Zur Behandlungsstrategie bei chronischer endogener Uveitis

Zusammenfassung

Hintergrund: Zur Behandlung der chronischen endogenen Uveitis werden primär lokale und systemische Kortikosteroide eingesetzt, sobald eine infektiöse Ätiologie ausgeschlossen ist. Sekundär werden oft immunmodulatorische Therapien erforderlich. Methoden: Das Spektrum der therapeutischen Optionen hat sich erheblich verbreitert mit Antiproliferativa und Alkylantien seit etwa 40 und Immunsuppressiva seit 20 Jahren. Ergebnisse: Für die meisten dieser relativ nebenwirkungsreichen Therapien fehlen kontrollierte Studien und klare Therapie-Empfehlungen. Das therapeutische Ansprechen wird erheblich von Krankheitsbild und immungenetischem Hintergrund des Patienten beeinflusst und ist oft schwer vorherzusagen. In den letzten Jahren wurden vermehrt die Vitrektomie und intravitreale Therapien eingesetzt. Seit Kurzem stehen Biologika als neue therapeutische Optionen zur Verfügung. Dazu gehören Interferon α, TNF alpha-Blocker und Antikörper gegen Interleukin, die meist gut verträglich sind und oft besser als immunsuppressive Therapien wirken. Schlussfolgerung: Die Anwendung biologischer Therapeutika bei chronischer endogener Uveitis erscheint auf der Basis persönlicher Erfahrung und publizierter Evidenz eine vielversprechende neue Option und wegen ihrer guten Verträglichkeit auch in der Behandlung von Kindern mit chronischer Uveitis eine attraktive Ergänzung der therapeutischen Optionen. Daten zur Wirksamkeit und den Nebenwirkungen insbesondere bei Langzeittherapie der Uveitis liegen noch nicht vor.

Abstract

Purpose: The treatment of chronic endogenous uveitis has included the use of local and systemic corticosteroids since the early 1950 s, and these still constitute the first-line option in the treatment, once an infectious aetiology has been excluded. Methods: Since the 1960 s, broad experience has been collected with antiproliferative and alcylating agents, and since the 1980 s several immunosuppressants have been employed in the therapy for endogenous uveitis. It has been recognised that the therapeutic response is not only related to a specific uveitic entity, but also to the genetic background of the individual. Results: Therefore, no clear guide lines for therapy exist and, for most of the drugs, controlled studies are not available. Vitrectomy and intravitreal drug delivery have been added as local options on top or in case of failure of systemic therapies. The advent of biological agents, however, i. e. the introduction of interferon α and TNF alpha blocking agents, has opened a new era in the treatment of immunogenetic and autoimmune disorders. Conclusion: Evidence-based knowledge and personal experience have been reviewed to provide an update on the therapeutic strategy for chronic endogenous uveitis. The newly introduced biologicals seem to represent an interesting addition to the existing therapeutic options. Informations pertaining to efficacy and side effects of a long-term treatment of uveitis are, nevertheless, as yet not available.

Schlüsselwörter

chronische Uveitis - Immunsuppressiva - Biologika - Etanercept - Infliximab - Interferon - Steroide - Kortikosteroide

Key words

chronic uveitis - immunosuppressants - biologicals - etanercept - infliximab - interferon - steroids - corticosteroids

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