Zeitschrift für Rheumatologie

, Volume 66, Issue 8, pp 662–671

ModerneTherapie bei systemischem Lupus erythematodes

Leitthema

Zusammenfassung

Auch wenn seit über 40 Jahren keine neue Therapie für den systemischen Lupus erythematodes (SLE) zugelassen wurde, haben sich die Behandlungsmöglichkeiten in dieser Zeit entscheidend erweitert. Die zugrunde liegende Evidenz für die meisten Therapieformen ist weiterhin eher gering, dennoch gibt es einen großen Konsens über eine individuelle, an die Krankheitsaktivität und -ausprägung angepasste immunsuppressive Therapie. Verschiedene neue Substanzen, z. B. andere Immunsuppressiva und Anti-Zell-Therapien, wurden in meist offenen Studien geprüft. Im Hinblick auf die Erfahrung bei anderen Indikationen besitzen Mycophenolsäure und Rituximab ein viel versprechendes Potenzial, in der Therapie des Lupus zugelassen zu werden. Daneben besitzen aber „alte Medikamente“ wie die Antimalariamittel unverändert einen hohen Stellenwert. Entscheidend für die Verbesserung der Langzeitprognose sind neben der wirkungsvollen Unterdrückung der Krankheitsaktivität insbesondere die Behandlung von Komorbiditäten und das Vermeiden von negativen Therapie- und Erkrankungsfolgen wie Infektionen, Osteoporose und vorzeitiger Arteriosklerose im Sinne einer Sekundärprävention. Da diese „einfachen“ Maßnahmen in der modernen Therapie oft noch unberücksichtigt bleiben, setzen wir in dieser Übersicht zum aktuellen Behandlungskonzept bei SLE hier einen Schwerpunkt und gehen ausführlicher auf diese Aspekte ein. Im Hinblick auf neue, zukünftige Therapien verweisen wir auf andere aktuelle Publikationen.

Schlüsselwörter

Systemischer Lupus erythematodes Therapie Prävention 

Modern therapy for systemic lupus erythematosus

Abstract

Even though no new treatment for systemic lupus erythematosus (SLE) has been approved in over 40 years, the treatment possibilities have expanded decisively in this time. The available evidence for most forms of therapy is rather thin, yet there is a wide consensus on an individual immunosuppressive therapy that is adjusted to the illness activity and severity. Various new substances, e.g. other immunosuppressants and anti-cell therapies have been tested, mostly in open studies. Considering the experience in other indications, mycophenolate mofetil and rituximab have a very promising potential to be approved for therapy of SLE. Aside from these, “old medications” such as antimalarial drugs still possess a high value. Besides the effective suppression of the illness activity, this is especially decisive for the improvement of the long-term prognosis, the treatment of co-morbidities and secondary prevention and the avoidance of negative effects of the illness and therapy, such as infections, osteoporosis, and premature arteriosclerosis. As these “simple” measures often remain disregarded in modern therapy, they will be focused on in this overview on the current treatment concepts for SLE and these aspects will be discussed in greater depth. With regard to new future therapies, we refer the reader to other current publications.

Keywords

Systemic lupus erythematosus Treatment Prevention 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-UniversitätDüsseldorfDeutschland

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