Praxis der Cyclophosphamidtherapie in der Rheumatologie

Zusammenfassung

Auch nach der Einführung vieler neuer immunmodulatorischer Substanzen, wie z. B. den Biologika, hat Cyclophosphamid einen festen Stellenwert in der Behandlung bestimmter entzündlich-rheumatischer Erkrankungen wie der Lupus-Nephritis und anderen organschädigenden Verläufen bei systemischen Vaskulitiden. In dieser Übersichtsarbeit werden die wichtigsten Indikationen zum Einsatz von Cyclophosphamid bei schweren Krankheitsverläufen, sei es zum Krankheitsbeginn oder bei Krankheitsrezidiv, vorgestellt. Mit der Beschreibung wichtiger Erkenntnisse zum Einsatz von Cyclophosphamid sollen Nebenwirkungsrisiken dieser Substanz minimiert und zudem therapiebedingte Langzeitschäden vermieden werden. Daher liegt ein Schwerpunkt dieser Arbeit in der Darstellung der praktischen Durchführung der Cyclophosphamid-Therapie wie auch in der Prophylaxe von Cyclophosphamid-assoziierten Nebenwirkungen. Schließlich wird eine Bewertung der oralen versus parenteralen Applikation wie auch der Abgrenzung des stationären bzw. teilstationären/ambulanten Cyclophosphamid-Einsatzes vorgenommen. Cyclophosphamid bleibt vorerst eine unverzichtbare Substanz im Behandlungsspektrum der Rheumatologie wie auch der klinischen Immunologie.

Summary

Although a couple of new immunomodulatory or immunosuppressive substances, mainly the biologicals, have been established, Cyclophosphamide still plays an important role in the treatment of severe systemic rheumatic diseases such as lupus-nephritis and other systemic vasculitides affecting vital parts. The most important indications concerning severe courses, early stages of disease as well as relapses of disease are presented. Essential acknowledgments in the use of Cyclophosphamide, are described in order to minimize side effects and to avoid long-term damage caused by its application. Therefore, this paper is focused on the description of the practical use of Cyclophosphamide-therapy and on the prevention of Cyclophosphamide-associated side effects. Moreover, different forms of application (oral vs parenteral) and indications for an inpatient use of Cyclophosphamide are evaluated. For the time being Cyclophosphamide remains an indispensable option within the armentarium of rheumatological and immunological treatment.

Schlüsselwörter

Cyclophosphamid - rheumatische Systemerkrankungen - systemische Vaskulitiden - klinische Immunologie - Therapie-Nebenwirkungen

Keywords

Cyclophosphamide - systemic rheumatic diseases - systemic vasculitis - clinical immunology - therapeutic side effects

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