Endokrine Orbitopathie: aktueller Stand der medikamentösen Therapie

Zusammenfassung

Hintergrund Die Therapie schwerer Manifestationsformen der endokrinen Orbitopathie (EO) ist immer noch eine Herausforderung und verlangt eine gute interdisziplinäre Zusammenarbeit. Von besonderer Bedeutung ist die stadiengerechte antientzündliche Therapie, um irreversible Schäden zu vermeiden.

Material und Methode Diskussion der neuesten Ergebnisse multizentrischer randomisierter Therapiestudien zur antientzündlichen Therapie der endokrinen Orbitopathie und von neuen Therapiekonzepten.

Ergebnisse Bei der milden Form der EO kann der Spontanverlauf unter Selensupplementation abgewartet werden. Bei der moderat schweren aktiven Form der EO besteht die Primärtherapie aus einer i. v. Steroidstoßtherapie (kumulativ 4 – 5 g) in Kombination mit einer Orbitaspitzenbestrahlung bei Motilitätsstörungen. Bei ungenügendem Ansprechen nach 6 Wochen kann eine immunsuppressive Therapie hinzugefügt werden. Bei schwerer visusbedrohender Manifestation ist meist eine knöcherne Orbitadekompression die Therapie der Wahl. Durch konsequente Grundlagenforschung konnten inzwischen auch für die EO zielgerichtete Therapien entwickelt werden. Der IGF-1-Rezeptor-Antikörper Teprotumumab zeigte sich in einer Phase-III-Studie als effektiv, sodass in Kürze mit einer Zulassung zu rechnen ist.

Schlussfolgerung Das aktuell noch gültige Therapiekonzept bei der endokrinen Orbitopathie der zunächst antientzündlichen Therapie gefolgt von der operativen Korrektur der bleibenden Defekte ändert sich möglicherweise durch den Einsatz zielgerichteter Therapien in der Zukunft.

Schlüsselwörter

Orbita - Strabologie - okuläre Tumoren - Morbus Basedow - EO

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