Neue Therapieansätze bei Sepsis

Zusammenfassung

Die Behandlung der Sepsis setzt sich zusammen aus der Fokussanierung sowie aus der supportiven und adjuvanten Therapie. Insbesondere die letztere Behandlungsschiene war während der letzten Jahre Gegenstand vieler Studien. Verschiedenste Ansätze zeigten in tierexperimentellen Untersuchungen und Phase-1-Studien viel versprechende Ergebnisse, konnten in großen Multicenter-Studien jedoch nicht bestehen. So führte die Applikation von TNF-Rezeptoren oder Interleukin-1-Rezeptorantagonisten zu keiner Prognoseverbesserung bei Patienten mit Sepsis. Auch die meisten gegen TNFα gerichteten Studien zeigten keine statistisch signifikanten Therapieergebnisse. Inzwischen liegt jedoch eine große Studie vor, die eine signifikante Verbesserung der Überlebensrate mit monoklonalen TNF-Antikörpern belegt. Mit der kürzlich veröffentlichten PROWESS-Studie konnte auch bei einer großen Patientenpopulation eine Senkung der Mortalität durch die therapeutische Gabe von Protein C nachgewiesen werden. Weiterhin unterstützt die momentane Datenlage die niedrig dosierte Kortisontherapie bei Patienten mit vasopressorabhängigem septischen Schock.

Summary

The treatment of sepsis consists of focus control as well as supportive and adjuvant therapy. Especially the last option has been investigated during the last years. Different approaches showed promising results in animal experiments and phase-I trials but did not prove to be successful in large multicenter studies. The application of TNF-receptors or interleukin-1 receptor antagonists did not lead to an improvement of outcome in patients with sepsis. Most studies with TNF-antibodies also presented negative results. However, a recent large study with a monoclonal antibody against TNFα demonstrated a significant survival benefit. The recently published PROWESS study is the first investigation demonstrating the decrease of mortality in patients with sepsis after administration of protein C. Additionally, current data support the low-dose hydrocortisone therapy in patients with vasopressor dependent septic shock.

Schlüsselwörter

Sepsis - TNF-Antikörper - ATIII - Protein C - Hydrokortison

Key words

Sepsis - TNF-antibodies - ATIII - Protein C - Hydrocortisone

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