Vedolizumab bei Colitis ulcerosa und Morbus Crohn: eine Standortbestimmung

Zusammenfassung

Die Therapie mit Vedolizumab, dem ersten in der Medikamentenklasse der antiintegrinblockierenden Moleküle zugelassenen Medikament für Colitis ulcerosa und Morbus Crohn, ist seit Juli 2014 in Deutschland verfügbar. Durch eine spezifische Rezeptorbindung wurde eine relative Darmselektivität ohne die bekannten Nebenwirkungen der systemischen Immunsuppression von Anti-TNF-α-Antikörpern erreicht. Das Nebenwirkungsprofil von Vedolizumab scheint nach den vorliegenden Daten günstiger als das der Anti-TNF-α-Therapie zu sein. Vedolizumab ist für die Induktionstherapie bei Colitis ulcerosa und Morbus Crohn geeignet, wenn auch die Kinetik des Ansprechens gegenüber den Anti-TNF-α-Antikörpern langsamer zu sein scheint. In der Erhaltungstherapie zeigen aber die Vedolizumab-Daten bei einem Ansprechen der Patienten auf die Induktionstherapie eine gute und anhaltende Remissionserhaltung im Langzeitverlauf mit einem geringeren Verlust der Wirksamkeit im Behandlungsverlauf im Vergleich zur Anti-TNF-α-Therapie. Aufgrund der Datenlage scheint die Effizienz von Vedolizumab bei der Colitis ulcerosa eher etwas höher als beim Morbus Crohn zu sein.

Abstract

Vedolizumab, the first drug in the class of anti-integrin molecules, is newly approved for ulcerative colitis and Crohn's disease and can be prescribed in Germany since mid-2014. By a specific receptor binding a relatively gut-selective mode of action was achieved without the known side effects of the systemic immunosuppression of the anti-TNF-alpha antibodies. According to the present data the safety profile of Vedolizumab appears to be more favorable than that of the anti-TNF- alpha therapy. Vedolizumab is suitable for induction therapy in patients with ulcerative colitis and Crohn's disease, however the kinetic of response compared with the anti-TNF-alpha antibodies seems to be slower. For maintenance therapy the Vedolizumab data show a deep and sustained remission in patients initially responding to induction therapy with a lower loss of efficacy in the long-term treatment known from the anti-TNF-alpha therapy. On the basis of currently available data the efficacy of Vedolizumab in ulcerative colitis appears to be slightly better than in Crohn's disease.

Schlüsselwörter

Colitis ulcerosa - Morbus Crohn - chronisch entzündliche Darmerkrankung - Darm

Key words

ulcerative colitis - Crohn's disease - chronic inflammatory bowel disease - GI tract

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