Immunsuppressive und biologische Therapieoptionen bei chronisch entzündlichen Darmerkrankungen

Kernaussagen

Auf verschiedenen Ebenen wurde und wird unter Aufbietung großer finanzieller Mittel und Rekrutierung tausender Patienten versucht, im Rahmen kontrollierter Studien mittels sog. biologischer Therapeutika regulierend in die mukosale Inflammationskaskade einzugreifen und den Entzündungsprozess zu unterbinden.

Die Hoffnung auf eine selektivere und damit effektivere und nebenwirkungsärmere Therapie ist leider weitgehend enttäuscht worden. Das einzige bisher wirksame Therapeutikum Infliximab wird durch seine mangelhafte langfristige Effektivität und durch seine infektiologischen Komplikationen limitiert.

Daher muss derzeit das Ziel in der Therapie chronisch entzündlicher Darmerkrankungen sein, frühzeitig die Indikation zur immunsuppressiven Therapie zu stellen und diese dann konsequent und adäquat dosiert mit klassischen Immunsuppressiva durchzuführen.

Langfristig gesehen, wird es allerdings sinnvoll sein, den Paradigmenwechsel in der Pathogenese, nämlich die Rolle eines Defektes der angeborenen Immunabwehr (s. o.), auch in neue Therapieansätze umzusetzen. Dies bedeutet den Ausblick auf eine kausale Therapie, die dann hoffentlich auch nicht mehr die Nachteile der Immunsuppression in Kauf nehmen müsste.

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