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Klin Monbl Augenheilkd 2018; 235(05): 553-561
DOI: 10.1055/a-0577-8006
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Therapiekonzepte zur Behandlung von Patienten mit nicht infektiöser Uveitis: biologische Disease Modifying Antirheumatic Drugs

Therapeutic Concepts for Treatment of Patients with Non-infectious Uveitis Biologic Disease Modifying Antirheumatic Drugs
Karoline Walscheid
1   Augenzentrum und Ophtha-Lab, St. Franziskus-Hospital, Münster
,
Uwe Pleyer
2   Universitäts-Augenklinik, Charité, Campus Virchow-Klinik, Berlin
,
Arnd Heiligenhaus
1   Augenzentrum und Ophtha-Lab, St. Franziskus-Hospital, Münster
› Author Affiliations
Further Information

Publication History

eingereicht 21 December 2017

akzeptiert 09 February 2018

Publication Date:
12 April 2018 (online)

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Zusammenfassung

Biologika stellen eine hochwirksame Therapieoption für verschiedene nicht infektiöse Uveitisformen dar. Einziges zugelassenes Biologikum ist der TNF-α-Inhibitor Adalimumab, alle anderen Präparate müssen im Rahmen einer Off-Label-Therapie gegeben werden. Die Indikation zur Therapieinitiierung mit einem Biologikum besteht, wenn die Erkrankung nicht ausreichend anspricht auf eine Behandlung mit systemischen Steroiden und/oder csDMARDs (konventionell-synthetischen disease modifying antirheumatic drugs) oder diese aufgrund von unerwünschten Wirkungen nicht gegeben werden können. Derzeit in der klinischen Anwendung befindliche biologische DMARD-Präparate wirken über zytokinspezifische Mechanismen (TNF-α-Inhibition, Interferone, Hemmung der Signaltransduktion von Interleukin-1 [IL-1], IL-6 und IL-17) sowie Hemmung der T-Zell-Kostimulation (CTLA-4-Fusionsprotein), oder B-Zell-Depletion (Anti-CD20). Alle Präparate müssen parenteral verabreicht werden. Die Einleitung einer Biologikatherapie sollte nach interdisziplinärer Abstimmung und Ausschluss von Kontraindikationen erfolgen. Ein regelmäßiges klinisches und laborchemisches Monitoring unter der Therapie ist erforderlich.

Abstract

Biologic disease modifying antirheumatic drugs (bDMARDs) can be highly efficient in the treatment of various non-infectious uveitis entities. Currently, the TNF-α-inhibitor Adalimumab is the only in-label therapeutic option, whereas, all other bDMARDs need to be given as an off-label therapy. bDMARDs are indicated in diseases refractory to conventional synthetic DMARD therapy and/or systemic steroids, or in patients in whom treatment with those is not possible due to side effects. Therapeutic mechanisms currently employed are cytokine-specific (interferons, inhibition of TNF-α or of interleukin [IL]-1-, IL-6- or IL-17-signalling), inhibit T cell costimulation (CTLA-4 fusion protein), or act via depletion of B cells (anti-CD20). All bDMARDs need to be administered parenterally, and therapy is initiated by the treating internal specialist only after interdisciplinary coordination of all treating subspecialties and after exclusion of contraindications. Regular clinical and laboratory monitoring is mandatory for all patients while under bDMARD therapy.

Schlüsselwörter

Biologika - Therapie - TNF-α - Uveitis

Key words

biologics - therapy - TNF-α - uveitis
 

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