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Therapie chronisch-entzündlicher Darmerkrankungen (CED)

Einsatz von Biologika zur CED-Behandlung bei Kindern und Jugendlichen

Treatment of chronic inflammatory enterocolitis (CIE)

Use of biologics for treatment of CIE in children and adolescents

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Zusammenfassung

Biologika, insbesondere TNFα-Blocker (TNF: Tumornekrosefaktor), haben die Therapie chronisch-entzündlicher Darmerkrankungen optimiert. Infliximab ist als bisher einziger TNFα-Blocker für Kinder mit moderatem bzw. schwerem Morbus Crohn zugelassen. Studiendaten ergaben bei ihnen einen Steroid sparenden und das Wachstum optimierenden Effekt. Bei Versagen einer Standardtherapie sowie bei extraintestinalem Befall und Fisteln ist Infliximab indiziert und wird zunehmend primär oder früh im Therapiekonzept eingesetzt. Bei Kindern mit schwerer Colitis ulcerosa ist es trotz fehlender Zulassung eine mindestens gleichwertige Alternative zu bisherigen Immunsuppressiva. Bei Wirkungsverlust von Infliximab kann Adalimumab trotz fehlender Zulassung als Therapieversuch angewendet werden. Dies gilt sowohl für den Morbus Crohn als auch für die Colitis ulcerosa. In jedem Fall sind Eltern und Patienten entsprechend aufzuklären und über kurz- und langfristige Sicherheitsaspekte der Biologika vollständig zu informieren.

Abstract

Infliximab, a monoclonal antibody against TNFα has been approved for induction and maintenance of remission in moderate to severe pediatric Crohn’s disease which is unresponsive to conventional therapy. Regularly scheduled maintenance therapy is recommended. Inflixmab is also at least an equal therapeutic alternative to previous immune suppressants in children with severe ulcerative colitis despite the lack of approval. Adalimumab may be used for attempted therapy in cases of loss of response to infliximab despite the lack of approval. Patients and their parents must be fully informed on short and long-term safety data as well as adverse events with TNFα blockers.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor ist Mitglied im Advisory Board chronisch-entzündliche Darmerkrankungen im Kindesalter der Fa. Essex sowie als Referent für die Firmen Essex und Abbott tätig.

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  1. Klinik für Kinder- und Jugendmedizin, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467, Potsdam, Deutschland

    M. Radke

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Correspondence to M. Radke.

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Radke, M. Therapie chronisch-entzündlicher Darmerkrankungen (CED) . Monatsschr Kinderheilkd 158, 766–773 (2010). https://doi.org/10.1007/s00112-010-2195-3

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