Dtsch Med Wochenschr 2020; 145(01): 40-46
DOI: 10.1055/a-1060-2736
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Anti-B-Zell-Antikörpertherapie zur Remissionserhaltung bei Granulomatose mit Polyangiitis und mikroskopischer Polyangiitis

Anti B-cell-antibody treatment for maintenance of remission in granulomatosis with polyangiitis and microscopic polyangiitis
Kirsten de Groot
1   Medizinische Klinik III (Nephrologie, Dialyse, Hypertensiologie, Rheumatologie), Klinikum Offenbach GmbH und KfH-Nierenzentrum Offenbach/Main
,
Peer Malte Aries
2   Rheumatologie im Struenseehaus, Hamburg
,
Marion Haubitz
3   Medizinische Klinik III (Nieren- und Hochdruckerkrankungen), Klinikum Fulda
,
Bernhard Hellmich
4   Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum-Süd, Medius-Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-Teck
,
Peter Lamprecht
5   Klinik für Rheumatologie und klinische Immunologie, Universität zu Lübeck, Lübeck
,
Jens Thiel
6   Klinik für Rheumatologie und Klinische Immunologie, Department Innere Medizin, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2020 (online)

Zusammenfassung

Die Granulomatose mit Polyangiitis (GPA) und die mikroskopische Polyangiitis (MPA) stellen als primäre nekrotisierende Kleingefäßvaskulitiden die häufigsten ANCA-assoziierten Vaskulitiden dar. Bei diesen, früher oft tödlich verlaufenden Erkrankungen kann heute durch eine Stadien-adaptierte Immunsuppression in den meisten Fällen eine Remission erzielt werden. Diese mündet jedoch nicht in eine Heilung oder medikamentenfreie Langzeitremission. Es bedarf deshalb einer remissionserhaltenden Therapie. Aktuelle randomisierte kontrollierte Studien zeigen, dass unter einer remissionserhaltenden Behandlung mit halbjährlich verabreichtem anti-B-Zell-Antikörper Rituximab weniger Rezidive auftreten als unter der bisherigen Standardmedikation mit Azathioprin bei vergleichbarem Nebenwirkungsprofil. Diese Daten führten 2018 zur Zulassung von Rituximab als remissionserhaltende Therapie der GPA und MPA. Unter einer solchen Rituximab-Therapie muss mit einer Immunglobulindepletion sowie späten Zytopenien mit begleitenden Infekten gerechnet werden. Leitlinien und Expertenempfehlungen zu Infektprophylaxen, Impfungen und Immunglobulinsubstitution werden in diesem Beitrag vorgestellt.

Abstract

Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the most frequent primary necrotizing small vessel vasculitides. In these formerly fatal diseases remission can be induced by stage- and activity-adapted immunosuppressive regimens in the majority of patients. This does not lead to drug-free long-term remission or even cure. Consequently, maintenance of remission medication is needed. Recent randomized controlled trials demonstrated that maintenance treatment with the anti-B-cell antibody Rituximab, administered 6-monthly as opposed to azathioprine leads to a significantly lower relapse rate but a similar profile of adverse events. These data enabled the extension of the approval of Rituximab for maintenance of remission treatment of GPA and MPA in Germany in 2018. Guidelines and expert recommendations concerning measures of infection prevention and vaccination of immunosuppressed patients as well as the management of hypogammaglobulinemia and cytopenia on Rituximab are presented in this review.

 
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