Systemische Immunsuppressiva in der Therapie der Psoriasis

Zusammenfassung

Immunsuppressiva wirken auf einen Schenkel der psoriatischen Pathogenese, dem aktivierten Immunsystem. Hierbei lassen sich aufgrund ihres Wirkungsprinzips fünf therapeutische Ansatzpunkte erkennen: (i) Hemmung der Effektorzytokine, (ii) Hemmung der T-Zellproliferation, (iii) Hemmung der T-Zellaktivierung, (iv) Hemmung der T-Zellmigration und (v) Modulation der Immunantwort. Die Entwicklung systemischer Immunsuppressiva hat nicht nur das Spektrum der Psoriasistherapie maßgeblich erweitert, sondern hat auch einen profunden Beitrag zum Verständnis der Pathogenese der Psoriasis geleistet. Sie sind sehr wirksam in der Vermeidung von Transplantatabstossungsreaktionen. Betrachtet man ihr Wirkungs-Nebenwirkungs-Verhältnis hinsichtlich der Behandlung einer benignen chronischen Dermatose, wie der Psoriasis, so muss eine kritische Abwägung bezüglich ihres Einsatzes vorgenommen werden. Systemische Immunsuppressiva müssen demnach schweren, therapierefraktären Fällen der Psoriasis vorbehalten bleiben.

Abstract

Immunosuppressive drugs act on one part of the psoriatic pathogenesis, the activated immune system. Different therapeutical strategies can be considered on the background of their molecular mechanisms therefore of action: (i) inhibition of effector cytokines, (ii) inhibition of T-cell proliferation, (iii) inhibition of T-cell activation, (iv) inhibition of T-cell migration and (v) modulation of the immunoreaction. On the one hand the development of systemic immunosuppressive drugs has enlarged our therapeutical possibilities in psoriasis. On the other hand these substances increased our understanding of the molecular pathways involved in the pathogenesis of psoriasis. Immunosuppressive drugs are highly potent in avoiding graft reactions, but in therapy of a benign, chronic dermatosis like psoriasis it should be considered that these compounds are also associated with significant cutaneous and/or systemic adverse effects and the risk/benefit ratio must be taken into account. Systemic immunosuppressive drugs are therefore limited to patients with a severe psoriasis refractory to other therapies.

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