Zusammenfassung
Der Einsatz von Biologika in der Therapie rheumatischer Erkrankungen erlaubt eine bessere Kontrolle hochaktiver Erkrankungsverläufe. Durch die damit assoziierte, intensivere Immunsuppression werden jedoch auch häufiger als unter konventioneller Basistherapie opportunistische Infektionen gesehen. Bei diesen Infektionen handelt es sich oft um Reaktivierungen latenter, an sich banaler Virusinfektionen, welche ohne schwere Immunsuppression praktisch nie beobachtet werden. Einige der neueren Biologika, wie Natalizumab, Efalizumab oder Rituximab, scheinen ein besonderes Risiko für die Reaktivierung des JC-Polyoma-Virus darzustellen. Klinisch manifestiert sich dies als progressive multifokale Leukenzephalopathie (PML), eine bisher nicht behandelbare, oft tödliche Enzephalitis. Der Einsatz dieser Substanzen sollte daher bei Patienten mit intensiver Vorbehandlung, gleichzeitiger Einnahme mehrerer immunsuppressiv wirkender Medikamente inklusive Kortikosteroiden und höherem Alter mit Vorsicht erfolgen.
Abstract
The use of biologicals in the therapy of rheumatic diseases allows more effective treatment of patients with very active disease. Such regimens, however, can induce a more severe treatment-related immunosuppression and, as a consequence, opportunistic infections that are rarely seen with conventional immunosuppressive therapy appear to occur more frequently. The majority of these opportunistic infections are common viral infections which become latent and only cause severe disease if they are reactivated in a severely immunocompromised host. However, some of the newer biologicals, especially natalizumab, efalizumab or rituximab, appear to carry a special risk for the reactivation of JC polyoma virus manifesting as progressive multifocal leukoencephalopathy, a severe, untreatable and often fatal encephalitis. Therefore, such treatments should be used with caution in patients who have been or are being treated with combined immunosuppressive therapy including corticosteroids. Elderly patients are specifically at risk for this “normal” side effect.
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Glück, T. Seltene virale Infektionen unter Immunsuppression. Z. Rheumatol. 70, 375–378 (2011). https://doi.org/10.1007/s00393-010-0741-y
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DOI: https://doi.org/10.1007/s00393-010-0741-y