Zusammenfassung
Hintergrund: Die TNF-Antagonisten Infliximab, Adalimumab und Etanercept haben eine zunehmende Bedeutung in der Behandlung entzündlich-rheumatischer Erkrankungen: der rheumatoiden Arthritis (RA), der Psoriasisarthritis (PsA) und der ankylosierenden Spondylitis (AS). Trotzdem haben die noch relativ hohen Kosten nicht nur in Deutschland zu einer im europäischen Vergleich restriktiven Verordnungspraxis unter der Vorstellung besserer Wirtschaftlichkeit geführt. Ob eines der Präparate insgesamt kostengünstiger als die anderen ist, ist letztlich ungeklärt, zumal die unterschiedliche Verabreichung und Dosierung die Berechnung und Bewertung erschwert. Ziel und Methoden: Berechnung und Vergleich der Kosten der TNF-Blocker bei den verschiedenen rheumatischen Erkrankungen und Analyse der klinischen Situation bei der Indikationsstellung. Ergebnisse: Die TNF-Blocker weisen einige pharmakologische Unterschiede auf. Die Kosten sind ebenfalls different, dies liegt zum großen Teil an der Abhängigkeit von Dosis und Körpergewicht. In einem begrenzten Bereich bestehen zudem Anhaltspunkte für ein Dosis/Wirkungsverhältnis. Zwar sind die Ansprechraten insgesamt vergleichbar, es gibt aber Unterschiede in der Wirksamkeit bei den einzelnen Symptomen bzw. Erkrankungen. Das Verordnungsverhalten entspricht nicht dem Muster in den klinischen Studien. Über erfolgreiche Therapiewechsel untereinander wurde berichtet. Die Therapie-Adhärenz ist nicht unterschiedlich zwischen den Präparaten. Das Nebenwirkungsspektrum unterscheidet sich wenig. Schlussfolgerung: Es besteht keine Veranlassung, ein Präparat grundsätzlich zu bevorzugen, da es unterschiedliche Kostenvor- und -nachteile für die Präparate gibt.
Abstract
Background: The TNF-antagonists infliximab, adalimumab and etanercept are gaining increasing importance in the treatment of inflammatory rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PA) and ankylosing spondylitis (AS). Even so, in a European comparison the relatively high costs have led rather to a restrictive prescription practice under the presumption of better economics not only in Germany. Whether or not these preparations are on the whole economically more favourable than others is still not clarified, especially because the different forms of administration and dosages make calculation and evaluation difficult. Objective and Methods: The aim of this study is to calculate and compare the costs of TNF-blockers in various rheumatic diseases and analyse the clinical situation for their indication. Results: The TNF-blockers exhibit some pharmacological differences. The costs also differ, this is mainly due to the dependence of the dose on body weight. To a limited extent there is also some evidence for a dose-efficacy relationship. Although the response rates are similar, there are differences in efficacy with regard to individual symptoms and diseases. Prescription practice does not correspond to the pattern of clinical studies. Successful cross-over therapies have been reported. Therapy adherence does not differ between the preparations. The spectrum of side effects shows only minor variations. Conclusions: There is no reason to specifically favour one product since the all have differing cost advantages and disadvantages.
Schlüsselwörter
TNF-Antagonisten - Infliximab - Adalimumab - Etanercept - rheumatische Erkrankungen - Kostenvergleich
Key words
TNF-antagonists - Infliximab - Adalimumab - etanercept - inflammatory rheumatic diseases - cost comparisons
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Prof. Dr. med. J. Braun
Rheumazentrum Ruhrgebiet, St.-Josefs-Krankenhaus
Landgrafenstr. 15
44652 Herne
Email: braun@rheumazentrum-ruhrgebiet.de
