Infektionsrisiko durch Biologika

Leitthema

Zusammenfassung

Tumor-Nekrose-Faktor- (TNF-)α spielt eine essenzielle Rolle in der Vermittlung und Aufrechterhaltung entzündlicher Prozesse, sowohl bei Autoimmunerkrankungen als auch in der Infektabwehr einschließlich der Granulomformation. TNF-α-Antagonisten sind hocheffektiv in der Therapie der rheumatoiden Arhritis (RA) und weiterer Autoimmunerkrankungen. Sie kompromittieren jedoch die ohnehin durch eine Autoimmunerkrankung reduzierte Infektabwehr, insbesondere bei der Kontrolle von Infektionen, die mit einer Granulombildung einhergehen, wie z. B. der Tuberkulose. Weitere Biologika mit anderen Wirkprinzipien wie Inhibition von Interleukin- (IL-)1 (Anakinra), B-Zell-Depletion (Rituximab) und Blockierung der T-Zell-Kostimulation (Abatacept) sind mittlerweile entwickelt und für die Therapie der RA zugelassen. Nach anfänglicher Skepsis, die insbesondere durch die erhöhte Inzidenz von Tuberkulosereaktivierungen unter TNF-α-Antagonisten geschürt wurde, haben Biologika heute eine feste Rolle in der Anwendung als Immunsuppressiva bei verschiedenen Autoimmunerkrankungen. Zur Reduktion unerwünschter Nebenwirkungen – vor allem von Infektionen – gibt es heute Richtlinien für Screening-Untersuchungen und Verlaufskontrollen. Die Effizienz dieser Untersuchungen und Kontrollen wurde eindrucksvoll anhand der drastischen Reduktion der Tuberkulosefälle unter der Therapie mit TNF-α-Antagonisten belegt. Diese Übersicht fasst die aktuelle Datenlage hinsichtlich des Infektionsrisikos der Biologika zusammen und gibt Aufschluss über notwendige Screening-Untersuchungen und Verlaufskontrollen vor und unter Therapie, um Nebenwirkungen wie Infektionen zu vermeiden oder frühzeitig zu erkennen sowie Kontraindikationen und Abbruchgründe.

Schlüsselwörter

Biologika Opportunistische Infektionen Tuberkulose 

Risk of infection by biologics

Abstract

Tumor necrosis factor (TNF-α) plays an essential role in the orchestration of inflammatory processes including autoimmune disorders, host defence and granuloma formation. TNF antagonists are highly effective in the therapy of rheumatoid arthritis, but they compromise host defence mechanisms, especially concerning bacterial infections inducing granuloma formation, such as tuberculosis. Other biologics have been developed and approved for the therapy of rheumatoid arthritis, e.g. an interleukin (IL-1) blocking agent (anakinra), an antibody that depletes CD20 positive B-cells (rituximab) and an inhibitor of T-cell co-stimulation (abatacept). In spite of initial skepticism regarding side effects, such as an increased risk of infections, biologics now play an essential role in the therapy of autoimmune diseases due to the implementation of efficient screening measures concerning side effects (such as reactivation of tuberculosis). This review summarizes the current available data regarding risk of infection and gives and overview on recommended screening, contraindications and events that require withdrawal of therapy.

Keywords

Biologics Opportunistic infections Tuberculosis 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland

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