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Antizytokintherapie

Anticytokine therapy

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Zusammenfassung

Zytokininhibitoren haben die Behandlung chronisch-entzündlicher Erkrankungen revolutioniert, insbesondere die Therapie von Autoimmunerkrankungen. Dabei nimmt die Tumor-Nekrose-Faktor(TNF)-α-Blockade weiterhin eine zentrale Stellung ein. Mittlerweile stehen 5 TNF-Antagonisten mit Indikationen in der Rheumatologie, Dermatologie und Gastroenterologie zur Verfügung. Weitere Therapieansätze kamen in den letzten 10 Jahren hinzu, z. B. die Blockade von Interleukin(IL)-1, IL-6 und IL-12/23. Der große Vorteil der Zytokinblockade ist ihr schneller Wirkungseintritt und spezifischer Wirkansatz verbunden mit einem tolerablen Nebenwirkungsprofil. Dennoch können teils schwere Nebenwirkungen auftreten, v. a. die Tuberkulose- und Hepatitis-B-Infektion bzw. -Reaktivierung. Ein entsprechendes Screening vor der Therapie ist daher Standard. Ebenso ist eine gute Dokumentation des Krankheitsverlaufs von Bedeutung. Die Entwicklung weiterer Behandlungsansätze zur Remissionsinduktion und -erhaltung bleibt unerlässlich.

Abstract

Anticytokine therapies have revolutionized the treatment of chronic inflammatory diseases, particularly autoimmune diseases such as rheumatoid arthritis. As the first introduced principle of cytokine blockade in the 1990s, tumor necrosis factor (TNF)-α antagonists still represent the leading anticytokine therapy. There are currently five TNF antagonists available with indications in the fields of rheumatology, dermatology, and gastroenterology. Other therapeutic approaches have been introduced in the last 10 years, e.g., the blockade of interleukin (IL)-1, IL-6, and IL-12/23. The advantages of cytokine blockers are their rapid onset of action with high response rates and a tolerable safety profile. Nevertheless, anticytokine therapy can cause increased rates of tuberculosis and hepatitis B infections or reactivation. An appropriate screening before therapy is mandatory, and thorough monitoring of the disease course before and during therapy is also important. The development of further anticytokine drugs for the induction and maintenance of remission is, therefore, required.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: E. Feist und G.-R. Burmester: Vorträge und Beratungstätigkeit sowie klinische Studien mit Abbott, MSD, Pfizer, Roche/Chugai, UCB, Novartis und MedImmune. L. Naumann: Vorträge mit Abbott und Roche/Chugai.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    L. Naumann,  E. Feist & G.-R. Burmester

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  1. L. Naumann
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  2. E. Feist
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  3. G.-R. Burmester
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Correspondence to E. Feist.

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Naumann, L., Feist, E. & Burmester, GR. Antizytokintherapie. Internist 54, 449–463 (2013). https://doi.org/10.1007/s00108-012-3202-7

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  • DOI: https://doi.org/10.1007/s00108-012-3202-7

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