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Was muss der Internist bei Patienten unter Biologikabehandlung beachten?

Infektionen und Autoimmunphänomene

What should specialist in internal medicine be aware of in patients treated with biologics?

Infections and autoimmune phenomena

  • Schwerpunkt: Biologika in der Inneren Medizin
  • Published:
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Zusammenfassung

Biologika zur Beeinflussung des Immunsystems spielen in der Behandlung von Autoimmun- und Tumorerkrankungen eine wichtige Rolle. Durch den Einsatz dieser nebenwirkungsarmen und gut wirksamen Therapeutika hat sich die Behandlung deutlich verbessert, sodass es zu einem längeren therapeutischen Einsatz kommt. Daher spielen Nebenwirkungen in der ärztlichen Betreuung auch außerhalb der Primärbehandlung eine immer größere Rolle. Durch die immunsuppressiven bzw. immunmodulierenden Biologika steigt das Risiko von Infektionen mit typischen Erregern vor allem der oberen Atemwege und des Urogenitaltrakts. Aber auch Infektionen mit selteneren Erregern wie Pilzen oder Mykobakterien treten vermehrt auf. Unter immunverstärkenden Biologika treten an den verschiedensten Organen Autoimmunphänomene auf, die zunächst durch Pausierung der Therapie oder aber durch eine immunsuppressive Therapie behandelt werden können.

Abstract

Biologics that influence the immune system play a crucial role in the treatment of autoimmune and malignant diseases. Overall these drugs have revolutionized treatment as they demonstrate high efficacy and a relatively low amount of side effects. This leads to longer treatment of patients with a high quality of life. Side effects, especially longer-term side effects, become ever more important as patients are simultaneously seen by different physicians due to comorbidities. Infections, mainly of the upper airway or urogenital tract, represent the main side effect of immunosuppressive biologics, but atypical infections by fungi or mycobacteria may also occur. Biologics that enhance the immune response such as checkpoint inhibitors lead to autoimmune phenomena necessitating the interruption of treatment or immunosuppressive treatment.

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  1. Klinik I für Innere Medizin, Universitätsklinikum Köln, Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Kerpener Str. 62, 50937, Köln, Deutschland

    Thomas Zander & Michael Hallek

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Correspondence to Thomas Zander.

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T. Zander und M. Hallek geben an, dass kein Interessenkonflikt besteht.

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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Michael Hallek, Köln

Elisabeth Märker-Hermann, Wiesbaden

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Zander, T., Hallek, M. Was muss der Internist bei Patienten unter Biologikabehandlung beachten?. Internist 63, 165–170 (2022). https://doi.org/10.1007/s00108-021-01259-8

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  • DOI: https://doi.org/10.1007/s00108-021-01259-8

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