Z Gastroenterol 2018; 56(03): 275-302
DOI: 10.1055/s-0044-100044
Mitteilungen
© Georg Thieme Verlag KG Stuttgart · New York

Zweiter österreichischer Konsensus zur sicheren Anwendung von anti-TNF-α-Antikörpern bei chronisch-entzündlichen Darmerkrankungen

Second Austrian consensus on the safe use of anti-TNFα-antibodies in patients with inflammatory bowel diseases
Wolfgang Miehsler
1   Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg
,
Clemens Dejaco
2   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
,
Hans-Peter Gröchenig
3   Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder St.Veit, St.Veit a. d. Glan
,
Harry Fuchssteiner
4   Abteilung für Innere Medizin 4, Ordensklinikum Linz, Linz a. d. Donau
,
Christoph Högenauer
5   Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
,
Lili Kazemi-Shirazi
2   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
,
Harald Maier
6   Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien
,
Andreas Mayer
7   Klinische Abteilung für Innere Medizin 2, Universitätsklinikum St. Pölten, St. Pölten
,
Alexander Moschen
8   Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
,
Walter Reinisch
2   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
,
Wolfgang Petritsch
5   Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
,
Reingard Platzer
9   Abteilung für Innere Medizin 1, Landesklinikum Wiener Neustadt, Wiener Neustadt
,
Pius Steiner
10   Abteilung für Innere Medizin 1, Klinikum Wels-Grieskirchen, Wels
,
Herbert Tilg
8   Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
,
Harald Vogelsang
2   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
,
Heimo Wenzl
5   Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
,
Gottfried Novacek
2   Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
› Author Affiliations
Further Information

Publication History

22 July 2017

21 December 2017

Publication Date:
12 March 2018 (online)

Zusammenfasung

Anti-TNF-α-Antikörper haben die Therapie chronisch-entzündlicher Darmerkrankungen und anderer immunmediierter inflammatorischer Erkrankungen revolutioniert. Der zunehmende Einsatz dieser Substanzen war Anlass, den Konsensusbericht zur sicheren Anwendung von Infliximab der Arbeitsgruppe für Chronisch Entzündliche Darmerkrankungen der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie aus dem Jahr 2010 zu aktualisieren und auf alle anti-TNF-α-Antikörper zu erweitern. Der vorliegende Konsensusbericht fasst die aktuelle Datenlage zur sicheren Anwendung von anti-TNF-α-Antikörpern zusammen und berücksichtigt folgende Themen: allgemeines Infektionsrisiko, bakterielle Infekte (inkl. Clostridium difficile, Tuberkulose, Nahrungsmittelhygiene), Pneumozystis jiroveci, virale Infektionen (inkl. Hepatitis B, Hepatitis C, HIV, CMV, VZV), Impfungen und Impfempfehlungen, gastrointestinale Aspekte (perianale Fistel, abdominale Fistel, Stenose), dermatologische Aspekte (Haut-Malignome, Ekzem-ähnliche anti-TNF-α-assoziierte Hautläsionen), Infusionsreaktionen und Immunogenität, demyelinisierende Erkrankungen, Hepatotoxizität, Hämatotoxizität, Herzinsuffizienz, Malignomrisiko und Einsatz nach Malignomen, sowie Schwangerschaft und Stillen. Da der Konsensusbericht als praktischer Leitfaden für die sichere Anwendung dieser Substanzen dienen soll, wurden die relevanten Aspekte in einer Checkliste zusammengefasst, die sich in zwei Teile „vor Therapie“ und „während Therapie“ gliedert.

Abstract

Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i. e., Clostridium difficile, Tuberculosis, food hygiene), Pneumocystis jiroveci, viral infections (i. e., Hepatitis B, Hepatitis C, HIV, CMV, VZV), vaccination in general and recommendation for vaccines, gastrointestinal aspects (i. e., perianal fistula, abdominal fistula, intestinal strictures, stenosis and bowel obstruction), dermatologic aspects (skin malignancies, eczema-like drug-related skin eruption), infusion reactions and immunogenicity, demyelinating diseases, hepatotoxicity, haematotoxicity, congestive heart failure, risk and history of malignancies, and pregnancy and breast feeding. For practical reasons, the relevant aspects are summarized in a checklist which is divided into two parts: issues to be addressed before therapy and issues to be addressed during therapy.

 
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