Systemischer Lupus erythematodes

Zusammenfassung

Wenn man die Therapieoptionen bei systemischem Lupus erythematodes (SLE) oberflächlich betrachtet, hat sich in den vergangenen Jahrzehnten nicht allzu viel verändert. Glukokortikoide, Cyclophosphamid, Azathioprin und Hydroxychloroquin sind (ur)alte Bekannte. Neue Zulassungen gab es in Europa bis 2011 nicht. Das hat sich in diesem Jahr mit Belimumab geändert, das in Europa und den USA zugelassen wurde. Viele weitere neue therapeutische Ansätze sind in klinischen Prüfungen. Ganz entscheidend aber hat sich zudem die Behandlungsstrategie geändert: Cyclophosphamid wird heute sehr sparsam eingesetzt, die Rolle von Azathioprin und Mycophenolat-Mofetil (MMF) ist klarer geworden. Methotrexat hat sich einen festen Platz erobert. Glukokortikoide werden möglichst rasch unter die Cushingdosis gesenkt. Antimalariamittel hingegen sind das Standardmedikament für (fast) alle SLE-Patientinnen und Patienten geworden. Daneben spielen Sonnenschutz und Vitamin D eine wichtige Rolle sowie die Kontrolle kardiovaskulärer und anderer Risikofaktoren.

Summary

A superficial look on the therapeutic options for systemic lupus erythematosus will not reveal important breakthroughs in the last decades. Glucocorticoids, cyclophosphamide, azathioprine and antimalarials have been there for ages. Until 2011, no novel therapeutic agents have been approved. This has changed in 2011. Belimumab has been approved both in the U.S. and in Europe. Many more novel therapeutic approaches are being tested in clinical trials. In addition, however, therapeutic strategies have changed dramatically: Cyclophosphamide is being used in a much reduced fashion, the role of azathioprine and mycophenolate mofetil (MMF) has been better clarified. Methotrexate has found its way into SLE standard therapy. Glucocorticoids are reduced to below 10 mg predniso(lo)ne q.d. as soon as feasible, while hydroxychloroquine has become the standard drug for essentially all SLE patients. In addition, UV protection and vitamin D both play an important role, as does the control of cardiovascular and other risk factors.

Schlüsselwörter

Systemischer Lupus erythematodes - Glukokortikoide - Antimalariamittel - Cyclophosphamid - Rituximab - Belimumab

Keywords

Systemic lupus erythematosus - glucocorticoids - antimalarials - cyclophosphamide - rituximab - belimumab

• Literatur

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