Ernsthafte Infektionen und Biologika bei der juvenilen idiopathischen Arthritis

Zusammenfassung

Biologika haben die Therapiemöglichkeiten der juvenilen idiopathischen Arthritis (JIA) in den letzten 15 Jahren erheblich erweitert. Trotz der hohen Wirksamkeit sind Sicherheitsaspekte, insbesondere Infektionen, von großem Interesse. Das Risiko für medizinisch bedeutsame bakterielle Infektionen scheint allein aufgrund der Erkrankung bei JIAPatienten erhöht und weiter durch die anti- rheumatische Behandlung anzusteigen. Insgesamt ist die Häufigkeit ernsthafter Infektionen niedrig. Die Kombination von Daten aus verschiedenen Quellen ergeben vergleichbare Raten ernsthafter Infektionen pro 100 Patientenjahre für Abatacept (1,1 [0,5–2,5]), Adalimumab (1,9 [1,4–2,6]), Etanercept (1,5 [1,4–1,8]) sowie Tocilizumab (2,06 [1,0–4,3] und gering-fügig höhere für Golimumab (3,0 [1,3–7,3]) und Infliximab (3,4 [1,7–6,8]). Der Vergleich von Patientenkohorten ohne eine Biologikatherapie (0,67 [0,48–0,93]) ergibt ein signifikant erhöhtes Risiko (p < 0,05) für ernsthafte Infektionen für alle Biologika mit Ausnahme von Tocilizumab und Abatacept aufgrund kleinerer Fallzahlen. Ein Herpes zoster ist die einzige häufiger auftretende spezifische Infektion. Opportunistische Infektionen einschließlich Tuberkulose sind sehr selten. Insgesamt sind die Sicherheitsprofile von für die JIA zugelassenen Biologika sehr akzeptabel.

Summary

Biologics for therapy of juvenile idiopathic arthritis (JIA) have opened new options since for about now 15 years. Despite high effectiveness, safety effects, especially infections are of great interest. The risk for medically important bacterial infections seems increased in JIA patients by the disease itself and seems to be further increased by antirheumatic treatment. Combining data from several sources, rates of serious infections per 100 patient-years seem comparable for Abatacept (1.1; 0.5–2.5), Adalimumab (1.9;1.4–2.6), Etanercept (1.5; 1.4–1.8), and Tocilizumab (2.1; 1.0–4.3], and were slightly higher for Golimumab (3.0; 1.3–7.3) and Infliximab (3.4; 1.7–6.8). Using patient cohorts treated with Methotrexate without a biologic as comparator, risk ratios for serious infections were significantly increased for all biologics except for Tocilizumab and Abatacept due to fewer patient numbers. Opportunistic infections including tuberculosis ware very rare. Herpes zoster is the only specific infection occurring more frequently throughout the studies. Thus, the safety profiles of actually approved biologics are highly acceptable.

Schlüsselwörter

Juvenile idiopathische Arthritis - Adalimumab - Abatacept - Canakinumab - Etanercept - Infliximab - Tocilizumab - Sicherheit - Infektionen

Keywords

Juvenile idiopathic arthritis - Adalimumab - Abatacept - Canakinumab - Etanercept - Infliximab - Tocilizumab - safety - infections

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