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Biologika bei SLE

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Zusammenfassung

Bei allen häufigeren rheumatischen Erkrankungen sind Biologika seit vielen Jahren nicht mehr wegzudenken. In der Behandlung des systemischen Lupus erythematodes (SLE) wird seit zehn Jahren die B-Zell-Depletion bei meist schwerst kranken SLE Patienten als Off label-Therapie eingesetzt. Die ersten kontrollierten Rituximab-Studien bleiben jedoch, wie viele andere klinische Prüfungen beim SLE, wider Erwarten negativ, und neue klinische Prüfungen mit einem besseren Protokoll versuchen derzeit die Frage endgültig zu klären. Erst 2012 begann mit der Zulassung von Belimumab die Ära der zugelassenen Biologikatherapie. Dieser Anti-Blys/BAFF-Antikörper verhindert Schübe, spart Glukokortikoide ein und verbessert deutlich die Lebensqualität, zum Teil durch drastische Verbesserung der durch Immunkomplexe bedingten ausgeprägten Abgeschlagenheit. Vielversprechende Daten zu mehreren anderen Ansätzen lassen hoffen, dass weitere Biologika den Einzug in den klinischen Alltag finden werden.

Abstract

Biologics have become indispensable in the last decade in the treatment of the more common rheumatic diseases. For treating systemic lupus erythematodes (SLE), B-cell depletion, albeit off-label, has been a well-accepted strategy in severe and refractory disease. Unexpectedly, however, the results of the first randomized controlled rituximab trials in SLE were negative. New trials with improved study protocols are ongoing, which should resolve this issue. In 2012, with the approval of belimumab, SLE finally entered the era of approved biological therapies. The anti-Blys/BAFF antibody belimumab showed prevention of SLE flares, glucocorticoid sparing, and significant improvement in the quality of life of SLE patients, in part by drastically reducing immune complex mediated fatigue. Positive reports on further targeting approaches give hope that additional biological agents will be available for SLE therapy soon.

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Authors and Affiliations

  1. Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich

    Thomas Karonitsch

  2. Medizinische Klinik und Poliklinik III, Universitätsklinikum „Carl Gustav Carus“ der Technischen Universität Dresden, Dresden, Deutschland

    Martin Aringer

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Correspondence to Thomas Karonitsch.

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Karonitsch, T., Aringer, M. Biologika bei SLE. Wien Med Wochenschr 165, 40–45 (2015). https://doi.org/10.1007/s10354-014-0322-9

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