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Medikamentöse Therapie der Colitis ulcerosa und Pouchitis

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Chronisch-entzündliche Darmerkrankungen

Zusammenfassung

Lange Zeit gab es in der Medikamentenentwicklung der Colitis ulcerosa (CU) im Anschluss an die Einführung der TNF-Hemmer keine wegweisenden Neuerungen. Dies hat sich seit der Zulassung des ersten Integrinhemmers Vedolizumab im Jahr 2014 geändert. Eine beachtliche Dynamik ist entstanden, was sich auch in einer mittlerweile kaum mehr zu übersehenden Anzahl von Therapiestudien für verschiedene Substanzgruppen niederschlägt. Die traditionelle Pyramide der Medikamententherapie – mit 5-Aminosalicylsäure als Basis, darüber Steroide, anschließend Thiopurine und TNF-Hemmer in der dünnen Spitze – wird nun durch die zahlreichen Neuerungen in den Therapieoptionen und deren Positionierung zunehmend infrage gestellt. Allerdings ist der definitive Platz der neueren Substanzen im Therapiealgorithmus noch genauer zu bestimmen und derzeit nicht eindeutig klar. Es zeichnet sich jedoch ab, dass die Therapie der CU komplexer wird. Es ist davon auszugehen, dass zukünftig auch verschiedene Optionen einer Kombinationstherapie geprüft werden müssen, wie es sich in diversen anderen Feldern der Medizin als sinnvoll erwiesen hat. Betrachtet man diese neuen Substanzen genauer, fällt auf, dass sich diverse Überlappungen mit anderen Disziplinen im Bereich der immunmediierten Erkrankungen ergeben, insbesondere der Rheumatologie, Dermatologie, aber auch Neurologie und klinischen Immunologie. Da in diesen Disziplinen einige der neuen Substanzen für andere Indikationen bereits länger zugelassen sind, ergeben sich hier wichtige Informationen hinsichtlich Nebenwirkungen und Sicherheit. Im Gegensatz zu den Informationen zu Nebenwirkungen haben die bisherigen Erfahrungen gezeigt, dass sich Effektivitätsdaten zum Beispiel aus der Rheumatologie nur sehr begrenzt auf chronisch-entzündliche Darmerkrankungen übertragen lassen. Im Folgenden werden die einzelnen Substanzklassen in Kürze dargestellt.

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  1. Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Zürich, Schweiz

    Luc Biedermann & Gerhard Rogler

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  1. Medizinische Klinik I, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Germany

    Jörg C. Hoffmann

  2. Klinik für Innere Medizin, Medius-Klinik Ostfildern-Ruit, Ostfildern, Germany

    Bodo Klump

  3. Allg.-, Viszeral- & Unfallchirurgie, Krankenhaus Porz am Rhein, Köln, Germany

    Anton Kroesen

  4. Medizinische Klinik I, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Britta Siegmund

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Biedermann, L., Rogler, G. (2020). Medikamentöse Therapie der Colitis ulcerosa und Pouchitis. In: Hoffmann, J.C., Klump, B., Kroesen, A., Siegmund, B. (eds) Chronisch-entzündliche Darmerkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59104-8_20

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