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Therapie mit nichtsteroidalen Antirheumatika (NSAR)

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Zusammenfassung

Weltweit gehören die nichtsteroidalen Antirheumatika (NSAR) zu den am häufigsten verordneten Medikamenten. Durch eine Hemmung der Prostaglandinsynthese führen sie zu einer raschen und guten analgetischen und antiphlogistischen Wirkung. Der Einsatz geht allerdings mit z. T. erheblichen, bisher oft unterschätzten Nebenwirkungen einher. Vor allem Nebenwirkungen am Gastrointestinaltrakt oder an der Niere können häufig den Einsatz limitieren. Alle herkömmlichen NSAR hemmen beide Isoformen der Cyclooxygenase (COX).

Über die Inhibition der COX-2 wird im Wesentlichen die antiphlogistische und analgetische Wirkung vermittelt, die Hemmung der COX-1 ist für einen großen Teil der Nebenwirkungen verantwortlich. Bei entsprechenden Risikopatienten sollten neben einer strengen Indikationsstellung für die Therapie mit NSAR eine medikamentöse Prophylaxe gastrointestinaler Nebenwirkungen durchgeführt werden. Alternativ kommen hier Substanzen aus der Gruppe der selektiven COX-2-Hemmer in Frage. Diese Substanzen zeigen in der Regel eine vergleichbar gute analgetische Wirksamkeit, bei einem deutlich reduzierten gastrointestinalen Risikoprofil, zumindest dort, wo zusätzliche Risiken, wie z. B. eine niedrig dosierte ASS-Therapie zur kardiovaskulären Prophylaxe nicht notwendig sind. Bei Patienten mit renaler Vorschädigung sind beide Substanzgruppen nur mit äußerster Vorsicht und unter strengen Kontrollen einzusetzen.

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs worldwide. Their analgetic and antiphlogistic effect results from an efficient inhibition of prostaglandin synthesis. The risk of side effects is remarkable. This concerns namely side effects in the gastrointestinal tract and the kidneys. The common NSAIDs inhibit both isoforms of the cyclooxygenase (COX). The analgetic and antiphlogistic effect results from the inhibition of COX-2, whereas the inhibition of COX-1 is responsible for the majority of side effects.

If NSAID therapy is necessary, patients at risk should receive an effective prophylaxis, or be treated with COX-2-selective substances. The analgetic effects of COX-2 inhibitors are comparable to common NSAIDs, with a significant reduction of the gastrointestinal risks, except in cases of additional risk factors, e.g., low-dose ASS therapy, etc. In cases of renal impairment both substances should be used with caution, and subtle monitoring is necessary.

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  1. Schwerpunkt Rheumatologie, Klinische Immunologie, Klinik Nephrologie, Innere Medizin IV, Dr.-Horst-Schmidt-Kliniken GmbH (HSK), Wiesbaden

    H. Bauer & E. Märker-Hermann

  2. Schwerpunkt Rheumatologie, Klinische Immunologie, Klinik Nephrologie, Innere Medizin IV, Dr.-Horst-Schmidt-Kliniken GmbH (HSK), Aukammallee 39, 65191, Wiesbaden

    H. Bauer

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  2. E. Märker-Hermann
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Correspondence to H. Bauer.

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Bauer, H., Märker-Hermann, E. Therapie mit nichtsteroidalen Antirheumatika (NSAR). Orthopäde 32, 1088–1094 (2003). https://doi.org/10.1007/s00132-003-0559-2

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