Therapie des Lupus erythematodes und der Lupusnephritis – Immunsuppression und mehr

Bei der Therapie des systemischen Lupus erythematodes (SLE) ist zu unterscheiden, ob eine milde Verlaufsform oder eine schwere Organmanifestation vorliegt. Während die milderen SLE-Fälle symptomatisch mit NSAR, niedrig dosierten Glukokortikoiden und Hydroxychloroquin behandelt werden, ist der Einsatz von immunsuppressiven Medikamenten bei schwerer Organbeteiligung unumgänglich. Für die Induktionstherapie der Lupusnephritis steht neben Ciclophosphamid auch Mycophenolatmofetil zur Verfügung. Ein Ansprechen nach 3 bzw. 6 Monaten ist hierbei ein guter prognostischer Marker für das Langzeitüberleben. Für die remissionserhaltende Therapie kommen Azathioprin oder MMF in Kombination mit Hydroxychloroquin zum Einsatz. Die Einführung von Belimumab hat darüber hinaus als erstes Biologikum in der Therapie des aktiven SLE das Tor für zukünftige, spezifischere Therapieansätze geöffnet.

Treatment of systemic lupus erythematosus (SLE) is based on disease activity and organ manifestation. While patients with mild lupus such as arthralgia or skin manifestation will be symptomatically treated using NSAID, low-dose corticosteroids and hydroxychloroquin, there is a need for immunosuppressive agents in lupus patients with severe organ involvement such as diffuse proliferative lupus nephritis. Treatment response after 3 and 6 months respectively is a good prognostic marker for long-term survival. For maintenance therapy, azathioprin or MMF in combination with hydroxychloroquin will be used. The introduction of belimumab as the first biological in lupus therapy opens a window for future specifically targeted therapy.

Key words

lupus erythematosus - lupus nephritis - therapy - immunosuppression

• Literatur

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