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(Neben-) Wirkungen der VEGF-Inhibition

(Side) effects of VEGF inhibition

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Zusammenfassung

„Vascular endothelial growth factor“ (VEGF) stellt – in der Embryo- und Organogese noch stärker als im Erwachsenenalter – einen wichtigen regulatorischen Faktor dar. Weil VEGF physiologische Abläufe wie Hämodynamik, (Lymph-) Gefäßstruktur, Hämatopoese, Immunabwehr, Hormonfreisetzung und Wundheilung reguliert, müssen mögliche Interaktionen einer medikamentösen Hemmung berücksichtigt werden.

Auch wenn durch die intravitreale Applikation eine systemische Freisetzung deutlich reduziert wird, können nachteilige Effekte auf die retinale Perfusion und die Integrität neuronaler Strukturen zum jetzigen Zeitpunkt noch nicht sicher ausgeschlossen werden. Bevor keine mehrjährigen Erfahrungen mit dem Einsatz der VEGF-Inhibitoren vorliegen, sind eine individuelle Diskussion der Indikationsstellung, ausführliche Aufklärungsgespräche und eine sorgfältige Dokumentation erforderlich. Aus ethischer Sicht darf die Anwendung der verfügbaren Wirkstoffe – trotz des unumstrittenen therapeutischen Nutzens – nicht bedenkenlos erfolgen. Für die Zukunft muss der direkte Vergleich der verschiedenen Präparate erst noch zeigen, ob sich Unterschiede für das Komplikationsspektrum ergeben.

Abstract

Vascular endothelial growth factor (VEGF) plays a pivotal role for embryo- and organogenesis. By regulating haemodynamics, (lymphoid) vessel architecture, haematopoiesis and immune system, endocrinology and reparative processes in adults, inhibited VEGF can cause multiple adverse events.

Although the intravitreal administration of smaller doses can drastically reduce the systemic exposure, possible local side effects on retinal perfusion and survival of neuronal tissue must be taken into consideration. Before experience has been gained with VEGF inhibitors for longer than several years, individual discussion before the use, extensive informed consent and careful follow-up are necessary. From the ethical point of view, the available drugs should not be used without hesitation despite the clear benefit. First experiences with bevacizumab (Avastin), the first available (off-label) drug in Germany, are reported. In future, direct comparison of the different available drugs has to assess possible differences in the risk-benefit profile.

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Danksagung

Die Autoren danken der gemeinnützigen Carl- und Esther-Christiansen-Stiftung, die die wissenschaftlichen Forschungsarbeiten auf dem Gebiet der Makuladegeneration finanziell unterstützt.

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    F. Ziemssen, K. U. Bartz-Schmidt & S. Grisanti

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Interessenkonflikt: Prof. Grisanti ist an klinischen Studien mit Macugen® und Lucentis® beteiligt. Trotz des möglichen Interessenkonflikts bemüht sich der Beitrag um eine unabhängige und neutrale Bewertung.

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Ziemssen, F., Bartz-Schmidt, K.U. & Grisanti, S. (Neben-) Wirkungen der VEGF-Inhibition. Ophthalmologe 103, 484–492 (2006). https://doi.org/10.1007/s00347-006-1354-3

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