Proliferative Formen bedürfen einer Behandlung - Therapie der Lupusnephritis: Standards und Zukunftsperspektiven

Die Lupusnephritis gilt als Prognosefaktor für den Verlauf des systemischen Lupus erythematodes. Proliferative Formen sind in jedem Fall behandlungsbedürftig. Neben dem in den 1980er-Jahren des letzten Jahrhundert eingeführten Standard, der Cyclophosphamidtherapie (CYC), welche dosisabhängig mit erheblichen Nebenwirkungen und frequenten Sekundärinfektionen verbunden ist, weisen sich klinischen Studien zufolge weitere zuverlässige Therapieoptionen mit modernen Immunsuppressiva zur Induktionstherapie aus. Neben Dosisminimierungskonzepten für Cyclophosphamid mit Azathioprin als sequenzieller Therapie stehen hier Azathioprin und Mycophenolatmofetil (MMF) im Fokus. Die Arbeit stellt die Bedeutung dieser Immunsuppressiva vor dem Hintergrund weiterer etablierter Substanzen wie Cyclosporin und der aktuellen Studienlage zusammen, gibt einen Überblick über die verfügbaren weiteren Behandlungskonzepte der Lupusnephritis, die wie die Immunadsorption oder der CD20-Antikörper Rituximab teilweise nur additiv zur Immunsuppression eingesetzt werden sollten, und verweist auf mögliche Zukunftsperspektiven.

Lupus nephritis can be considered as an essential prognostic factor for the progression of systemic lupus erythematodes. There is no question that proliferative forms of lupus nephritis are to be treated with immunosuppressants. Since introduction of the standard therapy cyclophosphamide in the late eighties of the last century, alternative therapies were tried due to the various adverse effects of cyclophosphamide for example frequent secondary infections and ovarial insufficiency in young women. Based on clinical trials we can speak of therapeutic options nowadays that are probably as reliable as cyclophosphamide as induction therapy. Besides dose minimization concepts for cyclophosphamide including azathioprine as sequential therapy, induction therapies with azathioprine or mycophenolate mofetil (MMF) are discussed. The paper focuses the importance of these immunosuppressants against the background of other established substances as cyclosporine considering the actual clinical trial. Furthermore, it gives a survey of further therapeutic options of lupus nephritis as immunoadsorption or the anti-CD-20-antibody rituximab, most of them only suitable for additional application to current immunosuppression. Also future prospects are given.

Key Words

lupus nephritis - classification - immunsuppressants - immunadsorption - plasmapheresis - anti-lymphocyte antibodies - gentherapy

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