Therapie des SLE 2020: aktueller Stand nach den EULAR-Empfehlungen 2019

Zusammenfassung

Die Veröffentlichung der neuen ACR/EULAR Klassifikationskriterien für den systemischen Lupus erythematodes (SLE) und die Überarbeitung der EULAR-Empfehlungen zum Management des SLE im vergangenen Jahr beinhalten viele wichtige Neuerungen, die die Klassifikation und Versorgung von Lupus-Patienten verändern werden. Dies bezieht sich sowohl auf generelle Grundprinzipien der Versorgung sowie auf konkrete Therapieempfehlungen. So kann ein SLE erst als solcher klassifiziert werden, wenn antinukleäre Antikörper (ANA) unabhängig von Titer-Höhe und Fluoreszenzmuster nachgewiesen werden können. Sind ANA nachgewiesen, erhalten Lupus-spezifische Symptome und serologische Auffälligkeiten einen Punktwert. Ab einem Wert von 10 kann ein SLE-Patient als solcher klassifiziert werden. Im Hinblick auf die Versorgung von SLE-Patienten sollte jede Therapie ganz im Sinne eines treat-to-target Ansatzes mit dem Ziel der Remission verfolgt werden. Dies dient der Sicherung des Langzeitüberlebens, der Reduktion von Schaden sowie der Verbesserung von Lebensqualität. Erreicht werden diese Ziele durch konsequente Therapie und regelmäßige Evaluation der Krankheitsaktivität. So sollen alle Patienten bei Abwesenheit von Kontraindikationen Antimalariamittel erhalten. Bei unzureichendem Ansprechen werden Steroidpulse über wenige Tage sowie der frühzeitige Einsatz von Immunsuppressiva (IM) empfohlen. Die einzelnen IM und ihre jeweiligen Indikationen sind im Text aufgeführt. Mit dem Einbezug von Biologika, insbesondere Belimumab und Rituximab, haben außerdem nun ganz neue Substanzklassen Einzug in die Empfehlungen gefunden.

Abstract

The publication of the new ACR/EULAR classification criteria for systemic lupus erythematosus (SLE) and the revision of the EULAR recommendations for SLE management issued last year implicate a lot of important alterations that will change the classification and care of lupus patients. This concerns both general principles of care and specific treatment recommendations. For example, SLE can only be classified as such if antinuclear antibodies (ANA) have been detected, irrespective of titer and fluorescence pattern. If ANAs have been detected, Lupus-specific symptoms and serological abnormalities are scored. Starting at a score of 10, an SLE patient can be classified as such. Regarding the care of LSE patients, every treatment should pursue a treat-to-target approach aiming at remission. This serves to ensure long-term survival, reduce damage and improve quality of life. These goals are achieved by rigorous treatment and regular assessment of disease activity. For instance, if not contraindicated, all patients are to receive anti-malaria drugs. In case of insufficient response, steroid pulses are recommended for a few days only and immunosuppressants (IM) should be used at an early point in time. Individual IMs and their indications are listed in the text. As biologics, especially Belimumab and Rituximab, are now included in the recommendations, these have come to comprise entirely new classes of substances.

Schlüsselwörter

Systemischer Lupus Erythematodes - zielgerichtete Therapie - EULAR Empfehlungen 2019 - ACR/EULAR Klassifikationskriterien für SLE

Key words

systemic lupus erythematosus - treat-to-target - EULAR recommendations 2019 - ACR/EULAR classification criteria for SLE

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