Aktueller Stand der Therapie der rheumatoiden Arthritis mit biologischen DMARDs

 

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Zusammenfassung

Biologika werden in der Rheumatologie seit 17 Jahren eingesetzt. Sie haben die Behandlungsmöglichkeiten bei Krankheiten wie der rheumatoiden Arthritis (RA) dramatisch verbessert und entscheidend dazu beigetragen, dass heute die Remission bei dieser Erkrankung das Behandlungsziel darstellt. Gegenwärtig sind aus dieser Wirkstoffgruppe neun Substanzen für die Behandlung der RA zugelassen, fünf davon hemmen TNF-α, je eines Interleukin-1, Interleukin-6, B-Lymphozyten und die Aktivierung von T-Lymphozyten. Zusätzlich stehen aktuell drei Infliximab-Bio -similars und ein Etanercept-Biosimilar zur Verfügung. Biologika kommen bei der RA bei Patienten mit ungünstiger Prognose als Zweitlinientherapie (in der Regel im Fall einer nicht ausreichend wirksamen Starttherapie mit Methotrexat = MTX) zum Einsatz, in den übrigen Fällen sollten sie bei Versagen konventioneller DMARDs spätestens als Drittlinientherapie eingesetzt werden. Sie sollten kombiniert mit MTX verwendet werden, so-fern dieser Kombinationspartner zur Verfügung steht. Bei MTX-Kontraindikation oder -Unverträglichkeit sind einige der Substanzen auch für die Monotherapie zugelassen, die beste Wirksamkeit bieten hier Tocilizumab und in zweiter Linie Etanercept. Bei Unwirksamkeit des ersten Biologikums ist ein Switch auf eine andere Substanz aus der Gruppe oft erfolgreich.

Summary

Biologic Disease-modifying antirheumatic drugs (bDMARD) are used since 2000 and have improved treatment possibilities in rheumatoid arthritis (RA) dramatically ensuring remission being a realistic treatment target today. BDMARD group so far includes five TNF-α inhibitors as well as inhibitors of Interleukin 1, Interleukin 6, B Lymphocytes and T-cell-activation, in addition three Infliximab biosimilars and one etanercept biosimilar. In RA bDMARDs should be used as second-line treatment if starting treatment (normally methotrexate [MTX]) fails in patients with unfavourable prognosis and as third-line treatment in all other cases. If possible, bDMARDs should be combined with MTX, in cases of MTX contraindications or adverse effects monotherapy with tocilizumab or etanercept is the best option. If the first bDMARD has failed, switch to a second one is possible and successful in many cases.

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