Zeitschrift für Rheumatologie

, Volume 66, Issue 1, pp 78–82

Neufassung der Empfehlungen der Kommission Pharmakotherapie der DGRh

Stellungnahme zum Einsatz von Mycophenolsäure bei SLE
Qualitätssicherung

Zusammenfassung

Die „Evidence-based-medicine-basierte“ Empfehlung zur Behandlung der diffus-proliferativen Lupusnephritis ist Kortison plus Cyclophosphamid, in der Regel nach dem NIH-Schema. Unerwünschte Wirkungen, Therapieresistenz und Rezidive unterstreichen die Notwendigkeit der Entwicklung alternativer Therapien zur Behandlung der Organbeteiligung. Mycophenolsäure bereichert die Therapiemöglichkeiten beim systemischen Lupus erythematodes (SLE) entscheidend. Basierend auf den zur Verfügung stehenden Studiendaten kann festgestellt werden, dass Mycophenolsäure eine Alternative zur gegenwärtigen Standardtherapie bei der schweren Lupusnephritis (Induktion und Erhaltung) darstellt und weniger Begleittoxizität aufweist. Langzeitdaten fehlen jedoch. Mycophenolsäure ist zudem bei therapierefraktärer aktiver Erkrankung effektiv. Unbeantwortet sind Fragen nach der optimalen Dosis und einer möglichen Reduktion bei Remission. Auch die Dauer der Erhaltungstherapie ist unklar. Mycophenolsäure gehört daher zu den Substanzen, die für die Behandlung der Lupusnephritis in großen, prospektiven, randomisierten klinischen Studien mit einer ausreichend langen Nachbeobachtungsphase geprüft werden.

Schlüsselwörter

Systemischer Lupus erythematodes (SLE) Mycophenolsäure Behandlung Lupusnephritis 

Revision of the recommendations of the Commission on Pharmacotherapy of the German Society for Rheumatology

Comment on the use of mycophenolic acid for systemic lupus erythematosus

Abstract

According to the NIH scheme, the “evidence based medicine” standard in the treatment of severe proliferative lupus-nephritis is cyclophosphamide in combination with steroids. Undesired effects, therapy resistance, and deficient long-term effects underscore the necessity for the development of alternative therapies for the treatment of organ involvement. Mycophenolate mofetil (MMF) possesses the potential to decisively improve the therapeutic possibilities for systemic lupus erythematosus (SLE). On the basis of the available data, MMF represents an alternative to the current standard therapies for severe lupus-nephritises and shows less toxicity. MMF is also effective in patients with other manifestations refractory to conventional therapy. Questions remain unanswered on the optimal dosage and possible reduction in cases of remission. In addition, the duration of maintenance therapy is unclear. Therefore, large, prospective, randomized clinical studies in the treatment of lupus-nephritis with a sufficiently long follow-up phase are underway.

Keywords

Systemic lupus erythematosus Mycophenolate mofetil Treatment Lupus-nephritis 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Klinik für Endokrinologie, Diabetologie und RheumatologieHeinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland
  2. 2.Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische ImmunologieCharité-Universtitätsmedizin Berlin, Campus MitteBerlinDeutschland

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