IBD ahead 2010 – Antworten auf zehn zentrale Fragen in der aktuellen Therapie des Morbus Crohn

Zusammenfassung

Die Therapie von Patienten mit chronisch entzündlichen Darmerkrankungen hat in den vergangenen Jahren und Jahrzehnten durch die Einführung verschiedener Immunsuppressiva wie auch die Zulassung monoklonaler Antikörper gegen TNF-α an Komplexität gewonnen und erfordert eine sorgfältige Überwachung der so behandelten Patienten. Nationale und internationale Leitlinien definieren für den Behandler einen diagnostischen und therapeutischen Rahmen, können jedoch nur eingeschränkt auf konkrete Fragen zum Prozedere bei einem individuellen Patienten eingehen. Im Rahmen eines von der Firma Abbott initiierten Projekts mit dem Titel „IBD ahead” haben 38 deutsche CED-Experten auf der Basis der publizierten Literatur und eigener Erfahrungen konkrete Vorschläge für den Umgang mit Kortikosteroiden, Immunsuppressiva und TNF-α-Antikörpern erarbeitet, um so die Lücke zwischen den Leitlinien und dem klinischen Alltag zu schließen. Es wurden Stellungnahmen zur Wahl des richtigen Zeitpunkts der Initiierung, der Dosierung und Dauer der einzelnen Substanzen wie auch zum Vorgehen bei Patienten mit einem Therapieversagen erarbeitet. Zudem wird zu Strategien in der Kombination der einzelnen Präparate, zum Sicherheitsmonitoring und den Risken hinsichtlich der Entstehung infektiöser Komplikationen und maligner Erkrankungen Stellung genommen. Die formulierten Empfehlungen werden jeweils anhand von Fallbeispielen aus der täglichen Praxis der beteiligten Zentren verdeutlicht.

Abstract

The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies against TNF-α and patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled ”IBD ahead” 38 German IBD experts have elaborated concrete proposals for dealing with corticosteroids, immunosuppressants and TNF-α antibodies on the basis of the published literature and their own personal experience in order to close the gap between these guidelines and daily clinical practice. Statements were developed on the choice of correct timing of initiation, dose and duration of the individual substances and on how to proceed with patients exhibiting treatment failure. Moreover, recommendations are also made on drug combination strategies, safety monitoring and the risks regarding the development of infectious complications and malignancies. These recommendations are illustrated by case studies from everyday practice in participating centres.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Morbus Crohn - intestinale Komplikation

Key words

chronic inflammarory bowel disease - Crohn’s disease - intestinal complications

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