Bislang kein wirklicher Durchbruch - Biologika bei chronisch entzündlichen Darmerkrankungen

Zusammenfassung

In den letzten Jahren wurden zahlreiche Studien zur Wirkung von Biologika bei chronisch entzündlichen Darmerkrankungen durchgeführt. Mit Ausnahme von Infliximab und anderen Tumornekrosefaktor-Antikörpern hat sich bisher keines der Prinzipien als hinreichend erfolgreich erwiesen, um in die Praxis überführt zu werden. Der Integrin-Antikörper Natalizumab zum Beispiel ist wegen Nebenwirkungsproblemen sogar vom Markt genommen worden. Bei Betrachtung der Studien zeigt sich, dass häufig die falschen Patienten eingeschlossen wurden, gelegentlich auch übersehen wurde, dass die Hemmung eines einzelnen Mediators aus einem redundanten Netzwerk nicht wirklich erfolgversprechend ist. Somit ist festzuhalten, dass Infliximab unser therapeutisches Arsenal bereichert hat, zumal es auch bei der Colitis ulcerosa bei etlichen Patienten wirksam ist, dass aber ein wirklicher Durchbruch in der Therapie durch die Biologika bislang nicht erfolgt ist.

Summary

During the last years numerous studies on the effects of biologics in chronic inflammatory bowel disease have been performed. With the exception of infliximab and some other tumor necrosis factor antibodies none of the principles has been sufficiently successful to be included in the routine armamentarium. The integrin antibody natalizumab has been retracted from the market due to serious side effects. When looking at the studies it becomes obvious that often wrong patients have been included into the trials and sometimes it has been overlooked that the inhibition of a signal mediator out of a redundant network is not really promising. Thus, we can conclude that infliximab has enriched our therapeutic arsenal, in particular since it also works in ulcerative colitis in a number of patients. However, the real breakthrough in the therapy has not yet been achieved by biologics.

Key Words

chronic inflammatory bowel diseases - biologics - Crohn's disease - ulcerative colitis - tumor necrosis factor - hormones - cytokines

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1 A Crohn's disease Clinical study Evaluating infliximab in a New long term Treatment regimen

Anschrift des Verfassers