Zusammenfassung
Gegen Tumor-Nekrose-Faktor-Alpha (TNF-α) gerichtete Therapien haben die Behandlung
der rheumatoiden Arthritis (RA) deutlich bereichert. Ein klinisches Problem ist derzeit,
dass etwa ein Drittel der Patienten während einer Therapie mit einem TNF-α-Blocker
keine messbare Symptombesserung erreicht. Weitere Probleme, die eine Therapieumstellung
erfordern können, sind eine fehlende anhaltende Symptombesserung oder unerwünschte
Wirkungen. Derzeit gibt es noch keine Leitlinien wie Patienten in dieser Situa-tion
weiter behandelt werden sollten. Für einen Therapiewechsel gibt es mittlerweile mehrere
gute Optionen, wobei sich in klinischen Studien und Kohorten zum Teil als praktikabel
erwiesen hat, eine Umstellung („Switch”) auf einen zweiten TNF-α-Blocker vorzunehmen.
Wie Studien und Kohorten zeigen, müssen jedoch Subgruppen von RA-Patienten definiert
werden, die von einem Switch klinisch nicht profitieren. Das Konzept steht derzeit
auf dem Prüfstand, zumal mit dem CD20-Antikörper Rituximab und dem T-Zell-Co-Stimulationsmodulator
Abatacept alternative Therapiestrategien nach TNF-α-Blocker Versagen erhältlich sind.
In dem Artikel beschreiben wir den Status quo der Studien zur Switch Situation und
geben einen Ausblick auf mögliche Therapieoptionen.
Abstract
Therapies directed against tumour necrosis factor α (TNF-α) have revolutionised the
management of patients with rheumatoid arthritis. However, it remains a clinical problem
that approximately one-third of the patients do not respond adequately. Furthermore,
it has become apparent that some patients gradually lose the effect over time or experience
adverse effects with the TNFα antagonists. There are no clear guidelines on the therapy
for these challenging patients. It might be useful to switch to another TNF-α antagonist
that is supported by small studies and registries. However, cohort studies underline
the necessity to identify patients who do not respond to such an anti-TNF switch.
This is of particular interest since the T-cell co-stimulation antagonist Abatacept,
as well as the B-cell depleting agent Rituximab, are also available for use in patients
who have had an inadequate response or intolerance to the TNF-α antagonists. In this
article, we review the current data and give an outlook on possible therapeutic strategies.
Schlüsselwörter
rheumatoide Arthritis - anti-TNF Therapie - abatacept - rituximab - switch
Key words
rheumatoid arthritis - anti-TNF therapy - abatacept - rituximab - switch
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Korrespondenzadresse
Prof. Dr. med. Christoph Baerwald
University Hospital Rheumatology Unit
Liebigstraße 22
04103 Leipzig
Phone: +341/972/47 10
Fax: +341/972/47 09
Email: christoph.baerwald@medizin.uni-leipzig.de
