B-Zell-Depletion mit Rituximab zur Therapie des juvenilen systemischen Lupus erythematodes

Zusammenfassung

Bei dem systemischen Lupus erythmatodes (SLE) handelt es sich um eine Autoimmunerkrankung, die jedes Organsystem betreffen kann. Die Ätiopathogenese ist bislang nicht vollständig geklärt. Tiermodelle zeigen, dass B-Lymphozyten bei der Krankheitsentstehung eine wesentliche Rolle spielen. Therapierefraktäre Verläufe erfordern den Einsatz von Medikamenten, die für diese spezielle Indikation nicht zugelassen sind, insbesondere betrifft dies Patienten im Kindesalter. Diese Arbeit gibt einen Überblick über die bislang publizierten Erfahrungen bei der Anwendung von Rituximab – einem gentechnisch hergestellten monoklonalen CD-20-Antikörper – bei insgesamt 48 Kindern und Jugendlichen mit SLE. Die Beobachtungszeit nach erster Anwendung von Rituximab in diesem Kollektiv beträgt bis zu 30 Monate. Der Therapieerfolg erscheint vielversprechend bei insgesamt guter Verträglichkeit. Auch wurden Remissionen bei wiederholten Therapiezyklen berichtet. Systematische Anwendungsbeobachtungen und insbesondere kontrollierte prospektive Studien wären wünschenswert.

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disorder which can affect every organ. Its aetiopathogenesis is not fully understood, but animal models have demonstrated that B lymphocytes play an important role in the pathogenesis of the disease. In refractory cases, drugs have to be applied which are not approved for this indication, especially in children. This paper reviews the published data of 48 paediatric patients suffering from severe SLE who underwent therapy with rituximab – a genetically engineered CD-20 antibody. The total observation period was up to 30 months. Responses seem promising with a good safety profile altogether. Successful repeated therapies have been reported. Published data seem to be inhomogeneous giving an evidence level of grade IV. Prospective studies and especially controlled trials are still needed.

Schlüsselwörter

systemsicher Lupus erythematodes - Rituximab - monoklonale Antikörper - B-Zellen - Cyclophosphamid

Key words

systemic lupus erythematosus - rituximab - monoclonal antibodies - B cells - cyclophosphamide

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