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Aktuelle Leitlinien zu ANCA-assoziierten Vaskulitiden

Gemeinsamkeiten und Unterschiede

Current guidelines on ANCA-associated vasculitides

Common features and differences

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Zusammenfassung

Ergebnisse zahlreicher prospektiver und teils auch randomisierter kontrollierter Studien haben in den vergangenen Jahren zu Änderungen etablierter Strategien zur Therapie der mit antineutrophilen zytoplasmatischen Antikörpern (ANCA) assoziierten Vaskulitiden (AAV) geführt. Seit 2014 haben insgesamt 4 Fachgesellschaften bzw. Studiengruppen die neuen Daten systematisch analysiert und basierend auf ihrer Auswertung evidenzbasierte Empfehlungen zum Management der AAV formuliert. Diese Empfehlungen enthalten Informationen zu Diagnose, Induktions- bzw. Erhaltungstherapie, supportiven Therapiemaßnahmen sowie zum Monitoring von Krankheitsaktivität und Folgeschäden. In dieser Übersicht vergleichen wir die jüngst publizierten Empfehlungen der Deutschen Gesellschaft für Rheumatologie (DGRh), der European League against Rheumatism (EULAR)/European Renal Association (ERA), der British Society of Rheumatology (BSR) und des Canadian Vasculitis Research Network (CanVasc). Die vergleichende Analyse ergibt zu zahlreichen Themen ein hohes Maß an Übereinstimmung, aber zeigt auch in vielen Punkten in Details abweichende und vereinzelt auch deutlich diskrepante Vorschläge zur Diagnose und Therapie der AAV. Abweichende Empfehlungen bestehen v. a. bei Themen mit geringer Evidenz aus klinischen Studien. Zudem resultieren einige Differenzen auch als Folge unterschiedlicher Bewertungen der publizierten Daten oder der Besonderheiten des jeweiligen nationalen Gesundheitssystems.

Abstract

The results of a number of prospective randomized controlled clinical trials have led to changes in established strategies for the treatment of antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) in recent years. Since 2014, a total of 4 scientific societies and study groups have systematically reviewed the new data and have formulated evidence-based recommendations for the management of AAV based on the analysis. These recommendations contain information on diagnosis, treatment (induction and maintenance), supportive care and monitoring of disease activity and resulting damage. This review compares the recently published recommendations of the German Society of Rheumatology (Deutschen Gesellschaft für Rheumatologie, DGRh), the European League Against Rheumatism (EULAR)/European Renal Association (ERA), the British Society of Rheumatology (BSR) and the Canadian Vasculitis Research Network (CanVasc). The comparative analysis reveals a high level of agreement on numerous topics but also shows some minor and even a few major differences in the respective recommended approach to diagnosis and treatment of AAV. Divergent recommendations predominantly exist in areas with little scientific evidence from clinical studies. Furthermore, some differences result from different interpretation of existing data or are influenced by characteristic features of the respective national healthcare system.

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Authors and Affiliations

  1. Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Klinik Kirchheim, Akademisches Lehrkrankenhaus der Universität Tübingen, Eugenstr. 3, 73230, Kirchheim u. Teck, Deutschland

    B. Hellmich

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Interessenkonflikt

B. Hellmich war als Koautor an der Erstellung der EULAR-Recommendations 2009 und 2016 und der DGRh-Leitlinie zum Management der AAV beteiligt und hat folgende Zuwendungen von der Industrie erhalten: Vortragshonorare – Abbvie, BMS, Celgen, Novartis, Orgentec, Pfizer, Roche; Honorare für Beratungsleistungen – BMS, Nippon-Kayaku, GSK, BMS, Roche.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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A. Zink, Berlin

B. Hellmich, Kirchheim-Teck

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Hellmich, B. Aktuelle Leitlinien zu ANCA-assoziierten Vaskulitiden. Z Rheumatol 76, 133–142 (2017). https://doi.org/10.1007/s00393-016-0223-y

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