Biologika für die frühe RA

Zusammenfassung

Der unmittelbare Beginn einer DMARD-Therapie nach Sicherung der Diagnose einer RA ist heute Standard. In der Regel wird die Therapie mit Methotrexat in Kombination mit Glucocorticoiden begonnen und bei Erfolglosigkeit durch eine DMARD-Kombination ersetzt. 5 Biologika, Infliximab, Etanercept, Adalimumab, Abatacept und Rituximab wurden bisher in Studien bei Früh-RA getestet und haben sich in Kombination mit Mtx als erfolgreich erwiesen. Im Standard-Algorithmus wird die Kombination Biologikum+Mtx bei Misserfolg einer DMARD-Kombination 6 Monate nach DMARD-Beginn angewendet. Ein Einsatz als Starttherapie hat hingegen in mehreren Strategie-Studien Vorteile im Vergleich zur DMARD-Kombinationstherapie nur radiologisch gezeigt. Ein früher Biologika-Einsatz (nach erfolgloser DMARD-Starttherapie) wird gleichwohl in den EULAR-Empfehlungen für Patienten mit Merkmalen einer ungünstigen Prognose nahegelegt, dieses Vorgehen ist jedoch bisher nicht durch Studien belegt – eine derartige Studie wäre dringend wünschenswert. Ein attraktives Konzept für die Zukunft könnte jedoch die Verwendung von Biologika+Mtx als Starttherapie mit dem Ziel sein, eine anhaltende medikamentenfreie Remission zu erreichen. Erste Studienresultate, z. B. in der BeST-Studie, belegen, dass dieses Konzept funktionieren könnte.

Abstract

DMARD treatment for early rheumatoid arthritis should today be started as soon as diagnosis is made. The combination of methotrexate (Mtx) and glucocorticoids is considered to be the first-line treatment followed by DMARD combinations in cases of a lack of success. 5 biologics, infliximab, etanercept, adalimumab, abatacept and rituximab, have been tested successfully in combination with Mtx in controlled early RA studies. Normally a biologic+Mtx should be the next step after lack of effect with DMARD combination, at least 6 months after starting DMARD treatment. Recently published EULAR recommendations consider a second step use of biologics after the first DMARD treatment has missed the target in cases with the presence of poor prognostic factors. This recommendation, however, is not evidence-based until now. Some recent studies, e. g., BeST suggest that a biologic+Mtx as starting regimen might induce long-lasting drug-free remission in many patients and so this could be an attractive concept for future.

frühe rheumatoide Arthritis - DMARDs - Biologika - medikamentenfreie Remission

early rheumatoid arthritis - DMARDs - biologics - drug-free remission

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