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Erschienen in: Der Internist 9/2016

28.06.2016 | Rheumatoide Arthritis | Arzneimitteltherapie

Langzeittherapie mit Glukokortikoiden

Gibt es eine sichere Dosierung?

verfasst von: Dr. C. Strehl, F. Buttgereit

Erschienen in: Die Innere Medizin | Ausgabe 9/2016

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Zusammenfassung

Glukokortikoide werden seit Langem erfolgreich zur Behandlung chronisch-entzündlicher Erkrankungen eingesetzt. Ihre hohe Wirksamkeit ist unumstritten, mögliche Nebenwirkungen geben jedoch ständig Anlass zur Diskussion bei Patienten und Ärzten. Da v. a. bei einer Langzeittherapie mit höheren Dosen unerwünschte Nebenwirkungen auftreten, stellt sich die Frage nach einer sicheren Dosierung von Glukokortikoiden. Eine Arbeitsgruppe bestehend aus Medizinexperten und Patienten hat sich mit der Literatur auseinandergesetzt und diese kritisch diskutiert. Neben Dosis und Dauer der Glukokortikoidtherapie spielen patientenspezifische Faktoren eine wichtige Rolle bei der Bewertung des tatsächlichen Schadensrisikos. Wenn man diese aktuellen Erkenntnisse und Empfehlungen beachtet und praktisch umsetzt, kann auch bei einer Langzeittherapie ein positives Nutzen-Risiko-Verhältnis erzielt werden.
Literatur
1.
Zurück zum Zitat Ajeganova S, Andersson ML, Frostegard J et al (2013) Disease factors in early rheumatoid arthritis are associated with differential risks for cardiovascular events and mortality depending on age at onset: a 10-year observational cohort study. J Rheumatol 40:1958–1966CrossRefPubMed Ajeganova S, Andersson ML, Frostegard J et al (2013) Disease factors in early rheumatoid arthritis are associated with differential risks for cardiovascular events and mortality depending on age at onset: a 10-year observational cohort study. J Rheumatol 40:1958–1966CrossRefPubMed
2.
Zurück zum Zitat Bakker MF, Jacobs JW, Welsing PM et al (2012) Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med 156:329–339CrossRefPubMed Bakker MF, Jacobs JW, Welsing PM et al (2012) Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med 156:329–339CrossRefPubMed
3.
Zurück zum Zitat Brassard P, Lowe AM, Bernatsky S et al (2009) Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada. Arthritis Rheum 61:300–304CrossRefPubMed Brassard P, Lowe AM, Bernatsky S et al (2009) Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada. Arthritis Rheum 61:300–304CrossRefPubMed
4.
Zurück zum Zitat Buttgereit F (2011) Do the treatment with glucocorticoids and/or the disease itself drive the impairment in glucose metabolism in patients with rheumatoid arthritis? Ann Rheum Dis 70:1881–1883CrossRefPubMed Buttgereit F (2011) Do the treatment with glucocorticoids and/or the disease itself drive the impairment in glucose metabolism in patients with rheumatoid arthritis? Ann Rheum Dis 70:1881–1883CrossRefPubMed
5.
Zurück zum Zitat Cambridge G, Acharya J, Cooper JA et al (2013) Antibodies to citrullinated peptides and risk of coronary heart disease. Atherosclerosis 228:243–246CrossRefPubMed Cambridge G, Acharya J, Cooper JA et al (2013) Antibodies to citrullinated peptides and risk of coronary heart disease. Atherosclerosis 228:243–246CrossRefPubMed
6.
Zurück zum Zitat Da Silva JA, Jacobs JW, Kirwan JR et al (2006) Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 65:285–293CrossRefPubMed Da Silva JA, Jacobs JW, Kirwan JR et al (2006) Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 65:285–293CrossRefPubMed
7.
Zurück zum Zitat Dixon WG, Suissa S, Hudson M (2011) The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses. Arthritis Res Ther 13:R139CrossRefPubMedPubMedCentral Dixon WG, Suissa S, Hudson M (2011) The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses. Arthritis Res Ther 13:R139CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Duru N, Goes MC van der, Jacobs JW et al (2013) EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 72:1905–1913CrossRefPubMed Duru N, Goes MC van der, Jacobs JW et al (2013) EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 72:1905–1913CrossRefPubMed
9.
Zurück zum Zitat Ethgen O, Lemos Esteves F de, Bruyere O et al (2013) What do we know about the safety of corticosteroids in rheumatoid arthritis? Curr Med Res Opin 29:1147–1160CrossRefPubMed Ethgen O, Lemos Esteves F de, Bruyere O et al (2013) What do we know about the safety of corticosteroids in rheumatoid arthritis? Curr Med Res Opin 29:1147–1160CrossRefPubMed
10.
Zurück zum Zitat Everdingen AA van, Jacobs JW, Siewert S, Van Reesema DR et al (2002) Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 136:1–12CrossRefPubMed Everdingen AA van, Jacobs JW, Siewert S, Van Reesema DR et al (2002) Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 136:1–12CrossRefPubMed
11.
