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Etanercept

Ein effektiver TNF-α-Antagonist zur Behandlung von Psoriasisarthritis und Psoriasis vulgaris

Etanercept

An effective TNF α-antagonist in the treatment of psoriatic arthritis and chronic plaque psoriasis

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Zusammenfassung

Mit dem TNF-α-Antagonisten Etanercept steht zur Behandlung der Psoriasisarthritis und der Psoriasis vulgaris ein effektives Medikament zur Verfügung. Etanercept ist ein rekombinant hergestelltes Fusionsprotein, das aus 2 Domänen des p-75-TNF-α-Rezeptors und dem Fc-Fragment des humanen IgG1 besteht. Als Protein ist Etanercept zwingend parenteral (subkutan) zu applizieren. Die Wirksamkeit ist sowohl für die psoriatischen Hautläsionen als auch die Gelenkbeteiligung durch kontrollierte Studien belegt. Die Dosierung beträgt 2-mal 25 mg/Woche, bei schweren Fällen ist eine Dosiserhöhung auf 2-mal 50 mg/Woche möglich. Vor Behandlungsbeginn sind Infektionen einschließlich Tuberkulose auszuschließen. Eine Kombinationsbehandlung mit anderen immunsuppressiven Medikamenten bzw. pharmakologischen Immunmodulatoren ist möglich. Alle topischen Antipsoriatika können ebenfalls mit einer Etanercepttherapie kombiniert werden. Im sog. Off-label-Gebrauch wurde das Fusionsprotein bei einer Reihe weiterer, überwiegend entzündlicher Dermatosen mit Erfolg eingesetzt. Bei richtiger Indikationsstellung, regelrechtem Monitoring und Beobachtung möglicher unerwünschter Wirkungen hat Etanercept ein akzeptables Sicherheitsprofil. Etanercept stellt neben anderen Biologics eine der wichtigsten therapeutischen Innovationen der letzten Jahre dar.

Abstract

Etanercept, an inhibitor of TNF α, has been found effective in the treatment of psoriatic arthritis and psoriasis vulgaris. Etanercept is a fusion protein made up of domains of the soluble, fully human p75-TNF α receptor and the Fc portion of human IgG1. The drug is a protein which must be administered subcutaneously. Several controlled studies have highlighted its efficacy for both skin symptoms and joint involvement. The usual dose is 25 mg s.c. twice weekly. Higher dosages of 50 mg twice weekly may be used in severe cases. Before starting the therapy with etanercept, infections including tuberculosis have to be excluded. Methotrexate and other pharmacological immunosuppressive agents can be combined with etanercept, as can all standard topical agents. Etanercept in off-label use has been found to also be useful in several other inflammatory dermatologic conditions. If patients are carefully monitored, etanercept is generally well-tolerated and has a good safety profile. The development of novel biologic agents such as etanercept is one of the most important therapeutic innovations of recent years.

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Notes

  1. Bei einer Grundgesamtheit eines Patientenkollektivs muss sich der Medianwert des PASI nach einem definierten Behandlungszeitraum um mindestens 90% im Vergleich zum Ausgangs-PASI verbessert haben.

Abbreviations

ACR:

American College of Rheumatology

AE:

Adverse Event

ANA:

Antinukleäre Antikörper

CD:

Clusters of differentiation (Nomenklatur der Oberflächenmarker)

DLQI:

Dermatology Life Quality Index (Index für Erfassung der Lebensqualität)

FDA:

Food and Drug Administration (US-amerikanische Zulassungsbehörde)

GCP:

Good Clinical Practice

HAQ:

Health Assessment Questionnaire

MTX:

Methotrexat

NSAR:

Nichtsteroidale Antirheumatika

PASI:

Psoriasis Area and Severity Index

PGA:

Physician Global Assessment

PsARC:

Psoriasis Arthritis Response Criteria

RA:

Rheumatoide Arthritis

TNF-α:

Tumornekrosefaktor-α

UAW:

Unerwünschte Arzneimittelwirkungen

VAS:

Visual Analog Scala (Visuelle Analogskala)

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Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Mitglied des Advilon Board von Wyeth Pharma GmbH Deutschland

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Custav Carus Dresden an der Technischen Universität Dresden

    G. Wozel

  2. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden, Fetscherstraße 74, 01307 , Dresden

    G. Wozel

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Correspondence to G. Wozel.

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Interessenkonflikt: Der Autor ist Mitglied des nationalen Advisory Board von Wyeth Pharma GmbH Deutschland.

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Wozel, G. Etanercept. Hautarzt 56, 819–830 (2005). https://doi.org/10.1007/s00105-005-1006-6

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  • DOI: https://doi.org/10.1007/s00105-005-1006-6

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