Indikationen und Wirksamkeit der Anti-TNF-Therapie

Zusammenfassung

Rheumatische Erkrankungen sind schwere Erkrankungen, die mit anhaltenden Schmerzen einhergehen, zum Verlust an Lebensqualität, Funktion, Arbeitsfähigkeit und auch zur Verkürzung des Lebens führen können. Sie verursachen erhebliche Kosten für das Gesundheitssystem. Mehrere Biologika als neue „disease modifying antirheumatic drugs“ sind in die Therapie von rheumatoider Arthritis, Spondyloarthropathien, Psoriasis-Arthritis und idiopathischer juveniler Arthritis eingeführt worden. Es fand sich eine zum Teil große Effektivität der Biologika, wobei dieser Artikel sich auf die Anti-TNF-Therapien, nämlich Adalimumab, Etanercept und Infliximab, konzentriert. Weitere Anti-TNF Therapien sind in Entwicklung. Mit deren Zulassung ist in den nächsten Monaten zu rechnen.

Summary

Rheumatoid arthritis, juvenile idiopathic arthritis, M. Bechterew und psoriasis arthropathy are chronic inflammatory autoimmune diseases. Several novel biologic disease-modifying anti-rheumatic drugs have become available for the treatment of these severe diseases. Anti-tumour necrosis factor-alpha (anti- TNF-α) medications, namely Adalimumab, Etanercept and Infliximab, act to neutralize the pro-inflammatory cytokine. The emergence of biologic therapies has proven to be highly successful in effectively treating this group of patients in the majority of cases. This article will review the currently available data on indications and efficacy of anti-TNF-α agents. Biologics targeting TNF-alpha in combination with methotrexate have revolution-ized the treatment of the above mentioned autoimmune diseases, producing significant improvement in clinical, radiographic, and functional outcomes. In this respect, new TNF blocking agents are under evaluation increasing the number of drugs available within the next months.

Schlüsselwörter

Rheumatoide Arthritis - juvenile idiopathische Arthritis - Morbus Bechterew - Psoriasis-Arthropathie - Etanercept - Adalimumab - Infliximab

Keywords

Rheumatoid arthritis - juvenile idiopathic arthritis - M. Bechterew - psoriasis arthropathy - anti TNF-α - Etanercept - Adalimumab - Infliximab

• Literatur

• 1 Antoni CE, Kavanaugh A, van der Heijde D. et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT).. J Rheumatol 2008; 35 (05) 869-876.
• 2 Braun J, Deodhar A, Dijkmans B. et al. Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy Study Group. Efficacy and safety of infliximab in patients with ankylosing spondylitis over a two-year period.. Arthritis Rheum 2008; 59 (09) 1270-1278.
• 3 Breedveld FC, Weisman MH, Kavanaugh AF. et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment.. Arthritis Rheum 2006; 54 (01) 26-37.
• 4 Dijkmans B, Emery P, Hakala M. et al Etanercept in the Longterm Treatment of Patients With Ankylosing Spondylitis.. J Rheumatol 2009. May 1 (Epub ahead of print)
• 5 Feldmann M, Maini RN. Discovery of TNF-alpha as a therapeutical target in rheumatoid arthritis: pre-clinical und clinical studies.. Joint Bone Spine 2002; 69 (01) 12-18.
• 6 Horneff G, De Bock F, Foeldvari I. et al German and Austrian Paediatric Rheumatology Collaborative Study Group. Safety and efficacy of combination of etanercept and methotrexate compared to treatment with etanercept only in patients with juvenile idiopathic arthritis (JIA): preliminary data from the German JIA Registry.. Ann Rheum Dis 2009; 68 (04) 519-525.
• 7 Keystone E, Heijde D, Mason Jr J.. et al. Certolizumab pegol plus methotrexate is significantly more effective than placebo plus methotrexate in active rheumatoid arthritis: findings of a fifty-two-week, phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study.. Arthritis Rheum 2008; 58 (11) 3319-3329.
• 8 Keystone EC, Genovese MC, Klareskog L. et al. GO-FORWARD Study.. Golimumab, a human antibody to tumour necrosis factor alpha given by monthly subcutaneous injections, in active rheumatoid arthritis despite methotrexate therapy: the GO-FORWARD Study Ann Rheum Dis 2009; 68 (06) 789-796.
• 9 Gaubitz M.Klareskog, Rodriguez-Valverde V. et al the Etanercept Study 301 Investigators. A longterm, open-label trial of the safety and disease-modifying antirheumatic drugs rheumatoid arthritis not treated with other efficacy of etanercept (En-brel) in patients with others disease-modifying antirheumatic drugs.. Ann Rheum Dis 2006; 65: 1578-1584.
• 10 Kristensen LE, Christensen R, Bliddal H. et al. The number needed to treat for adalimumab, etanercept, and infliximab based on ACR50 response in three randomized controlled trials on established rheumatoid arthritis: a systematic literature review.. Scand J Rheumatol 2007; 36 (06) 411-417.
• 11 Lovell DJ, Ruperto N, Goodman S. et al Pediatric Rheumatology Collaborative Study Group, Pediatric Rheumatology International Trials Organisation. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis.. N Engl J Med 2008; 359 (08) 810-820.
• 12 Manger B, Michels H, Nüsslein HG. et al. und die Kommission Pharmakotherapie der Deutschen Gesellschaft für Rheumatologie. Neufassung der Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur Therapie mit Tumornekrosefaktorhemmenden Wirkstoffen bei entzündlich-rheumatischen Erkrankungen, 2006. http://dgrh.de/fileadmin/media/Qualitaetssicherung/Therapie-Empfehlungen/TNF-Blocker_06.pdf
• 13 Mease PJ, Gladman DD, Ritchlin CT. et al. Adalimumab Effectiveness in Psoriatic Arthritis Trial Study Group. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial.. Arthritis Rheum 2005; 52 (10) 3279-3289.
• 14 Mease PJ, Kivitz AJ, Burch FX. et al Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression Arthritis Rheum. 2004; 50 (07) 2264-2272.
• 15 Mease PJ, Ory P, Sharp JT. et al. Adalimumab for long-term treatment of psoriatic arthritis: 2-year data from the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT).. Ann Rheum Dis 2009; 68 (05) 702-709.
• 16 Pierer M. Baerwald C. Biologikatherapie bei rheumatologischen Erkrankungen.. Internist 2008; 49: 938-946.
• 17 Revicki D, Heijde van der DM, Rentz AM. et al. Health-related quality of life outcomes in patients with active ankylosing spondylitis treated with adalimumab: results from a randomized controlled study.. Arthritis Rheum 2007; 57 (06) 1050-1057.
• 18 Smolen JS, Van Der Heijde DM, St Clair EW. et al Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group. Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial.. Arthritis Rheum 2006; 54 (03) 702-710.
• 19 van der Heijde D, Schiff MH, Sieper J. et al ATLAS Study Group. Adalimumab effectiveness for the treatment of ankylosing spondylitis is maintained for up to 2 years: long-term results from the ATLAS trial.. Ann Rheum Dis 2009; 68 (06) 922-929.
• 20 Wollenhaupt J, Alten R.M., Backhaus M. et al Aktualisiertes Therapieschema der Rheumatoiden Arthritis. Ergebnisse eines Konsensusprozesses deutscher Rheumatologen 2009. Recommendations for the Treatment of Rheumatoid Arthritis. Results from a German Consensus Conferenence: Update 2009. Akt Rheumatol.. Online first 15. Mai 2009.