Medikamentöse Therapieverfahren beim akuten Morbus Crohn und zur Remissionserhaltung

Zusammenfassung.

Durch die Fortentwicklung der medikamentösen Behandlung des Morbus Crohn hat sich die Prognose der betroffenen Patienten in den letzten Jahren deutlich verbessert. Zur den heute als Standard anerkannten Therapieverfahren zur Behandlung von Patienten mit Morbus Crohn zählt im akuten Schub nach wie vor die Gabe von Steroiden. Bei Therapierefraktärität kann die Gabe von TNFα-Antikörpern erwogen werden. Bei chronisch aktiven Verläufen gilt heute die Gabe von Immunsuppressiva wie Azathioprin, 6-Mercaptopurin (oder als Reservepräparat Methotrexat) als Standard. Bei mäßig akuten Schüben und bei geeigneter Lokalisation (v.a. Ileozökalregion) können auch topisch wirksame Steroide wie Budesonid eingesetzt werden. Steroide in systemischer oder topischer Form besitzen allerdings keinen therpeutischen Wert für die Remissionserhaltung. Die Effektivität der Gabe von 5-Aminosalicylsäure-Präparaten (5-ASA) für die Remissionserhaltung ist umstritten. Neue zusätzliche medikamentöse Therapieverfahren bei steroidrefraktären Patienten wie z. B. die Gabe neuer Immunsuppressiva wie Takrolimus oder Mycophenolat-Mofetil sind derzeit in der klinischen Erprobung und könnten eine weitere Verbesserung der therapeutischen Strategien erbringen. Möglicherweise wird es in Zukunft zudem möglich und nötig sein, Subgruppen der Patienten mit Morbus Crohn zu definieren, um bei den vorhandenen breiteren Behandlungsmöglichkeiten eine individuell optimale medikamentöse Behandlung erreichen zu können.

Schlüsselwörter:

Morbus Crohn - Therapie - akuter Schub - Remissionserhaltung

Medical treatment of acute and chronic crohn's disease.

The prognosis of patients suffering from Crohn's disease has markedly improved during the last years because of new developments in treatment strategies and concepts. For the treatment of acute flares of Crohn's disease still administration of corticosteroids has to be regarded as standard. In steroid refractory disease administration of TNF-antibodies may be considered. The treatment with immunosuppressive agents such as azathioprine, 6-mercaptopurine (or methotrexate as an alternative) is state of the art in chronically active disease. In moderate disease activity or ileocecal location topical steroids as for example budesonide may be used. Topical or systemic corticosteroids are of no therapeutical use for the maintenance of remission. The effectiveness of 5-aminosalicylic acid (5-ASA) for maintenance therapy is still a matter of discussion. New treatment strategies as for example administration of new immunosupressants such as tacrolimus of mycofenolate mofetil are presently studied and could improve the treatment of Crohn's disease patients in the near future. In addition, the Definition of subgroups of Crohn's disease may be possible or necessary in the near future, probably enabling the physician to chose an adapted, optimized therapy for each individual patient.

Key words:

Chrohn's disease - Treatment - Acute flares - Maintenance therapy

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