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Personalisierte Medizin bei Zytokin-gerichteten Therapien

Personalized medicine in cytokine-targeted therapy

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Zusammenfassung

Personalisierte Medizin versucht über die Definition von Patientencharakteristika (Biomarker) eine Prädiktion von Wirksamkeit und Sicherheit einer Therapie für den (im Idealfall) individuellen Patienten zu ermöglichen. Mittels stratifizierter Medizin kann über diagnostische Verfahren und Beschreibung von Patientengruppen eine Voraussage zum Ansprechen einer medikamentösen Therapie getroffen und ein bestmögliches Sicherheitsprofil für die umschriebene Patientengruppe erreicht werden. Anwendung finden beide Verfahren derzeit vorwiegend in den Gebieten der Hämatologie-Onkologie sowie in der Infektiologie. Angesichts dessen, dass bei modernen antirheumatischen Therapien in 30–40% ein Wirkversagen vorliegt, stellen Personalisierung und Stratifizierung in der Rheumatologie eine Möglichkeit dar, den Einsatz vorhandener Therapien zu optimieren. Eingesetzt werden als Erstlinientherapie nach Versagen konventioneller Basistherapien Zytokininhibitoren. Diese spielen eine entscheidende Rolle in der Therapie chronisch entzündlicher Erkrankungen. Inhibitoren proinflammatorischer Zytokine wie TNF-α, IL-1, IL-6 besitzen eine hohe Wirkpotenz, die aber nur bei einem Teil der Patienten erreicht werden kann. Erste Erkenntnisse zu möglichen Wegen der Stratifizierung und Personalisierung mittels molekularer oder genetischer Marker liegen vor.

Abstract

Personalized healthcare tries to predict the effectiveness and safety in individual therapeutic approaches by defining individual patient characteristics (biomarkers), while stratification uses diagnostic patterns for groups of patients for prediction of therapeutic response with less adverse reactions caused by the drugs applied. Both methods are implemented in oncology and infectiology and in the therapy of rheumatological diseases there is a need for both. Cytokine-directed therapies are important for the treatment of rheumatological diseases, especially when therapy with conventional disease-modifying antirheumatic drugs (DMARD) has failed. Despite the high potency of these drugs for inhibiting pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin 1 (IL-1) and IL-6, sufficient responses are only seen in some of the patients. Therefore, stratification and personalized medicine are ways to optimize efficacy and tolerability of biologic therapies. Some initial evidence is available for potential future strategies using molecular and genetic markers for stratified cytokine inhibition.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: FB erhielt Honorare für Beratung/Vortragstätigkeit von folgenden Firmen: Abbott/AbbVie. Pfizer, Chugai, MSD, AstraZeneca, Morphosys, Biotest Actelion, Roche.

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Authors and Affiliations

  1. CIRI/Rheumatologie, Klinikum Johann Wolfgang Goethe – Universität, 60590, Frankfurt am Main, Deutschland

    F. Behrens

  2. Rheumatologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland

    M. Köhm

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  1. F. Behrens
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  2. M. Köhm
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Correspondence to F. Behrens.

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Behrens, F., Köhm, M. Personalisierte Medizin bei Zytokin-gerichteten Therapien. Z. Rheumatol. 72, 41–48 (2013). https://doi.org/10.1007/s00393-011-0886-3

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