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Biologika und weitere neue Medikamente in der Rheumatologie seit 2000

Biologics and further new drugs for rheumatic diseases since 2000

Der Orthopäde volume 47, pages 906–911 (2018)Cite this article

Zusammenfassung

Hintergrund

Rheumatoide Arthritis (RA), Psoriasisarthritis (PsA) und axiale Spondyloarthritis (axSpa) sind unbehandelt schwere Erkrankungen, die Mobilität, Funktionalität und Lebensqualität des Betroffenen massiv einschränken.

Ziel der Arbeit

Auswirkungen von Biologika und weiteren neuen Medikamenten auf die Krankheitslast.

Material und Methode

Auswertung der Studienergebnisse und Registerdaten zu Wirkung und Sicherheit dieser Therapien.

Ergebnisse

Biologika haben in dramatischer Weise das Outcome bei allen 3 Erkrankungen verbessert und dazu beigetragen, dass heute als Therapieziel generell die Remission gilt. Speziell bei RA konnten durch diese Substanzen auch die kardiovaskuläre Komorbidität und die Mortalität deutlich verringert werden; das Fortschreiten radiologischer Veränderungen wird weitgehend blockiert. In jüngster Zeit tragen die Januskinase(JAK)-Inhibitoren mit ähnlich guten Ergebnissen zu den Behandlungsmöglichkeiten bei. Beide Medikamentengruppen zeichnen sich durch gute Verträglichkeit aus; zu beachten ist in erster Linie ein erhöhtes Infektionsrisiko.

Schlussfolgerung

Durch die Entwicklung der Biologika und weiterer neuer Medikamente sind diese 3 Erkrankungen in jüngerer Zeit gut behandelbar geworden. Bei leitliniengerechtem Einsatz wird die Krankheitslast in den meisten Fällen minimiert. Die gute Wirksamkeit wird nicht durch erhöhte Toxizität „erkauft“.

Abstract

Background

Rheumatoid arthritis (RA), psoriatic arthritis and axial spondyloarthritis are severe diseases, which without adequate treatment lead to extremely reduced mobility, functional status and quality of life.

Objective

The effects of biologics and further new antirheumatic drugs on the burden of disease.

Methods

Evaluation of study results and register data dealing with the efficacy and safety of these drugs.

Results

Biologics have been proven to dramatically improve the outcome of all three diseases and contributed to the fact that remission is a realistic target today. In addition, the cardiovascular risk and mortality in RA have been reduced and structural damage is considerably blocked by biologics. Recently Janus kinase (JAK) inhibitors contributed to the treatment possibilities in the same way. Biologics as well as JAK inhibitors offer an excellent safety profile and tolerability with infections being the most important risk.

Conclusion

With the availability of biologics and additional new drugs all three diseases have lost the status of difficult to treat diseases. Their usage according to the guidelines ensures that the burden of disease can been minimalized in most cases. The benefit-risk profile of these drugs has been shown to be excellent.

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Abbreviations

AU:

Arbeitsunfähigkeit

axSpa:

Axiale Spondyloarthritis

CRP:

C-reaktives Protein

DAS28:

Disease Activity Score 28

DMARD:

„Disease modifying antirheumatic drugs“

   b:

   „biological“

   bs:

   „biosimilar“

   bo:

   „biological original“

   cs:

   „conventional synthetic“

   ts:

   „target a particular molecular structure“, synthetic

EULAR:

European League Against Rheumatism

FFbH:

Funktionsfragebogen Hannover

GRAPPA:

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis

HIV:

„Human immunodeficiency virus“

IL:

Interleukin

JAK:

Januskinase

KV:

Krankenversicherung

MTX:

Methotrexat

NSAR:

Nichtsteroidale Antirheumatika

PDE4 :

Phosphodiesterase 4

PsA:

Psoriasisarthritis

RA:

Rheumatoide Arthritis

Tbc:

Tuberkulose

TNF-α:

Tumor-Nekrose-Faktor-α

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Affiliations

  1. Rheumatologisches Praxiszentrum, St. Bonifatius Str. 5, 81541, München, Deutschland

    K. Krüger

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  1. K. Krüger
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Correspondence to K. Krüger.

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Interessenkonflikt

K. Krüger hat Honorare für Beratungen und Vorträge von folgenden Firmen erhalten: Abbvie, Biogen, BMS, Celgene, Hexal, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Krüger, K. Biologika und weitere neue Medikamente in der Rheumatologie seit 2000. Orthopäde 47, 906–911 (2018). https://doi.org/10.1007/s00132-018-3650-4

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Schlüsselwörter

  • Rheumatoide Arthritis
  • Psoriasisarthritis
  • Ankylosierende Spondyloarthritis
  • „Disease-modifying antirheumatic drugs“
  • JAK-Inhibitoren

Keywords

  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Ankylosing spondyloarthritis
  • Disease-modifying antirheumatic drugs
  • JAK inhibitors