Zusammenfassung.
Durch die Fortentwicklung der medikamentösen Behandlung des Morbus Crohn hat sich
die Prognose der betroffenen Patienten in den letzten Jahren deutlich verbessert.
Zur den heute als Standard anerkannten Therapieverfahren zur Behandlung von Patienten
mit Morbus Crohn zählt im akuten Schub nach wie vor die Gabe von Steroiden. Bei Therapierefraktärität
kann die Gabe von TNFα-Antikörpern erwogen werden. Bei chronisch aktiven Verläufen
gilt heute die Gabe von Immunsuppressiva wie Azathioprin, 6-Mercaptopurin (oder als
Reservepräparat Methotrexat) als Standard. Bei mäßig akuten Schüben und bei geeigneter
Lokalisation (v.a. Ileozökalregion) können auch topisch wirksame Steroide wie Budesonid
eingesetzt werden. Steroide in systemischer oder topischer Form besitzen allerdings
keinen therpeutischen Wert für die Remissionserhaltung. Die Effektivität der Gabe
von 5-Aminosalicylsäure-Präparaten (5-ASA) für die Remissionserhaltung ist umstritten.
Neue zusätzliche medikamentöse Therapieverfahren bei steroidrefraktären Patienten
wie z. B. die Gabe neuer Immunsuppressiva wie Takrolimus oder Mycophenolat-Mofetil
sind derzeit in der klinischen Erprobung und könnten eine weitere Verbesserung der
therapeutischen Strategien erbringen. Möglicherweise wird es in Zukunft zudem möglich
und nötig sein, Subgruppen der Patienten mit Morbus Crohn zu definieren, um bei den
vorhandenen breiteren Behandlungsmöglichkeiten eine individuell optimale medikamentöse
Behandlung erreichen zu können.
Schlüsselwörter:
Morbus Crohn - Therapie - akuter Schub - Remissionserhaltung
Medical treatment of acute and chronic crohn's disease.
The prognosis of patients suffering from Crohn's disease has markedly improved during
the last years because of new developments in treatment strategies and concepts. For
the treatment of acute flares of Crohn's disease still administration of corticosteroids
has to be regarded as standard. In steroid refractory disease administration of TNF-antibodies
may be considered. The treatment with immunosuppressive agents such as azathioprine,
6-mercaptopurine (or methotrexate as an alternative) is state of the art in chronically
active disease. In moderate disease activity or ileocecal location topical steroids
as for example budesonide may be used. Topical or systemic corticosteroids are of
no therapeutical use for the maintenance of remission. The effectiveness of 5-aminosalicylic
acid (5-ASA) for maintenance therapy is still a matter of discussion. New treatment
strategies as for example administration of new immunosupressants such as tacrolimus
of mycofenolate mofetil are presently studied and could improve the treatment of Crohn's
disease patients in the near future. In addition, the Definition of subgroups of Crohn's
disease may be possible or necessary in the near future, probably enabling the physician
to chose an adapted, optimized therapy for each individual patient.
Key words:
Chrohn's disease - Treatment - Acute flares - Maintenance therapy
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PD Dr. med. Dr. phil. Gerhard Rogler
Prof. Dr. med. Jürgen Schölmerich
Klinik und Poliklinik für Innere Medizin I Universität Regensburg
93042 Regensburg
