Trotz der Fortschritte in der medikamentösen Therapie der Colitis ulcerosa sind die
Raten primärer und/oder sekundärer Behandlungsversagen immer noch beträchtlich. In
den letzten Jahren wurden zahlreiche neue Substanzen entwickelt und zugelassen. In
diesem Artikel diskutieren wir fallbasierte Entscheidungswege für die Auswahl geeigneter
entzündungshemmender Behandlungen bei CU-Patienten und fassen die Prinzipien der verschiedenen
Therapiestrategien zusammen.
Abstract
Ulcerative colitis (UC) is classified as a chronic inflammatory bowel disease (IBD)
and can present in various degrees of severity. In addition to mild courses of the
disease, such as uncomplicated proctitis, which can often be successfully treated
with topical 5-ASA formulations, complicated courses can be observed, which can sometimes
be life-threatening. Affected patients are often considerably burdened and often severely
restricted in their quality of life, as they suffer from numerous, often bloody bowel
movements, which are accompanied by abdominal cramps, urgency and sometimes even incontinence.
In addition, many UC patients suffer from concomitant extraintestinal inflammatory
manifestations including skin manifestations like psoriasis, erythema nodosum or joint
involvement such as spondylarthritis. For many years, steroids and conventional immunosuppressants
such as azathioprine were the only treatment options available. Twenty years ago,
the approval of the first anti-TNF antibody, Infliximab, marked a significant turning
point in IBD therapy. Despite the continuous progress in drug therapy, the rates of
primary and/or secondary treatment failure are still considerable. With this in mind,
a large number of additional substances have been developed and approved for the treatment
of UC in the recent years. In addition to TNF antibodies and their biosimilars, the
anti-integrin vedolizumab, various Janus kinase (JAK) inhibitors, an interleukin (IL)-12/-23p40
antibody, various IL-23p19 antibodies and sphingosine-1-phosphate receptor (S1PR)
modulators have broadened the therapeutic landscape and found their way into the clinical
treatment of UC patients. In this article we will discuss case-based decision paths
for the selection of fitting anti-inflammatory treatments in UC patients and summarize
the principles of the different therapeutic strategies for UC.
Schlüsselwörter
Colitis ulcerosa - entzündlichen Darmerkrankungen - CED - TNF-Antikörper - Sphingosin-1-Phosphat-Rezeptor
- Interleukin-23 - Januskinasen - JAK-Inhibitoren
Keywords
Ulcerative colitis - inflammatory bowel diseases - IBD - TNF antibodies - Sphingosine-1-phosphate
receptor - Interleukin-23 - Janus kinases - JAK inhibitors
