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Personalisierte Medizin bei der rheumatoiden Arthritis

Serologisch-klinische Patientenprofile in der Optimierung der B- und T-Zell-gerichteten Therapie

Personalized medicine for rheumatoid arthritis

Serological and clinical patient profiles to optimize B and T cell targeted therapy

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Zusammenfassung

B- und T-Zell-gerichtete Biologika haben sich neben Zytokinblockern als wirksame und sichere Therapieansätze in der Behandlung der rheumatoiden Arthritis bewährt. Darüber hinaus kann von einem großen Potenzial dieser Wirkstoffe auch zur Behandlung anderer systemischer Autoimmunerkrankungen ausgegangen werden, wie die Indikationserweiterung bzw. Zulassung für Rituximab zur Therapie von systemischen Vaskulitiden erkennen lässt. Aufgrund der verfügbaren Behandlungsoptionen im Biologikaeinsatz sind dabei prädiktive Faktoren für das Therapieansprechen sowie auch ein gut charakterisiertes Sicherheitsprofil essenziell, um diese Medikamente optimal einzusetzen. Obgleich eine personalisierte Medizin im eigentlichen Sinne gegenwärtig in der Rheumatologie noch nicht erreicht werden kann, liegen erste vielversprechende Möglichkeiten vor, unter Einsatz verschiedener Biomarker diesem Ziel näher zu kommen. Dabei konnte nicht nur gezeigt werden, dass eine B-Zell-gerichtete Therapie mit Rituximab bei Patienten mit seropositiver rheumatoider Arthritis eine stärkere Wirksamkeit im Vergleich zu seronegativen Patienten entfaltet. Weiterhin kann auch möglicherweise die Charakterisierung des Zytokinmilieus sowie auch von zirkulierenden und gewebsständigen B- sowie T-Subtypen zur Vorhersage eines Therapieansprechens beitragen.

Abstract

Nowadays B and T-cell directed biologics in addition to TNF inhibitors are established as effective and safe treatment options for rheumatoid arthritis. As shown by the approval of rituximab for the treatment of systemic vasculitis, these drugs can also be useful for the treatment of other systemic autoimmune diseases; however, to optimize therapeutic strategies, predictive factors for treatment response as well as a good characterized safety profile are essential. So far implementation of real personalized medicine is not feasible in the field of rheumatology, but first biomarkers have already been identified and provide promising results. In this context, it has been shown that a B-cell directed therapy with rituximab is more effective in seropositive patients with rheumatoid arthritis. In addition, characterization of the cytokine milieu as well as of circulating and tissue infiltrating B and T-cell subsets might be useful for prediction of treatment response in the near future.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: E.F. und T.D. erhielten Honorare für Vorträge und Beratungstätigkeit sowie Projektunterstützung von Roche Pharma AG, Chugai. E.F. erhielt Honorare für Vorträge, Beratertätigkeit und Projektunterstützung von BMS. T.D. erhielt Honorare für Vorträge von BMS.

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  1. Med. Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charite Universitätsmedizin Berlin, CC12, Charitéplatz 1, 10098, Berlin, Deutschland

    E. Feist

  2. Med. Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité, Universitätsmedizin Berlin, CC12 & DRFZ Berlin, Berlin, Deutschland

    T. Dörner

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Correspondence to E. Feist.

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Feist, E., Dörner, T. Personalisierte Medizin bei der rheumatoiden Arthritis. Z. Rheumatol. 72, 49–58 (2013). https://doi.org/10.1007/s00393-011-0885-4

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