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Ulkusrisiko und-prophylaxe bei der Therapie mit nichtsteroidalen Antirheumatika

Therapy with nonsteroidal antiinflammatory drugs: Risk and prevention of gastrointestinal ulcer

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Zusammenfassung

Nichtsteroidale Antirheumatika gehören zu den am häufigsten verordneten Medikamenten in den westlichen Ländern. Die hohe Inzidenz gastrointestinaler Nebenwirkungen, die potentiell lebensgefährlich sein können, erfordern Maßnahmen zur Prävention in der Praxis. Vor der Applikation von NSAR ist die Indikation kritisch zu hinterfragen und bei Notwendigkeit des Einsatzes die Identifikation von Risikopatienten praktisch bedeutsam. Patienten mit einem hohen Risiko für gastrointestinale Nebenwirkungen durch NSAR sollten als Prophylaxe Misoprostol in einer Dosis von 2- bis 3mal 200 μg/Tag erhalten. Misoprostol ist zur Zeit das einzige Medikament mit eindeutig gesicherter Wirksamkeit in der Prophylaxe der NSAR-induzierten Ulcera ventriculi und duodeni sowie deren Komplikationen. NSAR sind Inhibitoren des Schlüsselenzyms der Prostaglandinsynthese, der Cyclooxygenase. Neuere Erkenntnisse zeigen, daß zwei Isoenzyme der Cyclooxygenase existieren, von denen die Cyclooxygenase 1 für die Aufrechterhaltung von Organfunktionen von großer Bedeutung ist und die Cyclooxygenase 2 im entzündeten Gewebe exprimiert wird. Mittlerweile wurden gezielt Substanzen entwickelt, die fast ausschließlich die Aktivität der Cyclooxygenase 2 inhibieren. Zukünftige Studien müssen zeigen, ob das pathophysiologische Konzept der selektiven Cyclooxygenase-2-Inhibition mit hoher antiinflammatorischer Wirksamkeit ohne gastrointestinale Nebenwirkungen vom Tiermodell auf den Menschen übertragbar ist.

Summary

Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently prescribed drugs in western countries. The high incidence of adverse gastrointestinal effects which are potentially life-threatening require steps for prevention. The use of NSAIDs should be restricted to patients with inflammatory rheumatic diseases. If NSAIDs are indicated it is important to identify patients who are at high risk to develop serious gastrointestinal side effects. These patients should receive Misoprostol at a dose of 2 to 3×200 μg per day. Up to date Misoprostol is the only drug with proven efficacy with respect to the prevention of gastroduodenal ulcer and its complications. NSAIDs inhibit the key enzyme of prostaglandin synthesis, the cyclooxygenase. Recently published data show that 2 isoenzymes of the cyclooxygenase exists. Cyclooxygenase-1 is primarily involved in the maintenance of organ function whereas cyclooxygenase-2 is expressed in inflamed tissue. Specific cyclooxygease-2 inhibitors have been developed. Clinical trials have to prove if the concept of a selective cyclooxygenase-2 inhibition with high antiinflammatory potency but lack of gastrointestinal side effects holds true in humans.

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  1. Abteilung Rheumatologie, Medizinische Hochschule, Konstanty-Gutschow-Straße 8, D-30625, Hannover

    Lars Köhler, Wilfried Mau & Henning Zeidler

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Köhler, L., Mau, W. & Zeidler, H. Ulkusrisiko und-prophylaxe bei der Therapie mit nichtsteroidalen Antirheumatika. Med. Klin. 92, 726–735 (1997). https://doi.org/10.1007/BF03044669

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