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Optimierung der konservativen (Nichtbiologika‑)Therapie bei chronisch-entzündlichen Darmerkrankungen

Optimization of conservative (nonbiologics) treatment for inflammatory bowel diseases

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Zusammenfassung

In den Leitlinien der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zu den chronisch-entzündlichen Darmerkrankungen (CED) Morbus Crohn und Colitis ulcerosa hat das konservative Vorgehen mit Aminosalizylaten, Kortikosteroiden und klassischen Immunsuppressiva wie Thiopurinen und Methotrexat immer noch Vorrang vor dem frühen Einstieg mit sog. Biologika (antikörperbasierte Therapien). Dies ist nicht nur aus Kostengründen sinnvoll, sondern auch wegen des oft blanden Verlaufs beider Erkrankungen und der Möglichkeit einer frühen Therapieeskalation („accelerated step up“) bei kompliziertem Verlauf mit einer effektiven Immunsuppression zur Umgehung einer Steroidlangzeittherapie. Die Ausschöpfung der konservativen Medikamente vermeidet auch die frühe Einschränkung der therapeutischen Optionen durch den nahezu regelhaften Wirkverlust und dann notwendigen Wechsel der wenigen zugelassenen Antikörper.

Abstract

The guidelines concerning inflammatory bowel diseases of the German Society for Digestive and Metabolic Diseases (DGVS) still prioritise conservative treatment with aminosalicylates, corticosteroids and classical immunsuppressants like thiopurines and methotrexate over an early start with so-called biologics (antibody-based therapies). This is rational not just for cost reasons but also because of the frequently mild course of the diseases and the possibility of an accelerated step up with effective immunosuppression to avoid long-term steroids during complicated courses. The full use of classical drugs also avoids early limitations due to the frequent loss of response and then necessary switch between the few licensed antibodies.

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Authors and Affiliations

  1. Universitätsklinik Tübingen, Tübingen, Deutschland

    E. F. Stange

  2. Innere Medizin I, Asklepios Klinik Nord Heidberg, Tangstedter Landstraße 400, 22417, Hamburg, Deutschland

    E. F. Stange &  K. Herrlinger

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E. F. Stange hat gegen ein Honorar die Firmen Amgen, CureVac, Dr. Falk Pharma, Janssen, Merck und Takeda beraten und unterstützt von den Firmen AbbVie, Dr. Falk Pharma, Ferring, Janssen und Takeda Fortbildungsvorträge gehalten. K. Herrlinger hat für die Firma Dr. Falk Pharma Artikel verfasst und Vorträge gehalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stange, E.F., Herrlinger, K. Optimierung der konservativen (Nichtbiologika‑)Therapie bei chronisch-entzündlichen Darmerkrankungen. Gastroenterologe 14, 431–440 (2019). https://doi.org/10.1007/s11377-019-00386-x

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