Update: Medikamentöse Therapie bei Colitis ulcerosa

Trotz der Fortschritte in der medikamentösen Therapie der Colitis ulcerosa sind die Raten primärer und/oder sekundärer Behandlungsversagen immer noch beträchtlich. In den letzten Jahren wurden zahlreiche neue Substanzen entwickelt und zugelassen. In diesem Artikel diskutieren wir fallbasierte Entscheidungswege für die Auswahl geeigneter entzündungshemmender Behandlungen bei CU-Patienten und fassen die Prinzipien der verschiedenen Therapiestrategien zusammen.

Abstract

Ulcerative colitis (UC) is classified as a chronic inflammatory bowel disease (IBD) and can present in various degrees of severity. In addition to mild courses of the disease, such as uncomplicated proctitis, which can often be successfully treated with topical 5-ASA formulations, complicated courses can be observed, which can sometimes be life-threatening. Affected patients are often considerably burdened and often severely restricted in their quality of life, as they suffer from numerous, often bloody bowel movements, which are accompanied by abdominal cramps, urgency and sometimes even incontinence. In addition, many UC patients suffer from concomitant extraintestinal inflammatory manifestations including skin manifestations like psoriasis, erythema nodosum or joint involvement such as spondylarthritis. For many years, steroids and conventional immunosuppressants such as azathioprine were the only treatment options available. Twenty years ago, the approval of the first anti-TNF antibody, Infliximab, marked a significant turning point in IBD therapy. Despite the continuous progress in drug therapy, the rates of primary and/or secondary treatment failure are still considerable. With this in mind, a large number of additional substances have been developed and approved for the treatment of UC in the recent years. In addition to TNF antibodies and their biosimilars, the anti-integrin vedolizumab, various Janus kinase (JAK) inhibitors, an interleukin (IL)-12/-23p40 antibody, various IL-23p19 antibodies and sphingosine-1-phosphate receptor (S1PR) modulators have broadened the therapeutic landscape and found their way into the clinical treatment of UC patients. In this article we will discuss case-based decision paths for the selection of fitting anti-inflammatory treatments in UC patients and summarize the principles of the different therapeutic strategies for UC.

Kernaussagen

• Die Therapie einer akut schweren Colitis ulcerosa kann mit Ciclosporin oder mit Infliximab, in Kombination mit Azathioprin, erfolgen.

• Eine auf Lokaltherapie refraktäre Proktitis ulcerosa sollte wie eine ausgedehntere Colitis mit Biologika oder Small Molecules behandelt werden.

• Unter einer Therapie mit Anti-TNF-Antikörpern tritt gelegentlich eine paradoxe Psoriasis auf. Sollte diese durch eine topische Therapie nicht zu beherrschen sein, bietet sich eine Umstellung auf Anti-IL-23-Antikörper an.

• Small Molecules sind aufgrund ihrer Größe plazentagängig. Ein Einsatz in der Schwangerschaft bzw. in der Stillzeit sollte daher vermieden werden.

• Bei der Auswahl der anti-entzündlichen Therapie sollte – neben der Behandlung der luminalen Entzündungsaktivität – ebenfalls die Therapie möglicher simultan auftretender extraintestinaler Manifestationen mitbetrachtet werden.

• Komplexe therapierefraktäre Krankheitsverläufe sollten in einem interdisziplinären Entzündungsboard diskutiert werden.

Schlüsselwörter

Colitis ulcerosa - entzündlichen Darmerkrankungen - CED - TNF-Antikörper - Sphingosin-1-Phosphat-Rezeptor - Interleukin-23 - Januskinasen - JAK-Inhibitoren

Keywords

Ulcerative colitis - inflammatory bowel diseases - IBD - TNF antibodies - Sphingosine-1-phosphate receptor - Interleukin-23 - Janus kinases - JAK inhibitors

Publikationsverlauf

Artikel online veröffentlicht:
31. März 2025

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