Neue Immunsuppressiva und das Risiko opportunistischer Infektionen

ZUSAMMENFASSUNG

Die neuen therapeutischen Immunmodulatoren haben aufgrund ihres Wirkmechanismus unterschiedliche Infektionsrisiken. IL-1-Blockade erhöht vor allem das Risiko für bakterielle Infektionen. Die IL-5-hemmenden Substanzen bergen möglicherweise ein erhöhtes Risiko für Parasitosen. IL-6-Blockade führt zu einem erhöhten Risiko für schwere bakterielle und opportunistische Infektionen (OI), vergleichbar mit den TNF-α-Inhibitoren. Die IL-12/23-Blockade mit Ustekinumab zeigt wie auch der B-Lymphozyten-Stimulator (BLyS)-Inhibitor Belimumab im Vergleich mit anderen Therapeutika kein erhöhtes Infektionsrisiko. Unter einer IL-17-Hemmung ist vor allem mit gehäuften mukokutanen Kandidosen zu rechnen, insbesondere unter Bimekizumab. Der T-Zell-Aktivierungshemmer Abatacept erhöht das Risiko für Herpes Zoster (HZ), während andere Infektionen im Vergleich zu anderen Disease-Modifying Anti-Rheumatic Drugs (DMARD) sogar geringer sind. Auch Anifrolumab, ein Typ-1-Interferon-Inhibitor, erhöht das Risiko für HZ, aber auch für Atemwegsinfektionen. Beim Einsatz von Januskinase-Inhibitoren (JAKi) ist insbesondere mit HZ zu rechnen, wogegen andere OI seltener und in ihrer Häufigkeit mit den meisten älteren Biologika vergleichbar sind.

Schlüsselwörter

Opportunistische Infektionen - Disease-Modifying Anti-Rheumatic Drugs (DMARD - Interleukin-Antagonisten - Januskinase-Inhibitoren (JAKi) - Herpes Zoster

Publication History

Article published online:
05 June 2024

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