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Klin Monbl Augenheilkd 2021; 238(05): 569-578
DOI: 10.1055/a-1423-8961
DOI: 10.1055/a-1423-8961
Übersicht
Aktuelle Möglichkeiten der antiviralen Therapie und Impfung bei SARS-CoV-2
Article in several languages: English | deutsch
Zusammenfassung
Das sich seit Ende 2019 weltweit verbreitende neuartige Coronavirus SARS-CoV-2 („severe acute respiratory syndrome coronavirus type 2“) führte auf globaler Ebene zu schweren gesundheitlichen und volkswirtschaftlichen Problemen. Bis Ende Februar 2021 wurden weltweit mehr als 100 Mio. SARS-CoV-2-Fälle gemeldet. Die durch SARS-CoV-2 ausgelöste Erkrankung COVID-19 („Coronavirus-Disease-2019“) lässt sich in 3 Phasen einteilen: eine frühe Phase mit Fieber und Husten (Phase I), die pneumovaskuläre Erkrankung (Phase II) und die hyperinflammatorische Erkrankung (Phase III). Da im frühen Krankheitsstadium besonders die Virusreplikation eine wichtige Rolle spielt und im späteren Verlauf das Immunsystem der Patienten, ergeben sich, je nach Krankheitsstadium, verschiedene Therapiemöglichkeiten. Das antivirale Nukleosidanalogon Remdesivir ist das einzige therapeutische Medikament mit einer bedingten Zulassung in der Europäischen Union. Eine Behandlung mit Remdesivir sollte bei Patienten, die zusätzlichen Sauerstoff ohne invasive Beatmung erhalten, möglichst frühzeitig nach Symptombeginn eingeleitet werden. Das entzündungshemmende Kortikosteroid Dexamethason sollte wiederum erst später im Krankheitsverlauf bei Patienten mit Sauerstofftherapie verabreicht werden. Da Autopsien auf ein verstärktes Auftreten von thromboembolischen Ereignissen durch COVID-19 hindeuten, wird eine zusätzliche Behandlung mit gerinnungshemmenden Medikamenten empfohlen. Die Entwicklung von Medikamenten ist sehr zeitaufwendig, weshalb es naheliegend ist, schnell verfügbare Rekonvaleszenzplasmen von Patienten nach überstandener SARS-CoV-2-Infektion für die Behandlung von COVID-19 zu testen. Groß angelegte Studien deuten jedoch auf eine geringe Effektivität dieser Rekonvaleszenzplasmen hin. Um die Ausbreitung von SARS-CoV-2 einzudämmen, ist die Entwicklung von Impfstoffen von essenzieller Bedeutung. Derzeit sind in der Europäischen Union die mRNA-Impfstoffe Tozinameran der Unternehmen BioNTech und Pfizer sowie mRNA-1273 der Firma Moderna und der Vektorimpfstoff AZD1222 des Konzerns AstraZeneca zugelassen. Alle 3 Impfstoffe konnten in großen klinischen Studien eine hohe Effektivität ausweisen. Neben diesen zugelassenen Impfstoffen werden noch viele weitere in klinischen Studien erprobt. In dem vorliegenden Artikel wird eine Übersicht über Therapiemöglichkeiten von COVID-19 sowie über Impfstoffe zum Schutz vor SARS-CoV-2 gegeben.
Publication History
Received: 26 February 2021
Accepted: 10 March 2021
Article published online:
21 May 2021
© 2021. Thieme. All rights reserved.
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