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Indikation und Option neuer immunmodulatorischer Therapien beim Sjögren-Syndrom

Indications and options of new immune modulatory therapies for Sjögren’s syndrome

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Zusammenfassung

Das Sjögren-Syndrom ist eine systemische entzündlich-rheumatische Erkrankung unklarer Genese mit bislang häufig inadäquater Therapiemöglichkeit. Die symptomatische Linderung der Sicca-Beschwerden sowie der gezielte Einsatz von Glukokortikoiden, NSAR und Immunsuppressiva sind weiterhin Grundlage in der Therapie des Sjögren-Syndroms. Aus neuen Erkenntnissen zur Ätiopathogenese des multifaktoriellen Krankheitsbildes werden derzeit neue Therapieansätze entwickelt. B-Zell-gerichtete Therapien zeigen z. T. viel versprechende Ergebnisse und unterstreichen die Bedeutung der B-Zelle in der Immunpathogenese. Die B-Zell-depletierende Therapie mit Rituximab hat Einzug gehalten in die Standardtherapie verschiedener niedrig- und hochmaligner B-Zell-Non-Hodgkin-Lymphome, auch bei Patienten mit Sjögren-Syndrom-assoziiertem Lymphom. Inwiefern auch T-Zell-gerichtete Verfahren wirksam und sicher eingesetzt werden können, muss durch kontrollierte klinische Studien geklärt werden. Demgegenüber ergibt sich derzeit keine Empfehlung zum Einsatz einer Tumornekrosefaktor- (TNF-)α-Blockade beim Sjögren-Syndrom. Für den Wirksamkeitsnachweis einer neuen Therapie sind zukünftig standardisierte Outcome-Parameter und Aktivitäts-Scores für das Sjögren-Syndrom dringend erforderlich.

Abstract

Sjögren’s syndrome is a systemic inflammatory rheumatic disorder of unknown origin with so far inadequate therapy options. Management of Sjögren’s syndrome is still primarily palliative using local symptomatic measures, and if appropriate glucocorticoids, NSAIDs and immunosuppressive drugs. New clues to the pathogenesis of this disorder pave the way for new therapeutic strategies. In particular targeting B-cells offers promising results and emphasizes the role of B-cells in the pathogenesis of this complex disorder. Rituximab was introduced into the standard treatment of different forms of low-grade and high-grade B-cell non-Hodgkins lymphomas, and is also an option for some lymphomas associated with Sjögren’s syndrome. Whether interference with T-cell function is also a safe and effective strategy in Sjögren’s syndrome, has to be shown in controlled clinical trials. However, there is no clear evidence to suggest that treatment with TNF-alpha blockers is efficacious in Sjögren’s syndrome. Standardization of disease activity and outcome measurements are critical for further clinical trials for Sjögren’s syndrome.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Thomas Dörner hat Vortragshonorare durch die Fa. Roche Pharma AG, Deutschland, erhalten sowie finanzielle Unterstützung zur Durchführung von klinischen Studien durch die Fa. Immunomedics Inc. Eugen Feist hat Vortragshonorare durch die Fa. Roche Pharma AG, Deutschland, erhalten.

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Authors and Affiliations

  1. Interdisziplinäres Sjögren-Syndrom-Centrum, Berlin, Deutschland

    E. Feist, T. Dörner & A. Hansen

  2. Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin BerlinKlinische, Charitéplatz 1, 10117, Berlin, Deutschland

    E. Feist

  3. Institut für Transfusionsmedizin, Charité Universitätsmedizin Berlin und Deutsches Rheumaforschungs Zentrum, Berlin, Deutschland

    T. Dörner

  4. Medizinische Poliklinik, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    A. Hansen

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  1. E. Feist
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  3. A. Hansen
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Correspondence to E. Feist.

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Feist, E., Dörner, T. & Hansen, A. Indikation und Option neuer immunmodulatorischer Therapien beim Sjögren-Syndrom. Z. Rheumatol. 66, 679–685 (2007). https://doi.org/10.1007/s00393-007-0231-z

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  • DOI: https://doi.org/10.1007/s00393-007-0231-z

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