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DOI: 10.1055/s-0038-1629964
Mitoxantron und Immunglobuline
Indikationen, Wirksamkeit, VerträglichkeitMitoxantrone and immunoglobulins – indications, effectiveness, side effectsPublication History
Publication Date:
31 January 2018 (online)
Zusammenfassung
Mitoxantron ist derzeit die wichtigste Substanz in der Eskalationstherapie der schubförmigen oder sekundär progredienten MS. Es führt sowohl zu einer Schubreduktion als auch zu einer Verlangsamung der klinischen und der radiologischen Progression. Die Substanz ist in der Regel gut verträglich. Auf Grund des Risikos einer Kardiomyopathie sollte jedoch eine Gesamtmenge von 140 mg/m2 KOF nicht überschritten werden. Auch auf das sehr geringe Risiko einer späteren akuten Leukämie müssen die Patienten hingewiesen werden.
Intravenöse Immunglobuline (IVIg) sind bislang vor allem bei schubförmiger MS sowie bei schwangeren MS-Patientinnen mit schubförmigem Verlauf und dem Risiko eines postpartalen Schubes untersucht worden. Die Ergebnisse legen einen positiven Effekt auf die Schubreduktion sehr nahe, so dass IVIg als Reservemedikation innerhalb der Basistherapie bewertet werden. Zur Behandlung der sekundär progredienten MS sowie zur Verstärkung einer Remyelinisierung sind sie offenbar jedoch nicht geeignet. Auch IVIg werden in der Regel gut vertragen. Problematisch ist ihr Off-label-Status, so dass eine Kostenübernahme durch Krankenkassen oft nur schwer zu erreichen ist.
Summary
Mitoxantrone is nowadays the most important drug within escalation therapy of relapsing-remitting (RR-MS) and secondary progressive (SP-MS) multiple sclerosis. It may reduce the frequency of relapses and decelerate progression of clinical symptoms as well as of radiologic findings, e.g. whole lesion load and number of Gadolinium-enhancing lesions. Mitoxantrone is usually well tolerated. Nevertheless due to the risk of cardiomyopathy not more than 140 mg/m2 should be administered during life. Moreover, there is a very small risk that leukaemia may develop as a sequel of mitoxantrone treatment.
Intravenous immunoglobulins (IVIg) have been investigated especially in RR-MS and in pregnant women with MS. The results demonstrate a reduction of the frequency of relapses and therefore IVIg may be used in RR-MS in cases when beta-interferon or glatirameracetate are not tolerated well. According to published data, IVIg do not play a role in the treatment of secondary progressive MS or to enhance remyelination. They are usually well tolerated, too. Because of their off label status IVIg are reimbursed by health insurances in only rare cases.
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