nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-203-7-5-20nogr-2006Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEКомбинированная гепатопротекторная фармакотерапия заболеваний печениCombined hepatoprotective pharmacotherapy for liver diseasehttps://orcid.org/0000-0003-4294-5531ОковитыйСергей ВладимировичOkovityiSergey V.sergey.okovity@pharminnotech.comhttps://orcid.org/0000-0002-8821-6142РайхельсонКарина ЛеонидовнаRaikhelsonKarina L.noemail@neicon.ruhttps://orcid.org/0000-0002-4690-1811ПриходькоВероника АлександровнаPrikhodkoVeronika A.noemail@neicon.ruНаучно-клинический и образовательный центр гастроэнтерологии и гепатологии, федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»; Научно-клинический и образовательный центр гастроэнтерологии и гепатологии, федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияScientific, Clinical and Educational Center of Gastroenterology and Hepatology, Saint Petersburg State University; Scientific, Clinical and Educational Center of Gastroenterology and Hepatology, Saint Petersburg State UniversityRussian FederationНаучно-клинический и образовательный центр гастроэнтерологии и гепатологии, федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияScientific, Clinical and Educational Center of Gastroenterology and Hepatology, Saint Petersburg State UniversityRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный химико-фармацевтический университет» Министерства здравоохранения Российской ФедерацииРоссияSaint Petersburg State Chemical and Pharmaceutical UniversityRussian Federation20220710202207520Copyright © Оковитый С.В., Райхельсон К.Л., Приходько В.А., 20222022Оковитый С.В., Райхельсон К.Л., Приходько В.А.Okovityi S.V., Raikhelson K.L., Prikhodko V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/2006

В клинической практике нередко используются одновременно несколько гепатопротективных средств в виде отдельных препаратов или фиксированных комбинаций, выпускаемых фармацевтической промышленностью. Комбинированное применение может обеспечивать как усиление того или иного фармакологического эффекта, так и расширение спектра гепатотропного действия. Наиболее часто в комбинациях изучаются и применяются эссенциальные фосфолипиды, глицирризиновая кислота, урсодезоксихолевая кислота, силибинин и S-аденозилметионин. В работе обсуждены патогенетические обоснования комбинированного использования гепатотропных лекарственных средств и проведен анализ результатов доклинических и клинических исследований, посвященных использованию комбинаций при различных заболеваниях печени.

Fixed-dose drug products as well as non-fixed hepatoprotective drug combinations are commonly used in modern clinical practice. Combined and concurrent drug use makes it possible to augment the pharmacological effects of individual agents, or extend the range of their potential indications. The drugs most commonly considered for combination therapy include essential phospholipids, glycyrrhizinic acid, ursodeoxycholic acid, silibinin, and S-adenosylmethionine. This paper discusses the rationale for combined use of liver-targeting drugs from a pathogenetic viewpoint, and provides a review of the evidence from clinical trials on combined pharmacotherapy for liver disease.

