Was gibt es Neues bei der Multiplen Sklerose?

Zusammenfassung

Dieser Übersichtsartikel informiert über Studienergebnisse der letzten 12 Monate zum Thema Multiple Sklerose (MS) sowie die neuesten Ergebnisse vom 26. Kongress des Europäischen Komittees zur Behandlung und Forschung der Multiplen Sklerose (ECTRIMS). Schwerpunkt sind die klinisch relevanten Studien und die Darstellung der Datenlage zu den zukünftigen oralen und Antikörper basierten Therapieoptionen der Multiplen Sklerose. Obwohl die Therapiemöglichkeiten für MS in den vergangenen Jahrzehnten deutlich erweitert wurden, werden neue Behandlungsoptionen und komfortablere Formen der Anwendung benötigt, um die Effizienz der Therapie zu erhöhen und die Therapieadhärenz zu verbessern. Die Zulassung der ersten oralen Substanz in der Behandlung der schubförmigen MS, Fingolimod, erfolgte im März 2011. Die aktuell nicht erteilte Zulassung für Cladribin zur Behandlung der schubförmigen Form der Multiplen Sklerose zeigt jedoch auch den schmalen Grat zwischen Therapienutzen und möglichen noch nicht beurteilbaren Nebenwirkungen der neuen Therapieoptionen. Dieser Artikel wird die jüngsten Entwicklungen auf dem Gebiet der MS-Behandlung referieren und dabei den Schwerpunkt auf die oralen Wirkstoffe (Fingolimod, Cladribin, BG00012, Teriflunomid und Laquinimod) sowie 2 neue monoklonale Antikörper (Alemtumzumab und Daclizumab) legen. Eine weitere relevante Neuerung 2011 ist ein Revisionsvorschlag zum MRT in der Diagnosestellung der MS aus der MAGNIMS Gruppe. Dieser Vorschlag erlaubt die Diagnose einer gesicherten MS nach erstem klinischem Ereignis, nun noch frühzeitiger zu stellen. Erste Ergebnisse zu Risikoprädiktionsalgorithmen sowie Biomarkern für das Risiko einer Immuntherapie mit Natalizumab liegen vor, mit dem Nachweis des anti-JCV-Antikörper im Serum scheint es einen ersten Biomarker zur Abschätzung des PML-Risikos einer progressiven multifokalen Leukenzephalopathie (PML) unter einer Natalizumabtherapie zu geben. Unter Berücksichtigung einer immunsuppressiven Vortherapie kann sich das individuelle PML Risiko bei gegebener Konstellation (immunsuppressive Vortherapie und Vorliegen von JC-Antikörpern) teilweise um den Faktor 10 und mehr unterscheiden. Neue Erkenntnisse zur Pathogenese, Genetik, Rolle von Umweltfaktoren, Diagnosestellung und Prognose werden zusammengestellt.

Abstract

This review reports on the results of clinical trials in multiple sclerosis of the last 12 months. The review focuses on the new oral immunotherapies and monoclonal antibodies as therapeutic options in the treatment of multiple sclerosis. Although the drug therapy has improved in multiple sclerosis during the last years, new therapeutic options are necessary to improve the efficacy and the adherence of patients to drugs. The first oral drug, fingolimod, in remitting-relapsing multiple sclerosis was approved in March 2011 in Europe after approval by the FDA in 2010. The postponed approval for cladribine by the EMA illustrates the difficult benefit-risk estimation of new drugs in multiple sclerosis. The new developments of new orals (cladribine, fingolimod, BG00012, teriflunomide and laquinimod) and two monoclonal antibodies alemtuzumab and daclizumab are described. The MAGNIMS criteria to diagnose MS with a cranial MRI scan enable the clinicians to determine the confirmed diagnosis of MS earlier after the clinically isolated syndrome. The anti-JC-virus antibody seems to be the first reliable biomarker to estimate the risk of progressive multifocal leukoencephalopathy (PML) in natalizumab-treated patients. Under consideration of a former immunosuppressive therapy, the individual risk for PML differs by about a factorof 10 or more under natalizumab therapy.

Schlüsselwörter:

Multiple Sklerose - Cladribin - Fingolimod - Laquinimod - Teriflunomid

Key words:

multiple sclerosis - cladribine - fingolimod - laquinimod - teriflunomide

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