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Sicherheit der Rheumatherapie im Alter

Safety of antirheumatic drug treatment in the elderly

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Zusammenfassung

Der Anteil an geriatrischen Patienten wird auch im Krankengut des Rheumatologen größer, wofür in erster Linie der demographischen Wandel und die im Zuge besserer Behandlungsmöglichkeiten geringere Mortalität verantwortlich sind. Die medikamentöse Behandlung älterer Rheumapatienten bringt jedoch spezielle Probleme mit sich. So weist diese Altersgruppe pharmakokinetische Besonderheiten auf, außerdem führen häufig vorhandene Multimorbidität und Multimedikation zu vermehrten Interaktionsrisiken und schlechterer Adhärenz. Gleichwohl gelten für diese Patienten die gleichen Therapieprinzipien und -ziele wie für die jüngere Klientel. Hier die richtige Balance zu finden, fordert vom Rheumatologen Fingerspitzengefühl bei der Wahl der in jedem einzelnen Fall bestgeeigneten Medikamente. Keineswegs sollte die Angst vor vermeintlich größeren Risiken dazu führen, dass Patienten dieses Alters nicht adäquat versorgt werden – ein Sachverhalt, der leider durch eine Reihe von Untersuchungen nahegelegt wird.

Abstract

Mainly due to the general demographic changes and decreasing mortality in rheumatic diseases based on therapeutic progress, the proportion of older patients treated by rheumatologists is growing. Drug treatment in the elderly, however, harbors certain risks including age-specific pharmacokinetic features and high rates of multimorbidity and polypharmacy resulting in a risk of drug interactions and adherence problems. Nevertheless, older patients suffering from rheumatic diseases ought to be treated with the same intensity and same targets as the younger counterparts. Bearing all these facts in mind it is a balancing act for rheumatologists to find an optimal treatment for the individual elderly patient. Fear of risks should not lead to hesitant use of drugs leaving these patients alone with treatment deficits, as some studies have suggested.

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Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin: K. Krüger: Vorträge und/oder Beratungstätigkeit für die Firmen Abbvie, Bristol Myers Squibb, Medac, MSD, Pfizer, Roche, UCB. Für A. Strangfeld und C. Kneitz liegt kein Interessenkonflikt vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. K. Krüger.

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Krüger, K., Strangfeld, A. & Kneitz, C. Sicherheit der Rheumatherapie im Alter. Z. Rheumatol. 73, 244–250 (2014). https://doi.org/10.1007/s00393-013-1245-3

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Schlüsselwörter

  • Antirheumatika
  • Medikamentöse Therapie
  • Medikamentensicherheit
  • Geriatrische Patienten
  • Medikamentöse Interaktionen

Keywords

  • Antirheumatic drugs
  • Drug treatment
  • Drug safety
  • Elderly patients
  • Drug interactions