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2020 | OriginalPaper | Buchkapitel

16. Medikamentöse Therapie des Morbus Crohn

verfasst von : Jörg C. Hoffmann

Erschienen in: Chronisch-entzündliche Darmerkrankungen

Verlag: Springer Berlin Heidelberg

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Zusammenfassung

Die individuelle Therapieplanung beim MC setzt eine detaillierte Diagnostik der Lokalisation, der Komplikationen sowie von Verlauf und Aktivität voraus. Basierend auf einer initialen und im Verlauf anzupassenden Risikostratifizierung sowie in Kenntnis invasiver und konservativer Therapiemodalitäten sollte ein Behandlungskonzept erarbeitet werden; dabei wird initial das Ziel der Remissionsinduktion und anschließend der Remissionserhaltung verfolgt. Es wird eine tiefe Remission angestrebt, die sich durch klinische Remission und Mukosaheilung auszeichnet. Bei hohem Risiko sollte bereits initial eine Biologikatherapie erfolgen (Top-down-Strategie), vorzugsweise mit einem Anti-TNF-α-Antikörper. Bei intermediärem Risiko wird eine beschleunigte Step-up-Strategie verfolgt, bei der neben einer Schubtherapie bereits initial Azathioprin oder Methotrexat eingesetzt wird. Bei niedrigem Risiko wird eine klassische Step-up-Therapie durchgeführt.

Systemische Kortikosteroide werden für den schweren Schub empfohlen. Topische Steroide sind bei leichten oder mittelschweren Schüben ausreichend wirksam, eine weniger wirksame Alternative sind Aminosalizylate. Nach erfolgter Schubtherapie hat Mesalazin keine Wirksamkeit in der Remissionserhaltung. Dagegen werden Azathioprin und 6-Mercaptopurin zur Therapie des chronisch-aktiven Verlaufes, zur Remissionserhaltung, falls erforderlich, und bei fistulierenden Verläufen empfohlen. Medikament der zweiten Wahl ist Methotrexat. Bei komplexen Fisteln sollte nach chirurgischer Drainage meist ein Anti-TNF-α-Antikörper eingesetzt werden. Ustekinumab und Vedolizumab stellen wirksame Ansätze zur MC-Therapie dar, wenn ein chronisch-aktiver Verlauf besteht, wobei Ustekinumab teurer aber auch schneller wirksam ist. Extraintestinale Manifestationen sollten bei der individuellen Therapieplanung berücksichtigt werden.

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Titel: Medikamentöse Therapie des Morbus Crohn
verfasst von: Jörg C. Hoffmann
Verlag: Springer Berlin Heidelberg
Buch: Chronisch-entzündliche Darmerkrankungen
Print ISBN: 978-3-662-59103-1

Electronic ISBN: 978-3-662-59104-8

Copyright-Jahr: 2020
DOI: https://doi.org/10.1007/978-3-662-59104-8_16

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