2021)№7 (2021)536019022023Copyright ©; 2021, Bionika MediaCopyright ©; 2021, ООО «Бионика Медиа»2021Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/249337

Objective. To carry out a systematic analysis of the data available in the world literature on the effects of various groups of drugs used in therapy for immune-mediated inflammatory rheumatic diseases (IMIRDs) on the female and male reproductive system, as well as methods to preserve reproductive function in this patient contingent. Materials and methods. The review includes Russian and foreign publications available in Pubmed on this topic over 2010-2020. Results. The authors analyze the data available in the literature on the effects of drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs), cyclophosphamide (CP), methotrexate (MTX), mycophenolate mofetil (MMF), azathioprine (AZA), sulfasalazine (SUL), hydroxychloroquine (HC), leflunomide, and biological agents (BAs) on the female and male reproductive system. The possible teratogenic effects of some of these drugs used during pregnancy were studied. Procedures to preserve reproductive function were also analyzed in patients with IMIRDs. Conclusion. CP is the only drug, the negative effect of which on female and male reproductive function was significantly proven. The negative effect of MTX and a tumor necrosis factor-a inhibitor on the male reproductive system and also the teratogenic effects of MMF and leflunomide during pregnancy are discussed. The effect of other drug groups remains controversial and requires further investigation. The design and clinical introduction of individual approaches to preserving reproductive function in this patient group also require further study.

Цель. Провести систематический анализ данных, имеющихся в мировой литературе, относительно влияния различных групп препаратов, применяемых при терапии иммуновоспалительных ревматических заболеваний (ИВРЗ), на состояние женской и мужской репродуктивной системы, а также методов сохранения репродуктивной функции у данного контингента больных. Материалы и методы. В обзор включены отечественные и зарубежные публикации системы Pubmed по данной теме за 2010-2020 гг. Результаты. Проанализированы литературные данные о влиянии таких препаратов, как нестероидные противовоспалительные препараты (НПВП), глюкокортикоиды (ГК), циклофосфамид (ЦФ), метотрексат (МТ), микофенолата мофетил (ММФ), азатиоприн (АЗА), сульфасалазин (ССЗ), гидроксихлорохин (ГХ), лефлуномид и генно-инженерные биологические препараты (ГИБП) на состояние женской и мужской репродуктивной системы. Для части препаратов изучено возможное тератогенное воздействие при их применении во время беременности. Также проанализировано применение методик сохранения репродуктивной функции у больных с ИВРЗ. Заключение. Единственным препаратом, отрицательное влияние которого на женскую и мужскую репродуктивную функцию достоверно доказано, является ЦФ. Обсуждается отрицательное влияние МТ и ингибитора фактора некроза опухоли альфа на состояние мужской репродуктивной системы; а также тератогенное воздействие ММФ и лефлуномида во время беременности. Влияние других групп препаратов остается спорным и требует дальнейшего исследования. Вопрос разработки и внедрения в клиническую практику индивидуальных подходов к сохранению репродуктивной функции у данного контингента больных также требует дальнейшего изучения.

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