Infektionen unter Biologika-Therapie

Zusammenfassung

Die Therapie mit Biologika, speziell TNF-α-Inhibitoren, gehört heute zum Alltag der Behandlung von Patienten mit entzündlich-rheumatischen Erkrankungen. Neben einer beeindruckenden Wirkung zeichnen sich diese Substanzen auch durch eine gute Verträglichkeit aus. Allerdings wurden seit den ersten Erfahrungen teils seltene und schwer verlaufende Infektionen berichtet. Diese Übersicht fasst den aktuellen Stand bezüglich des Auftretens von Infektionen sowohl in randomisierten klinischen Studien wie auch Post-Marketing-Übersichten und Patientenregistern zusammen. Die Daten zur schwerwiegenden und vermehrt beobachteten Tuberkulose sowie zur häufigsten chronischen Infektion, der chronischen Hepatitis, werden gesondert betrachtet. Die Angaben zum Auftreten von Infektionen sind durchaus unterschiedlich, insgesamt scheinen sie aber in der Mehrzahl der Analysen leicht vermehrt aufzutreten. Ob diese geringe Vermehrung auf die Biologika-Therapie oder doch andere Faktoren wie Komedikationen, Komorbiditäten oder eine vermehrte Aufmerksamkeit bei einer neuen Substanzklasse zurückzuführen ist, kann im Einzelfall nicht immer geklärt werden. Besonders beachtet werden muss eine vermehrte Inzidenz granulomatöser Erkrankungen, speziell der Tuberkulose. Durch ein konsequentes Screening vor Therapiebeginn sowie eine aufmerksame Begleitung des Patienten unter Therapie kann die Inzidenz der Tuberkulose, aber auch anderer Infektionen weiter gesenkt werden. Insgesamt bleibt das Nutzen-Risiko-Verhältnis bei der Therapie mit Biologika sehr gut.

Abstract

More than 1 million patients with rheumatic diseases have been treated with the currently available biologic response modifiers, especially TNF-α inhibitors. These agents provide considerable benefit to the patients and have demonstrated a good safety profile. However, serious and rare infections have also been reported. This review summarises our current knowledge with regard to infections in randomised controlled trials (RCTs) as well as in post-marketing surveys and patient registers. Special attention is directed towards tuberculosis and chronic hepatitis, the most frequent chronic infection in Mid-Europe. The reports about the rate of infections differ considerably; however, there are hints for a slight increase of infections under treatment with biologicals. Whether this increase may be attributed to the biological treatment itself, or might be caused also by comedication, comorbidity or even increased awareness in a new and expensive class of therapeutics cannot be decided in each case. Without question, the increased incidence of granulomatous infections, especially tuberculosis, deserves our attention. Screening of patients about to start TNF blocking agents and tight monitoring during the course of the treatment will reduce the risk of activating tuberculosis as well as other infections. In summary, biologicals, especially TNF-α inhibitors, continue to be safe and effective.

Schlüsselwörter

Biologika - TNF-α-Hemmer - Infektionen - Tuberkulose

Key words

biologicals - TNF-α inhibitors - infections - tuberculosis

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