Zusammenfassung
Für die Behandlung der schubförmig verlaufenden MS stehen inzwischen mehrere therapeutische
Optionen zur Verfügung, wobei die Behandlung mit immunmodulatorischen Substanzen inzwischen
zum Standard geworden ist. Auch diese Therapien sind jedoch nur partiell wirksam sowie
relativ teuer und müssen über Jahre oder gar lebenslang appliziert werden. Über die
therapeutischen Langzeiteffekte sowie die möglichen Nebenwirkungen einer Dauertherapie
ist nach wie vor wenig bekannt. Demgegenüber zeigen prospektiv durchgeführte epidemiologische
Studien immer deutlicher, dass nur ein kleiner Teil der MS-Patienten mit einem gutartigen
Verlauf rechnen darf. Jüngere Therapiestudien in chronischen Phasen der Erkrankung
stärken ferner die These, dass insbesondere immunmodulatorische Therapien in späteren
Erkrankungsstadien nur noch begrenzt oder gar nicht mehr wirksam sind, ihre maximale
Effektivität am ehesten jedoch zu Beginn - während der überwiegend inflammatorischen
Phase - der Erkrankung zeigen. Darüber hinaus belegen histopathologische sowie kernspintomographische
Studien, dass es bereits zu Beginn der Erkrankung zu axonalen Schädigungen kommt.
Es mehren sich daher die Stimmen, die einen möglichst frühen Therapiebeginn favorisieren.
Dieser Artikel diskutiert aktuelle Daten und Argumente, die für und gegen eine frühzeitige
Behandlung sprechen.
Abstract
For the treatment of remitting-relapsing MS (RRMS) several different therapeutical
options are now available with immunomodulatory drugs as the standard of current therapy.
The treatment with immunomodulatory drugs, however, is only partially effective, relatively
expensive and has to be administered for years or even life long. So far, little is
known about both, long-term treatment and long-term side effects. On the other hand,
long-term epidemiological studies clearly suggest that only a small percentage of
patients may hope for a benign course of the disease. Moreover, recent subgroup analysis
of clinical trials support the hypothesis that immunomodulatory drugs are less or
not at all effective in later stages of the disease but appear to be most effective
in earlier, more inflammatory driven phases. Furthermore, histopathological as well
as MRI-studies indicate that axonal damage is present even in early stages of the
disease. Therefore, the concept of early treatment is gaining further support. Critical
voices, however, are calling this concept into question, mainly because of high cost
and missing long-term data. This article discusses current data and different arguments
for and against the concept of early treatment.
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PD Dr. med. Volker Limmroth
Neurologische Universitätsklinik Essen
Hufelandstraße 55
45122 Essen
Email: Volker.Limmroth@uni-essen.de
