Chronisch aktiver Verlauf

Definition

Empfehlung

Ein chronisch aktiver Verlauf ist gekennzeichnet durch eine Persistenz der klinischen Symptome trotz einer adäquaten medikamentösen Therapie, die zwar eine Besserung, jedoch keine vollständige und dauerhafte (< 2 Rezidive pro Jahr) Remission bewirkt. Der Begriff der chronischen Aktivität kann entsprechend einer medikamentösen Stufentherapie auf verschiedene Therapieprinzipien bezogen werden (C).

Erläuterung

Es bestand bei der Konsensuskonferenz Übereinkunft, dass die chronische Aktivität vor allem über die klinische Symptomatik, die trotz einer adäquaten Therapie (s. Abschnitt „Aktiver Schub, Remissionserhaltung und fulminanter Schub”) weiterbesteht, definiert wird. Eine international verbindliche Definition liegt nicht vor, die Angaben zur Häufigkeit variieren [1] [2] [3] und die Einschlusskriterien für entsprechende Studien sind unterschiedlich [3] [4] [5] [6] [7] [8] [9] [10] [11]. In der Regel werden eine vergebliche Therapie mit Glukokortikoiden (Steroidrefraktärität) oder die Notwendigkeit einer dauerhaften Glukokortikosteroidgabe (Steroidabhängigkeit) gefordert.

Literatur

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