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NSAR und Coxibe: aktueller Stand

NSAIDs and COX-2-inhibitors: current status

  • Arzneimitteltherapie
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Zusammenfassung

Nichtsteroidale Antirheumatika (NSAR) sind nach wie vor ein zentraler Bestandteil der Schmerztherapie bei degenerativen und entzündlichen Erkrankungen des Skelettapparates. Der guten therapeutischen Wirksamkeit steht allerdings ein ausgedehntes Spektrum an Nebenwirkungen gegenüber. Coxibe als Weiterentwicklung der konventionellen NSAR erscheinen geeignet, die gastrointestinale Sicherheit vor allem bei Risikopatienten zu verbessern. Dieser Effekt ist offenbar auch in der Kombination von NSAR mit Protonenpumpenhemmern zu erzielen. Die Behandlung mit Coxiben ist allerdings mit einem erhöhten Risiko kardiovaskulärer Nebenwirkungen verknüpft. Möglicherweise trifft dies auch für konventionelle NSAR zu. Deshalb sollten Patienten mit entsprechendem Risikoprofil diese Substanzen nicht erhalten. Ansonsten gilt, dass die Behandlung so kurz und niedrig dosiert wie möglich durchzuführen ist. Zu beachten ist, dass eine begleitende Therapie mit Acetylsalicylsäure den protektiven Effekt der Coxibe am Gastrointestinaltrakt aufzuheben scheint. Ziel künftiger Studien sollte es sein, Risikogruppen klarer zu definieren, um dann die Therapie mit dem besten Nutzen-Risiko-Profil für den Patienten individuell auswählen zu können.

Abstract

NSAIDs (non steroidal anti-inflammatory drugs) are a crucial component for the therapy of pain induced by inflammatory and degenerative joint diseases. Nevertheless their known therapeutic efficacy is contrasted by significant side effects. The recently developed selective COX-2-inhibitors appear to have a better gastrointestinal safety profile, especially relevant to patients with an increased risk for gastrointestinal ulcers and bleeding. However, this effect may similarly be reached by the combination of NSAIDs with proton pump inhibitors. Recent data relate to an elevated myocardial infarction rate in patients using COX-2-inhibitors. This risk may also occur in conventional NSAIDs. Therefore an individual risk calculation is necessary before COX-2-inhibitors or NSAIDs are used. Treatment should be performed with the lowest dosage for the shortest time possible. Combination therapy with salicylic acid seems to abolish the protective effect of COX-2-inhibitors in the GI-tract. Definite risk factors for the treatment with NSAIDs and COX-2-inhibitors have to be defined in further studies providing the best treatment schedule for an individual patient.

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Authors and Affiliations

  1. Schwerpunkt Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik II der Universität, Klinikstraße 6–8, 97070, Würzburg

    C. Kneitz & H. P. Tony

  2. Praxiszentrum St. Bonifatius, München

    K. Krüger

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  1. C. Kneitz
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  2. H. P. Tony
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  3. K. Krüger
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Correspondence to C. Kneitz.

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Kneitz, C., Tony, H.P. & Krüger, K. NSAR und Coxibe: aktueller Stand. Internist 47, 533–540 (2006). https://doi.org/10.1007/s00108-006-1585-z

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