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DOI: 10.1055/s-2007-963393
© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York
Infliximab in der Therapie der Colitis ulcerosa
Infliximab und Colitis ulcerosa - Konsensuspapier der Arbeitsgruppe Chronisch-Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für GastroenterologieUse of Infliximab in Ulcerative ColitisPublication History
Publication Date:
14 August 2007 (online)

Zusammenfassung
Infliximab ist ein chimärer, monoklonaler Antikörper gegen Tumor Nekrose Faktor-alpha (TNF), der die Therapiestrategien chronisch entzündlicher Erkrankungen, wie Morbus Crohn (MC), rheumatoider Arthritis, Morbus Bechterew oder Psoriasis wesentlich verändert hat. Infliximab hat heute einen fixen Platz in den Therapiealgorithmen des MC. Entgegen basisimmunologischer Konzepte ermutigten erste Pilotstudien mit Infliximab bei steroidrefraktärer Colitis ulcerosa zu zwei großen placebokontrollierten Studien (ACT-Studien) an Patienten mit moderat bis schwer aktiver Colitis ulcerosa. Diese Studien belegten die klinische Wirksamkeit und Sicherheit von Infliximab bei Colitis ulcerosa und erbrachten Hinweise für mukosale Heilung und eine Verbesserung der Lebensqualität. Indikation für eine solche Therapie besteht damit bei mittelschwerer bis schwerer aktiver Colitis ulcerosa, die auf eine konventionelle Therapie (Kortikosteroide und Azathioprin/ 6-Mercaptopurin) unzureichend anspricht oder falls eine Unverträglichkeit oder medizinische Gegenanzeige für eine solche Therapie besteht. Daten aus einer placebokontrollierten Studie weisen zudem auf die Wirksamkeit von Infliximab bei der schweren, intravenös steroidrefraktären Colitis ulcerosa hin, womit nun eine therapeutische Alternative zu Cyclosporin A und Tacrolimus bei dieser Indikation besteht. Infliximab ist damit bei der Therapie der CU etabliert. Der sichere Umgang mit dieser Substanz erfordert allerdings das nötige Fachwissen.
Abstract
Infliximab, a chimeric monoclonal anti-tumour necrosis factor alpha (TNF) antibody has dramatically changed the management of various chronic inflammatory disorders such as Crohn’s disease (CD), rheumatoid arthritis, ankylosing spondylitis or psoriasis. This drug is well established for the treatment of CD in case of steroid-refractoriness, failure to respond to an immunosuppressant agent or fistulizing disease. The immunological concept that ulcerative colitis (UC) reflects primarily a T-helper cell type-2 mediated disease prevented the earlier use of anti-TNF agents in this disease. Promising initial pilot studies in steroid-refractory UC patients led to two large placebo-controlled trials in patients with moderate to severe UC. These studies clearly showed a benefit for infliximab treatment in UC with mucosal healing and improved life quality. Infliximab therefore can be used in patients not responding adequately to steroids and/or immunosuppressants. Furthermore, one study showed evidence that infliximab might also be effective in severe, intravenous steroid-refractory UC. Therefore, infliximab might be used alternatively to cyclosporine A or tacrolimus in this patient group. Infliximab has now been established as an additional treatment option in patients with chronic-active UC not responding to an immunosuppressive agent and/or in case of severe acute UC. Experienced gastroenterologists should be involved in the decision making for such a therapy to balance thoroughly the benefit/risk ratio for our patients.
Schlüsselwörter
Colitis ulcerosa - chronisch-entzündliche Darmerkrankungen - Tumor Nekrose Faktor
Key words
ulcerative colitis - inflammatory bowel diseases - tumor necrosis factor
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