Neue Therapieansätze bei der Multiplen Sklerose

Zusammenfassung

Die Pulstherapie mit Glukokortikosteroiden (GS) ist zur Zeit die einzige etablierte Behandlung einer akuten Verschlechterung bei MS, für die auch Studien relativ guten Evidenzgrades vorliegen. Bei Nonresponse mit schweren Ausfallssymptomen kann eine Plasmapherese-Serie erwogen werden. Zur immunmodulatorischen Basistherapie werden heute Interferone und Glatiramerazetat möglichst frühzeitig eingesetzt, um die Erfolgschancen der Langzeittherapie zu erhöhen. Bei hoher Schubfrequenz bzw. sekundär progredientem Verlauf ist Mitoxantron in Deutschland zugelassen. Neuartige Therapieansätze zur Behandlung des Schubs sowie zur Immunmodulation beeinflussen die fehlgeleitete Autoimmunreaktion auf verschiedenen Ebenen über die Induktionsphase der Immunantwort mit Antigenpräsentation und Kostimulation, die Adhäsion und Transmigration von Entzündungszellen und die lokale Zytotoxizität sowie Effektormechanismen. Vielversprechend sind u.a. der inhibierende VLA-4 Antikörper Natalizumab sowie neurotrophe Zytokine wie LIF (leucemia inhibitory factor).

Summary

Corticosteroid-pulse therapy is still the mainstay for the treatment of acute relapses of MS. In patients who fail to respond to steroid pulse therapy, plasmapheresis may lead to rapid and sustained improvement. Immunomodulatory treatment with interferon or glatirameracetate serves as basis for longterm therapy in relapsing-remitting MS. In patients with high relapse-rate or secondary disease progression mitoxantrone can be used in escalating treatment regimens. Novel immunotherapies act at different levels: they target the induction phase with antigen presentation and costimulation, adhesion and transmigration of inflammatory cells and local cytotoxicity. Promising agents include anti-VLA-4 antibodies (natalizumab TM), and neurotrophic cytokines such as LIF (leucemia inhibitory factor).

Key Words

multiple sclerosis - glucocorticosteroid therapy - plasma exchange - mitoxantrone - Natalizumab

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