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Stellungnahme zum Einsatz von Mycophenolat-Mofetil beim systemischen Lupus erythematodes

Statement on the use of mycophenolate mofetil for systemic lupus erythematosus

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Zusammenfassung

Mycophenolat-Mofetil (MMF) gehört zu den beim systemischen Lupus erythematodes (SLE) weltweit am besten untersuchten Immunsuppressiva. Kürzlich publizierte, multizentrische, randomisierte, kontrollierte Studien zur Wirksamkeit von MMF in der Behandlung der Lupus-Nephritis haben eine Aktualisierung der Stellungnahme zum Einsatz von MMF beim SLE erforderlich gemacht. In der Induktionstherapie der Lupus-Nephritis zeigt MMF eine vergleichbare Wirksamkeit wie i.v.-Cyclophosphamid, während in der Erhaltungstherapie MMF im Vergleich mit Azathioprin überlegen ist. Cyclophosphamid ist in der Erhaltungstherapie gegenüber MMF und vermutlich auch gegenüber Azathioprin unterlegen und sollte deshalb, aber auch wegen seiner Toxizität, nicht in der Erhaltungstherapie berücksichtigt werden. Auch bei anderen Organmanifestationen, die auf zugelassene Immunsuppressiva nicht ausreichend ansprechen und zu keiner dauerhaften Reduktion der Glukokortikoide auf tagesäquivalente Dosen von 7,5 mg Prednisolon oder weniger führen, stellt MMF eine Alternative dar.

Abstract

Mycophenolate mofetil (MMF) is among the few immunosuppressive drugs with sufficient data from controlled studies on the therapy of systemic lupus erythematosus (SLE). In the light of results from recently published randomized controlled trials on the effectiveness of MMF in the treatment of lupus nephritis, it has become necessary to revise the statement of the Germany Society of Rheumatology on the use of MMF for SLE. In the induction therapy of lupus nephritis MMF has been shown to be equivalent in effectiveness to i.v. cyclophosphamide and superior to azathioprine in the maintenance phase. Cyclophosphamide is inferior to MMF and probably also to azathioprine as maintenance therapy and should therefore, not be considered for this purpose and also because of its toxicity. For other organ manifestations MMF also constitutes an alternative when approved immunosuppressants are not able to control the disease and glucocorticoids cannot be reduced to 7.5 mg prednisolone daily equivalents or less.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: M. Aringer: Beratungstätigkeit und Vorträge für Roche und GSK, Teilnahme an Roche- und Astra Zeneca-Studien; R. Fischer-Betz: Beratungstätigkeit und Vorträge für Roche und GSK, Teilnahme an Roche- und Astra Zeneca-Studien; F. Hiepe: Beratungstätigkeit, Vorträge und Teilnahme an Studien: Roche, GSK/HGS und Aspreva.

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  1. Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    M. Aringer

  2. Poliklinik für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    R. Fischer-Betz

  3. Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitè Universitätsmedizin Berlin, Berlin, Deutschland

    F. Hiepe

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Kommission Pharmakotherapie der DGRh

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Correspondence to M. Aringer.

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Aringer, M., Fischer-Betz, R., Hiepe, F. et al. Stellungnahme zum Einsatz von Mycophenolat-Mofetil beim systemischen Lupus erythematodes. Z. Rheumatol. 72, 575–580 (2013). https://doi.org/10.1007/s00393-013-1213-y

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