Adalimumab in der Behandlung des adulten Morbus Crohn – Update eines Konsensus der Arbeitsgruppe Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie

Zusammenfassung

TNF-alpha-Antikörper haben den Verlauf von Morbus Crohn mit moderatem bis schwerem Verlauf wesentlich verbessert. Adalimumab ist der erste vollständig humane, monoklonale TNF-alpha-Antikörper, den Patienten selbst subkutan applizieren können. Adalimumab ist seit August 2012 zur Behandlung des mittelschweren bis schwergradigen, aktiven Morbus Crohn bei Patienten zugelassen, bei denen mit einer adäquaten Therapie mit einem Glukokortikoid und/oder einem Immunsuppressivum kein ausreichendes Ansprechen erzielt werden konnte, und/oder die eine entsprechende Unverträglichkeit aufweisen oder bei denen diese Therapien kontraindiziert sind. Mit Adalimumab können bei Patienten mit moderatem bis schwerem Morbus Crohn gegenüber Placebo signifikant höhere Raten an steroidfreier Remission und mukosaler Heilung erreicht, die Zahl der Morbus Crohn bedingten Krankenhausaufenthalte und Operationen verringert sowie die gesundheitsbezogene Lebensqualität verbessert werden. Adalimumab wirkt sowohl bei mit TNF-alpha-Antikörper vorbehandelten wie auch nicht vorbehandelten Patienten. Der Wirkungseintritt erfolgt innerhalb weniger Tage. Eine anhaltende Wirksamkeit ist bis zu 3 Jahren belegt. Die Sicherheitsdaten von Adalimumab entsprechen weitgehend jenen anderer TNF-alpha-Blocker. Allergische Reaktionen sind aufgrund der geringen Immunogenität von Adalimumab selten. Das vorliegende Update eines früheren Konsensus der Arbeitsgruppe Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) fasst die aktuelle Datenlage zu Adalimumab in der Behandlung des Morbus Crohn zusammen und soll als praktischer Leitfaden für die Anwendung von Adalimumab bei Patienten mit Morbus Crohn dienen.

Abstract

TNF alpha antibodies have clearly improved the outcome of moderate to severe Crohn’s disease. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which can be self-administered subcutaneously. Since August 2012 adalimumab is approved for the treatment of moderately to severely active Crohn’s disease, in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Compared to placebo adalimumab can induce significantly more often steroid-free remission and mucosal healing in patients with moderate to severe Crohn’s disease, reduce the rate of Crohn’s disease-related hospitalisations and surgery and improve health-related quality of life. Adalimumab is clinically efficacious both in patients with Crohn’s disease naïve to previous exposure to TNF-alpha antibodies and in those previously exposed with a rapid onset of action within days and confirmed maintenance performance over 3 years. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Due to its low immunogenicity allergic reactions are rare. The update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence on adalimumab for the treatment of Crohn’s disease and is aimed to assist as a code of practice in its applications.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Morbus Crohn - TNF-alpha-Blocker

Key words

chronic inflammatory bowel disease - Crohn’s disease - TNF alpha blocker

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