Zellgerichtete Therapien in der Rheumatologie

M. Wahle

doi:10.1055/s-0037-1620174

Arthritis und Rheuma, Inhaltsverzeichnis

Arthritis und Rheuma 2009; 29(04): 235-240
DOI: 10.1055/s-0037-1620174

Biologika in der Rheumatologie – zehn Jahre Anti-TNF-Therapie

Schattauer GmbH

Zellgerichtete Therapien in der Rheumatologie

Cell-directed therapies

M. Wahle

¹Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Schwerpunkt Rheumatologie, Medizinische Klinik II, Frankfurt am Main

› Institutsangaben

Abstract

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Zusammenfassung

Die Biologika-Therapie hat das Management der rheumatoiden Arthritis (RA) wesentlich bereichert. Gegen Zytokine gerichtete Wirkansätze werden von den die pathogenetisch beteiligten Zellen adressierenden Therapien unterschieden. Zu Letzteren gehören Abatacept (Fusionsprotein aus CTLA4 und Teilen des humanen IgG₁) sowie Rituximab (chimärer Anti-CD20-Antikörper). Abatacept hemmt die Aktivierung von T-Lymphozyten durch die Bin-dung an costimulatorische Moleküle auf anti-genpräsentierenden Zellen. Es hemmt die Krankheitsaktivität bei der RA und vermindert die radiologische Progression. Die Nebenwirkungen umfassen vor allem Infektionen, eine COPD exzerbiert häufiger. Rituximab wurde ursprünglich zur Behandlung von Non-Hodgkin-Lymphomen eingesetzt, es depletiert B-Lymphozyten aus Blut und Knochen-mark sowie weniger aus der Synovialis. Wie Abatacept hemmt es die Entzündungsaktivität und die radiologische Progression bei der RA. Beide sind auch bei Ineffektivität von TNF-alpha-Blockern wirksam. Als Nebenwirkun-gen von Rituximab treten vor allem Infektionen und Unverträglichkeitsreaktionen auf. Die Impfantwort ist abgeschwächt.

Summary

The management of rheumatoid arthritis has dramatically changed following the introduction of biological therapy. Cytokine-blocking regimens are distinguished from cell-directed therapies. Abatacept is a fusion protein of CTLA4 and parts of human IgG1. Activation of T-cells is inhibited after binding to co-stimulatory molecules on antigen-presenting cells. Abatacept attenuates disease activity and radiological progression in RA. Side effects include infections, and COPD tends to exacerbate more often. Rituximab is directed against CD20 and effectively depletes B-cells in the blood, bone-marrow, and to a lesser extent in the synovial tissue. Originally rituximab was developed to treat non hodgkin lymphoma. Rituximab has a favourable effect on disease activity and radiographic progression in RA. Rituximab as well as abatacept can be used in TNF-alpha antagonist resistant patients. The side effects of rituximab mainly consist of infections and allergic reactions. Vaccinations should be performed prior to the use of rituximab.

Schlüsselwörter

Rheumatoide Arthritis - Abatacept - Rituximab

Keywords

Rheumatoid arthritis - Abatacept - Rituximab

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Referenzen

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