Chronisch-entzündliche Darmerkrankungen

Was ist neu?

Chirurgische Therapie Die Auswertung von Langzeitdaten bestätigt die Gleichwertigkeit der primär chirurgischen vs. medikamentösen (Infliximab) Therapie bei Morbus-Crohn-Patienten mit isoliertem Ileozökalbefall.

Neu zugelassene und sich in später klinischer Entwicklung befindliche Therapien Der selektive JAK-1-Inhibitor Filgotinib ist kürzlich zur Behandlung von Colitis-ulcerosa-Patienten mit mittelschwerer bis schwerer Aktivität zugelassen worden, welche auf eine konventionelle oder biologische Therapie nicht angesprochen haben. Weiterhin ist der S1P-Rezeptor-Modulator Ozanimod, welcher den Abstrom von Lymphozyten aus dem Lymphknoten verhindert, ebenfalls zur Behandlung der genannten Colitis-ulcerosa-Patienten zugelassen worden. Der S1P-Rezeptor-Modulator Etrasimod wird aktuell in einer klinischen Phase-3-Studie bei Colitis ulcerosa getestet und der selektive JAK-1-Inhibitor Upadacitinib dürfte nächstes Jahr bei Colitis ulcerosa zugelassen werden. Zahlreiche IL-23p19-Inhibitoren befinden sich in fortgeschrittenen Studienphasen (Guselkumab, Mirikizumab, Brazikumab) bzw. haben diese bereits beendet (Risankizumab). Deren Zulassung ist zeitnah zu erwarten. Der lokal applizierbare Toll-like-Rezeptor-9-Agonist Cobitolimod könnte zukünftig eine lokal applizierbare Therapieoption bei Patienten mit linksseitiger Colitis ulcerosa darstellen.

Zukünftige therapeutische Herausforderungen Die Positionierung der bereits vorhandenen und zukünftigen Therapieoptionen in unseren Therapiealgorithmus muss noch definiert werden. Hierbei können wir auf Ergebnisse erster Head-to-Head-Studien zurückgreifen und sollten darüber hinaus bei jedem Patienten individuelle Faktoren berücksichtigen. Noch immer fehlen Prädiktoren für die Vorhersage des individuellen Therapieansprechens.

Abstract

Growing insights into the underlying immunopathogenesis of inflammatory bowel diseases (IBD) have led to the advent of targeted therapies, which selectively target pivotal mediators of the inflammatory process. This has enabled us to define and achieve novel therapeutic outcomes to prevent disease-associated complications and halt the progressive course of disease. In addition to already available treatment options, the selective Janus kinase type 1 inhibitor filgotinib and the selective sphingosine-1-phosphate receptor modulator Ozanimod have recently been approved for the treatment of ulcerative colitis patients. Furthermore, positive phase 2/3 induction and maintenance trial results have been reported for representatives of the class of IL-23p19 inhibitors, which are expected to further increase our therapeutic possibilities. All these agents can be applied as first-line or also subsequent treatment options and recent head-to-head trials have helped us to position these substances in our therapeutic algorithm. Nevertheless, there is still the currently unmet clinical need do establish predictive markers of response to identify the subgroup of IBD patients, that have a heightened probability of response to each therapy. In the following, we will give an overview of the recently approved or in late-stage clinical development tested substances and discuss their positioning in our therapeutic armamentarium.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - JAK-1-Inhibitor - IL-23-Inhibitor - Cobitolimod

Key words

Crohn’s disease - ulcerative colitis - JAK-1 inhibitor - IL-23 inhibitor - Cobitolimod

Publication History

Article published online:
15 March 2022

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