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Neue medikamentöse Ansätze bei chronisch-entzündlichen Darmerkrankungen

Verbesserte Ergebnisse durch personalisierte Behandlung?
  • S. Pröbsting
  • B. TerjungEmail author
Leitthema
  • 36 Downloads

Zusammenfassung

Die chronisch-entzündlichen Darmerkrankungen (CED) wie Morbus Crohn und Colitis ulcerosa sind komplexe Krankheitsbilder mit individuell sehr unterschiedlichen Ausprägungsmustern und Krankheitsverläufen, die auf einem Wechselspiel vielfältiger, teilweise noch nicht vollständig identifizierter, individuell unterschiedlicher Einflussfaktoren beruhen. Um strukturelle Darmschädigungen langfristig möglichst vermeiden zu können, sind effektive personalisierte Therapiealgorithmen erforderlich, die das breite Spektrum der derzeit und zukünftig verfügbaren Therapeutika mit einbeziehen. Wesentliche Säulen dieser Therapien stellen schon heute die Biologika und morgen zusätzlich die gegen „small molecules“ gerichteten Therapeutika dar, die einen gezielteren Eingriff in die krankheitsimmanenten Entzündungsprozesse sowie die Alteration des intestinalen Mikrobioms bei CED ermöglichen werden. Dieser Paradigmenwechsel im Patientenmanagement der CED erfordert ein enges Zusammenspiel zwischen klinisch-symptomatisch orientierten und biochemischen Verlaufsparametern(z. B. fäkales Calprotectin, C‑reaktives Protein [CRP], Bestimmung der Medikamentenspiegel), um den einzelnen CED-Patienten proaktiv, patientenorientiert und personalisiert behandeln zu können.

Schlüsselwörter

Colitis ulcerosa Morbus Crohn Biologika Small molecules Mikrobiom 

Novel medicinal strategies for chronic inflammatory bowel diseases

Improved results through personalized treatment?

Abstract

Chronic inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis are complex diseases characterized by individually distinct patterns of disease extent and disease course. They are also characterized by an interplay of diverse, partially not yet completely identified, individually different influencing factors. In order to avoid structural damage to the intestine in the long run, effective personalized therapy algorithms are needed that incorporate the wide range of currently available therapeutics and those available in the future. The key pillars of the current immunosuppressive therapeutic regimens are the biologics and tomorrow the novel therapeutics against small molecules will also enable more targeted interventions in the disease immanent inflammatory processes and in the alteration of the intestinal microbiome in IBD. This paradigm shift in patient management of IBD requires a close interplay between clinically-oriented and biochemical parameters, e. g. fecal calprotectin, C‑reactive protein (CRP) and determinations of drug levels, to treat IBD patients in a proactive, patient-oriented and personalized manner.

Keywords

Ulcerative colitis Crohn’s disease Biologics Small molecules Microbiome 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Pröbsting und B. Terjung geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung Innere Medizin – GastroenterologieGFO Kliniken BonnBonnDeutschland

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