Zweiter österreichischer Konsensus zur sicheren Anwendung von anti-TNF-α-Antikörpern bei chronisch-entzündlichen Darmerkrankungen

Wolfgang Miehsler; Clemens Dejaco; Hans-Peter Gröchenig; Harry Fuchssteiner; Christoph Högenauer; Lili Kazemi-Shirazi; Harald Maier; Andreas Mayer; Alexander Moschen; Walter Reinisch; Wolfgang Petritsch; Reingard Platzer; Pius Steiner; Herbert Tilg; Harald Vogelsang; Heimo Wenzl; Gottfried Novacek

doi:10.1055/s-0044-100044

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2018; 56(03): 275-302
DOI: 10.1055/s-0044-100044

Mitteilungen

Zweiter österreichischer Konsensus zur sicheren Anwendung von anti-TNF-α-Antikörpern bei chronisch-entzündlichen Darmerkrankungen

Second Austrian consensus on the safe use of anti-TNFα-antibodies in patients with inflammatory bowel diseases

Authors

Wolfgang Miehsler

¹Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg
Clemens Dejaco

²Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
Hans-Peter Gröchenig

³Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder St.Veit, St.Veit a. d. Glan
Harry Fuchssteiner

⁴Abteilung für Innere Medizin 4, Ordensklinikum Linz, Linz a. d. Donau
Christoph Högenauer

⁵Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
Lili Kazemi-Shirazi

²Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
Harald Maier

⁶Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien
Andreas Mayer

⁷Klinische Abteilung für Innere Medizin 2, Universitätsklinikum St. Pölten, St. Pölten
Alexander Moschen

⁸Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
Walter Reinisch

²Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
Wolfgang Petritsch

⁵Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
Reingard Platzer

⁹Abteilung für Innere Medizin 1, Landesklinikum Wiener Neustadt, Wiener Neustadt
Pius Steiner

¹⁰Abteilung für Innere Medizin 1, Klinikum Wels-Grieskirchen, Wels
Herbert Tilg

⁸Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
Harald Vogelsang

²Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
Heimo Wenzl

⁵Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
Gottfried Novacek

²Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien

Abstract

Zusammenfasung

Anti-TNF-α-Antikörper haben die Therapie chronisch-entzündlicher Darmerkrankungen und anderer immunmediierter inflammatorischer Erkrankungen revolutioniert. Der zunehmende Einsatz dieser Substanzen war Anlass, den Konsensusbericht zur sicheren Anwendung von Infliximab der Arbeitsgruppe für Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie aus dem Jahr 2010 zu aktualisieren und auf alle anti-TNF-α-Antikörper zu erweitern. Der vorliegende Konsensusbericht fasst die aktuelle Datenlage zur sicheren Anwendung von anti-TNF-α-Antikörpern zusammen und berücksichtigt folgende Themen: allgemeines Infektionsrisiko, bakterielle Infekte (inkl. Clostridium difficile, Tuberkulose, Nahrungsmittelhygiene), Pneumozystis jiroveci, virale Infektionen (inkl. Hepatitis B, Hepatitis C, HIV, CMV, VZV), Impfungen und Impfempfehlungen, gastrointestinale Aspekte (perianale Fistel, abdominale Fistel, Stenose), dermatologische Aspekte (Haut-Malignome, Ekzem-ähnliche anti-TNF-α-assoziierte Hautläsionen), Infusionsreaktionen und Immunogenität, demyelinisierende Erkrankungen, Hepatotoxizität, Hämatotoxizität, Herzinsuffizienz, Malignomrisiko und Einsatz nach Malignomen, sowie Schwangerschaft und Stillen. Da der Konsensusbericht als praktischer Leitfaden für die sichere Anwendung dieser Substanzen dienen soll, wurden die relevanten Aspekte in einer Checkliste zusammengefasst, die sich in zwei Teile „vor Therapie“ und „während Therapie“ gliedert.

Abstract

Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i. e., Clostridium difficile, Tuberculosis, food hygiene), Pneumocystis jiroveci, viral infections (i. e., Hepatitis B, Hepatitis C, HIV, CMV, VZV), vaccination in general and recommendation for vaccines, gastrointestinal aspects (i. e., perianal fistula, abdominal fistula, intestinal strictures, stenosis and bowel obstruction), dermatologic aspects (skin malignancies, eczema-like drug-related skin eruption), infusion reactions and immunogenicity, demyelinating diseases, hepatotoxicity, haematotoxicity, congestive heart failure, risk and history of malignancies, and pregnancy and breast feeding. For practical reasons, the relevant aspects are summarized in a checklist which is divided into two parts: issues to be addressed before therapy and issues to be addressed during therapy.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Infliximab - Adalimumab - Golimumab - anti-TNFα - Infektion - Sicherheit - Malignom - Impfung - Schwangerschaft - Colitis ulcerosa - Morbus Crohn

Key words

inflammatory bowel disease - Infliximab - Adalimumab - Golimumab - anti-TNFα - infection - safety - malignancy - vaccine - pregnancy - ulcerative colitis - Crohn's disease

Full Text

References

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