Neue Therapieansätze bei progredienter Multipler Sklerose

Die Therapie der Multiplen Sklerose hat sich in den letzten Jahren durch die Entwicklung neuer Medikamente für die schubförmige Phase der Erkrankung umfangreich gewandelt. Die Entwicklung von Medikamenten gegen eine Progression war bisher hingegen – abgesehen von Ocrelizumab, einem B-Zell-depletierenden Antikörper – wenig erfolgreich. In dieser Arbeit soll eine Übersicht über das Verständnis der Pathogenese und vielversprechende Therapieansätze für Progression in unterschiedlichen Stadien der Entwicklung gegeben werden.

Kernaussagen

• Die progrediente MS ist pathogenetisch durch eine chronische Inflammation mit Aktivierung von T- und B-Zellen und Mikroglia mit Freisetzung reaktiver Sauerstoffmetabolite, altersabhängige Akkumulation von Eisen und damit einhergehend neuronale Degeneration gekennzeichnet.

• Der B-Zell-depletierende Antikörper Ocrelizumab ist seit 2018 für die primär progrediente MS mit Krankheitsaktivität zugelassen und reduziert das Risiko der Behinderungsprogression um ca. 20%.

• Siponimod reduzierte Behinderungsprogression bei SPMS (Multiple Sklerose mit sekundär chronisch progredientem Verlauf) um 21% nach 3 Monaten.

• Es gibt eine Vielzahl potenzieller therapeutischer Ansätze, bestehend aus

  • antiinflammatorischen Ansätzen,

  • neuroprotektiven Ansätzen und

  • remyelinisierenden Ansätzen.

• Es besteht kein Konsens über einheitliche Outcome-Parameter bei Studien zur Progression.

Schlüsselwörter

neurologische Erkrankung - Medikamentenzulassung - Zentralnervensystem - Neurodegeneration

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