clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2023-3-44-54clinvest-674Research ArticleКЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯCLINICAL PHARMACOLOGYФармакотерапия глаукомы с точки зрения доказательной медициныPharmacotherapy of glaucoma in terms of evidence-based medicineФедоровВ. Н.FedorovV. N.

Федоров Владимир Николаевич - д. м. н., профессор, начальник научного отдела института фармации

Ярославль

Vladimir N. Fedorov - Dr. Sci. (Med.), Professor, Head of the Scientific Department of the Institute of Pharmacy

Yaroslavl

fedorov.vladimir@hotmail.comВдовиченкоВ. П.VdovichenkoV. P.

Вдовиченко Владимир Петрович - к. м. н., доцент кафедры фармакологии

Гродно

Vladimir P. Vdovichenko - PhD, Cand. Sci. Med., Senior Lecturer of the Department of Pharmacology

Grodno

vmariposa60@yahoo.comКорсаковМ. К.KorsakovM. K.

Корсаков Михаил Константинович - д. х. н., профессор, директор Центра трансфера фармацевтических технологий им. М.В. Дорогова

Ярославль

Michael K. Korsakov - Dr. Sci. (Che.), Professor, director 

Yaroslavl

mkkors@mail.ruСтраховВ. В.StrakhovV. V.

Страхов Владимир Витальевич - д. м. н., профессор, зав. кафедрой офтальмологии

Ярославль

Vladimir V. Strakhov - Dr. Sci. (Med.), Professor, Head of the Department of ophthalmology

Yaroslavl

strakhov51@mail.ruПоповаА. А.PopovaA. A.

Попова Анастасия Александровна - инженер-исследователь Центра трансфера фармацевтических технологий им. М.В. Дорогова

Ярославль

Anastasia A. Popova - research engineer

Yaroslavl

oftakit.popova@yandex.ruhttps://orcid.org/0000-0002-0032-0341ХохловА. Л.KhokhlovA. I.

Хохлов Александр Леонидович - фармакологии и клинической фармакологии, ректор, Председатель Совета по этике при Министерстве здравоохранения РФ

Ярославль

Alexander L. Khokhlov - academician of RAS, Dr. Sci. (Med.), Professor, Head of the Department of Pharmacology and Clinical Pharmacology, Rector, Acting Chairman of theEthics Council under the Ministry of Health of the RussianFederation

Yaroslavl

al460935@yandex.ruСулеймановС. Ш.SuleymanovS. S.

Сулейманов Салават Шейхович - д. м. н., профессор, директор

Хабаровск

Salavat S. Suleymanov - Dr. Sci. (Med.), Professor, director

Khabarovsk

suleymanov-sh@mail.ruФГБОУ ВО «Ярославский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFSBEI НЕ "Yaroslavl State Medical University" of the Ministry of Healthcare of the Russian FederationRussian FederationГродненский государственный медицинский университетБеларусьGrodno State Medical UniversityBelarusЦентр трансфера фармацевтических технологий им. М.В. Дорогова, Ярославский государственный педагогический университет им. К.Д. УшинскогоРоссияM.V. Dorogov Pharmaceutical Technology Transfer Center YSPU after K.D. UshinskyRussian FederationРоссийско-японский медицинский центр САИКОРоссияRussian-Japanese Medical Center "SAIKO"Russian Federation202320102023034454Copyright © Федоров В.Н., Вдовиченко В.П., Корсаков М.К., Страхов В.В., Попова А.А., Хохлов А.Л., Сулейманов С.Ш., 20232023Федоров В.Н., Вдовиченко В.П., Корсаков М.К., Страхов В.В., Попова А.А., Хохлов А.Л., Сулейманов С.Ш.Fedorov V.N., Vdovichenko V.P., Korsakov M.K., Strakhov V.V., Popova A.A., Khokhlov A.I., Suleymanov S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/674

Глаукома — заболевание, связанное с повышением внутриглазного давления (ВГД). Из фармакологических средств для лечения глаукомы различают препараты первой (наиболее эффективны и безопасны) и второй линии лечения. К первой линии лечения относятся аналоги простагландинов и бета-адреноблокаторы. Используемые в настоящее время аналоги простагландинов (латанопрост, биматопрост, тафлупрост и травопрост) являются аналогами PG F2α, осуществляющие своё действие через стимуляцию рецепторов FP. Их отличает оптимальное соотношение эффективности и риска побочного действия. Они удобны для пациента, т. к. для лечебного действия достаточно назначения 1 раз в день. Вследствие этого лечение глаукомы рационально начинать с одного из препаратов данной группы. С точки зрения фармакоэкономики наиболее доступным препаратом простагландинов является латанопрост, который в целом столь же эффективен, как и другие аналоги простагландинов. β-адреноблокаторы снижают продукцию ВГЖ, образование которой контролируется β1- и β2-адренорецепторами. Поэтому неселективные β-блокаторы (тимолол, левобунолол, метипранолол и картеолол) имеют фармакодинамическое преимущество перед селективными антагонистами β1-адренорецепторов (бетаксолол). Проведённые клинические исследования β-блокаторов показали, что, учитывая стоимость, эффективность и безопасность, тимолол оказался наиболее предпочтителен в терапии глаукомы. При наличии медицинских противопоказаний к применению препаратов первой линии или для усиления их эффективности используются α2-адреномиметики (апраклонидин и бримонидин), ингибиторы карбоангидразы (как правило, местного действия: дорзоламид и бринзоламид), М-холиномиметики (пилокарпин, карбахол и эхотиофат), а также ингибиторы Rho-киназы (рипасудил)

Glaucoma is a disease associated with increased intraocular pressure (IOP). Of the pharmacological agents for treating glaucoma, there are drugs of the first (most effective and safe) and second-line treatment. First-line treatment includes prostaglandin analogs and beta-blockers. The currently used prostaglandin analogs (latanoprost, bimatoprost, tafluprost and travoprost) are PG F2α analogs that act through stimulation of FP receptors. They are distinguished by the optimal ratio of effectiveness and risk of side effects. They are convenient for the patient because for the therapeutic effect, it is enough to prescribe 1 time per day. As a result, it is rational to start the treatment of glaucoma with a drug in this group. In terms of pharmacoeconomics, the most affordable prostaglandin drug is latanoprost, which is generally as effective as other prostaglandin analogs. β-adrenergic blockers reduce the production of intraocular fluid, the formation of which is controlled by β1- and β2-adrenergic receptors. Therefore, non-selective β-blockers (timolol, levobunolol, metipranolol, and carteolol) have a pharmacodynamic advantage over selective β1-adrenergic antagonists (betaxolol). Conducted clinical studies of β-blockers have shown that given the cost, efficacy and safety, timolol was the most preferable treatment for glaucoma. In the presence of medical contraindications to the use of first-line drugs or to enhance their effectiveness, α2-agonists (apraclonidine and brimonidine), carbonic anhydrase inhibitors (usually local action: dorzolamide and brinzolamide), M-cholinomimetics (pilocarpine, carbachol and echothiopate), and also Rho-kinase inhibitors (ripasudil)

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