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Uveitistherapie im Kindesalter

Biologika: zu oft – zu spät?

Therapy for childhood uveitis

Biologics: too often – too late?

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Zusammenfassung

Die Uveitis im Kindesalter unterscheidet sich von Uveitismanifestationen im Erwachsenenalter nicht nur durch die Art und Schwere der Entzündung, sondern auch durch die häufig schlechtere Prognose sowie altersspezifische Probleme, die bei der Therapie auftreten können. Biologika sind selektiv wirksame Proteine, die biotechnologisch hergestellt werden. Besondere Bedeutung kommt den TNF-α-Inhibitoren zu. Experimentelle und klinische Untersuchungen zeigen, dass TNF-α auch bei intraokulären Entzündungen beteiligt und die gezielte Blockade von TNF-α ein vielversprechender Ansatz in der Uveitistherapie ist. Bisher gibt es nur wenige Studien zur Wirksamkeit der Biologika sowohl im Erwachsenen- wie im Kindesalter. Die Daten (hier detailliert aufgeführt) sind jedoch zusammengenommen v. a. für Infliximab und Adalimumab so gut, dass eine Evidenz für ihre Wirksamkeit besteht. Erblindungen und Sehbehinderungen können hiermit in der Zukunft hoffentlich noch weiter reduziert werden. Somit haben die TNF-α-Blocker die Behandlung gerade der kindlichen Uveitis wesentlich verbessert. Aus der Kinderrheumatologie kommen neue Behandlungsansätze mit weiteren Biologika hinzu. Diese Übersicht soll Stärken und Schwächen der Biologikatherapie bei der kindlichen Uveitis aufzeigen sowie Hilfen zum richtigen Zeitpunkt des Therapiebeginns geben.

Abstract

Pediatric uveitis differs from uveitis seen in adulthood not only because of the uveitis presentation and severity of disease but also by a worse prognosis and age-specific problems that may occur under therapy. Biologics are selective acting proteins that are manufactured by biotechnology. The greatest amount of knowledge to date exists for the TNF alpha blocking agents. Experimental and clinical studies showed that TNF alpha plays a significant role in the process of intraocular inflammation, so it was a logical step to use TNF blocking agents in uveitis therapy. Randomized controlled studies are rare, but pooled data (as presented here) of case series published show good evidence for the efficacy especially of infliximab and adalimumab. It is to be hoped that blindness and severe sight disabilities can be further reduced by this treatment in the future. From pediatric rheumatology we have learned about even newer biologics. With this review we want to show the weaknesses and strengths of therapy with biologics and want to help in choosing this treatment at the indicated time point in the disease.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Dr. Friederike Mackensen war als Principal Investigator, Sprecher oder beratend für folgende pharmazeutische Unternehmen tätig: Abbott, Allergan, Esba Tech, Novartis, Merck Serono, Lux Biosciences.

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  1. Interdisziplinäres Uveitiszentrum, Augenklinik, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    F. Mackensen MD

  2. Klinik für Kinder und Jugendmedizin, Universität Heidelberg, Heidelberg, Deutschland

    T. Lutz

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Correspondence to F. Mackensen MD.

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Mackensen, F., Lutz, T. Uveitistherapie im Kindesalter. Ophthalmologe 108, 213–221 (2011). https://doi.org/10.1007/s00347-010-2260-2

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