заболевания печенигепатопротекторыэссенциальные фосфолипидыглицирризиновая кислотаурсодезоксихолевая кислотасилибининS-аденозилметионинliver diseasehepatoprotective agentsessential phospholipidsglycyrrhizinic acidursodeoxycholic acidsilibininS-adenosylmethionineReferencesFong S.Y., Brandl M., Bauer-Brandl A. Phospholipid-based solid drug formulations for oral bioavailability enhancement: A meta-analysis. Eur J Pharm Sci. 2015;80:89-110. doi:10.1016/j.ejps.2015.08.005Fong S.Y., Brandl M., Bauer-Brandl A. Phospholipid-based solid drug formulations for oral bioavailability enhancement: A meta-analysis. Eur J Pharm Sci. 2015;80:89-110. doi:10.1016/j.ejps.2015.08.005Medvedeva N.V., Prosorovskiy V. N., Ignatov D. V., et al. Biomed Khim. 2015;61(2):219-230. (In Russ.) doi:10.18097/PBMC20156102219@@Медведева Н. В., Прозоровский В. Н., Игнатов Д. В. и др. Лекарственные препараты и транспортные наносистемы на основе растительных фосфолипидов. Биомедицинская химия. 2015;61(2):219-230. doi:10.18097/PBMC20156102219Medvedeva N.V., Prosorovskiy V. N., Ignatov D. V., et al. Biomed Khim. 2015;61(2):219-230. (In Russ.) doi:10.18097/PBMC20156102219@@Медведева Н. В., Прозоровский В. Н., Игнатов Д. В. и др. Лекарственные препараты и транспортные наносистемы на основе растительных фосфолипидов. Биомедицинская химия. 2015;61(2):219-230. doi:10.18097/PBMC20156102219Okovityi S.V., Bolotova V. Ts., Anisimova N. A., et al. Prospects for using plant extracts to correct fat and carbohydrate metabolism disorders. Pharmacy. 2020;69(2):17-22. (In Russ.) doi:10/29296/25419218-2020-02-03@@Оковитый С. В., Болотова В. Ц., Анисимова Н. А. и др. Перспективы применения растительных извлечений для коррекции нарушений жирового и углеводного обмена. Фармация. 2020;69(2):17-22. doi:10/29296/25419218-2020-02-03Okovityi S.V., Bolotova V. Ts., Anisimova N. A., et al. Prospects for using plant extracts to correct fat and carbohydrate metabolism disorders. 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Г., Байкова И. Е., Кисляков В. А. и др. Динамика провоспалительных цитокинов у пациентов с алкогольной болезнью печени на фоне лечения Фосфогливом. Лечебное дело. 2009;(3):66-74.Mekhtiev S. N. Perspectives for complex therapy of patients with advanced fibrosis due to alcoholic liver disease. Effektivnaya Farmakoterapiya. 2011;(2):15-22. (In Russ.) @@Мехтиев С. Н. Перспективы комплексной терапии больных алкогольной болезнью печени с выраженными стадиями фиброза. Эффективная фармакотерапия. 2011;(2):15-22.Mekhtiev S. N. Perspectives for complex therapy of patients with advanced fibrosis due to alcoholic liver disease. Effektivnaya Farmakoterapiya. 2011;(2):15-22. (In Russ.) @@Мехтиев С. Н. Перспективы комплексной терапии больных алкогольной болезнью печени с выраженными стадиями фиброза. Эффективная фармакотерапия. 2011;(2):15-22.Li J.Y., Cao H. Y., Liu P., et al. Glycyrrhizic acid in the treatment of liver diseases: literature review. Biomed Res Int. 2014;2014:872139. doi:10.1155/2014/872139Li J.Y., Cao H. Y., Liu P., et al. Glycyrrhizic acid in the treatment of liver diseases: literature review. Biomed Res Int. 2014;2014:872139. doi:10.1155/2014/872139Ipatova O.M., Torkhovskaia T. I., Kniazhev V. A., et al. Use of a novel hepato-protective preparation “Phosphogliv” for inhibition of development of chronic hepatitis in rats. Vopr Med Khim. 1998;44(6):537-543. (In Russ.) @@Ипатова О. М., Торховская Т. И., Княжев В. А. и др. Торможение с помощью нового гепато-протекторного препарата «Фосфоглив» развития хронического гепатита у крыс. Вопросы Медицинской Химии. 1998;44(6):537-542.Ipatova O.M., Torkhovskaia T. I., Kniazhev V. A., et al. Use of a novel hepato-protective preparation “Phosphogliv” for inhibition of development of chronic hepatitis in rats. Vopr Med Khim. 1998;44(6):537-543. (In Russ.) @@Ипатова О. М., Торховская Т. И., Княжев В. А. и др. Торможение с помощью нового гепато-протекторного препарата «Фосфоглив» развития хронического гепатита у крыс. Вопросы Медицинской Химии. 1998;44(6):537-542.Ivashkin V.T., Bakulin I. G., Bogomolov P. O., et al. Efficacy and safety of glycyrrhizic acid combined to essential phospholipids (Phosphogliv) at non-alcoholic fatty liver disease: results of multicenter double blind randomized placebo-controlled post-registration clinical study (IV phase) «Gepard» (PHG-M2/P02-12).Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(2):34-43. (In Russ.) doi:10.22416/1382-4376-2017-27-2-34-43 @@Ивашкин В. Т., Бакулин И. Г., Богомолов П. О. и др. Результаты многоцентрового двойного слепого рандомизированного плацебо-контролируемого пострегистрационного (IV фаза) клинического исследования «Гепард» (PHG-M2/P02-12), проведенного с целью оценки эффективности и безопасности комбинированного препарата глицирризиновой кислоты и эссенциальных фосфолипидов (Фосфоглив) при неалкогольной жировой болезни печени. Российский Журнал Гастроэнтерологии, Гепатологии, Колопроктологии. 2017;27(2):34-43.Ivashkin V.T., Bakulin I. G., Bogomolov P. O., et al. Efficacy and safety of glycyrrhizic acid combined to essential phospholipids (Phosphogliv) at non-alcoholic fatty liver disease: results of multicenter double blind randomized placebo-controlled post-registration clinical study (IV phase) «Gepard» (PHG-M2/P02-12).Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(2):34-43. (In Russ.) doi:10.22416/1382-4376-2017-27-2-34-43 @@Ивашкин В. Т., Бакулин И. Г., Богомолов П. О. и др. 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Efficacy of essential phospholipids in treatment of patients with non-alcoholic steatohepatitis. Klinicheskie Perspektivy Gastroenterologii, Gepatologii. 2010;(3):3-11. (In Russ.) @@Вьючнова Е. С., Маев И. В., Бабина С. М. Эффективность эссенциальных фосфолипидов в лечении больных с неалкогольным стеатогепатитом. Клинические перспективы гастроэнтерологии, гепатологии. 2010;(3):3-11.Moyseyenko V.O., Manzhalii E. G. Possibilities of the use of Phosphogliv preparationin the treatment of steatohepatitiswith concomitant chronic colitis. Modern Gastroenterology. 2014;2(76):107-115. (In Russ.) @@Мойсеенко В. А., Манжалий Э. Г. Возможности применения препарата «Фосфоглив» в лечении стеатогепатита с сопутствующим хроническим колитом. Сучасна Гастроентерологія. 2014;2(76):107-115.Moyseyenko V.O., Manzhalii E. G. Possibilities of the use of Phosphogliv preparationin the treatment of steatohepatitiswith concomitant chronic colitis. Modern Gastroenterology. 2014;2(76):107-115. (In Russ.) @@Мойсеенко В. А., Манжалий Э. Г. Возможности применения препарата «Фосфоглив» в лечении стеатогепатита с сопутствующим хроническим колитом. Сучасна Гастроентерологія. 2014;2(76):107-115.Bakulin I.G., Bokhan N. A., Bogomolov P. O., et al. Efficacy and safety of glycyrrhizic acid and essential phospholipids (Phosphogliv) combination for alcoholic liver disease: results of the double-blind randomized placebo-controlled multicenter post-registration (phase IV) clinical trial «Jaguar» (PHG-M2/P03-12).Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(3):57-68. (In Russ.) doi:10.22416/1382-4376-2017-27-3-57-68 @@Бакулин И. Г., Бохан Н. А., Богомолов П. О. и др. 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The authors declare that there are no conflicts of interest present.