Zusammenfassung
Chronisch-entzündliche Darmerkrankungen weisen eine zunehmende Inzidenz auf und betreffen meist jüngere Menschen in kritischen Lebensphasen. Eine frühe Diagnosestellung sowie eine daraus resultierende schnelle und effiziente Therapieeinleitung sind daher essenziell. In Deutschland hat sich hier das akzelerierte „Step-up“-Vorgehen durchgesetzt, eine schnelle Therapieeskalation bei fehlendem Ansprechen mit früher Einleitung einer immunsuppressiven Therapie. Trotz neuer Therapiestrategien fehlen für eine Subgruppe von Patienten weitere medikamentöse Optionen. Zukünftig könnten für diese Subgruppe die Adhäsionsmolekülantikörper eine neue Therapiemöglichkeit darstellen. Um jedoch primär eine individuelle Therapieplanung zu ermöglichen, ist die Identifizierung von Prädiktoren, die den weiteren Krankheitsverlauf zuverlässig vorhersagen, unabdingbar. Sollten sich die Transkriptomdaten der CD8+-T-Zellen prospektiv bestätigen, steht hier in absehbarer Zukunft ein wichtiger Biomarker zur Verfügung.
Abstract
There is a continuously increasing incidence in inflammatory bowel diseases affecting mostly young people who are in a vulnerable phase of life. Thus, early diagnosis and initiation of an effective therapeutic regimen is critical in order to maintain a good quality of life. In Germany, the standard therapeutic strategy is an accelerated step up approach, including the introduction of early immunosuppressive therapy if required. Although novel therapeutic strategies have found their way into clinical use there is still a substantial subgroup of patients where effective therapy is lacking. The future introduction of anti-adhesion molecule antibodies might provide a realistic option for this subgroup. Equally important is the availability of predictive markers allowing stratification of patients into subgroups at the time of diagnosis. Assuming that the CD8+ T cell transcriptome approach will be confirmed in prospective trials, personalized therapy in patients with inflammatory bowel disease will be the next step.
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Die korrespondierende Autorin weist auf folgende Beziehungen hin:
Die Autorin ist im Advisory Board von Abbott GmbH & Co. KG und MSD und hat Vortragshonorare von den Firmen Abbott GmbH & Co. KG, MSD, Dr. Falk Pharma GmbH und Ferring Arzneimittel GmbH erhalten.
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Siegmund, B. Chronisch-entzündliche Darmerkrankungen. Pathologe 33 (Suppl 2), 211–214 (2012). https://doi.org/10.1007/s00292-012-1641-5
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DOI: https://doi.org/10.1007/s00292-012-1641-5