Zurück zum Zitat Friedman MA, Winthrop K (2016) Vaccinations for rheumatoid arthritis. Curr Opin Rheumatol 28:330–336CrossRefPubMed Friedman MA, Winthrop K (2016) Vaccinations for rheumatoid arthritis. Curr Opin Rheumatol 28:330–336CrossRefPubMed
12.
Zurück zum Zitat Gaujoux-Viala C, Gossec L (2014) When and for how long should glucocorticoids be used in rheumatoid arthritis? International guidelines and recommendations. Ann N Y Acad Sci 1318:32–40CrossRefPubMed Gaujoux-Viala C, Gossec L (2014) When and for how long should glucocorticoids be used in rheumatoid arthritis? International guidelines and recommendations. Ann N Y Acad Sci 1318:32–40CrossRefPubMed
13.
Zurück zum Zitat Goes MC van der, Jacobs JW, Boers M et al (2010) Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 69:1015–1021CrossRefPubMed Goes MC van der, Jacobs JW, Boers M et al (2010) Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 69:1015–1021CrossRefPubMed
14.
Zurück zum Zitat Goes MC van der, Jacobs JW, Boers M et al (2010) Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Ann Rheum Dis 69:1913–1919CrossRefPubMed Goes MC van der, Jacobs JW, Boers M et al (2010) Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Ann Rheum Dis 69:1913–1919CrossRefPubMed
15.
Zurück zum Zitat Goes MC van der, Jacobs JW, Jurgens MS et al (2013) Are changes in bone mineral density different between groups of early rheumatoid arthritis patients treated according to a tight control strategy with or without prednisone if osteoporosis prophylaxis is applied? Osteoporos Int 24:1429–1436CrossRefPubMed Goes MC van der, Jacobs JW, Jurgens MS et al (2013) Are changes in bone mineral density different between groups of early rheumatoid arthritis patients treated according to a tight control strategy with or without prednisone if osteoporosis prophylaxis is applied? Osteoporos Int 24:1429–1436CrossRefPubMed
16.
Zurück zum Zitat Gorter SL, Bijlsma JW, Cutolo M et al (2010) Current evidence for the management of rheumatoid arthritis with glucocorticoids: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 69:1010–1014CrossRefPubMed Gorter SL, Bijlsma JW, Cutolo M et al (2010) Current evidence for the management of rheumatoid arthritis with glucocorticoids: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 69:1010–1014CrossRefPubMed
17.
Zurück zum Zitat Hench PS, Kendall EC et al (1949) The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone; compound E) and of pituitary adrenocorticotropic hormone on rheumatoid arthritis. Mayo Clin Proc 24:181–197 Hench PS, Kendall EC et al (1949) The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone; compound E) and of pituitary adrenocorticotropic hormone on rheumatoid arthritis. Mayo Clin Proc 24:181–197
18.
Zurück zum Zitat Hoes JN, Jacobs JW, Boers M et al (2007) EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 66:1560–1567CrossRefPubMedCentral Hoes JN, Jacobs JW, Boers M et al (2007) EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 66:1560–1567CrossRefPubMedCentral
19.
Zurück zum Zitat Hoes JN, Jacobs JW, Verstappen SM et al (2009) Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis 68:1833–1838CrossRefPubMed Hoes JN, Jacobs JW, Verstappen SM et al (2009) Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis 68:1833–1838CrossRefPubMed
20.
Zurück zum Zitat Huscher D, Thiele K, Gromnica-Ihle E et al (2009) Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68:1119–1124CrossRefPubMed Huscher D, Thiele K, Gromnica-Ihle E et al (2009) Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68:1119–1124CrossRefPubMed
21.
Zurück zum Zitat Johansson H, Kanis JA, Oden A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233CrossRefPubMed Johansson H, Kanis JA, Oden A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233CrossRefPubMed
22.
Zurück zum Zitat Kirwan JR, Balint G, Szebenyi B (1999) Anniversary: 50 years of glucocorticoid treatment in rheumatoid arthritis. Rheumatology 38:100–102CrossRefPubMed Kirwan JR, Balint G, Szebenyi B (1999) Anniversary: 50 years of glucocorticoid treatment in rheumatoid arthritis. Rheumatology 38:100–102CrossRefPubMed
23.
Zurück zum Zitat Mazzantini M, Torre C, Miccoli M et al (2012) Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol 39:552–557CrossRefPubMed Mazzantini M, Torre C, Miccoli M et al (2012) Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study. J Rheumatol 39:552–557CrossRefPubMed
24.
Zurück zum Zitat Movahedi M, Beauchamp ME, Abrahamowicz M et al (2015) Risk of incident diabetes associated with dose and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis Rheumatol doi:10.1002/art.39537 Movahedi M, Beauchamp ME, Abrahamowicz M et al (2015) Risk of incident diabetes associated with dose and duration of oral glucocorticoid therapy in patients with rheumatoid arthritis. Arthritis Rheumatol doi:10.1002/art.39537
25.
Zurück zum Zitat Pincus T, Cutolo M (2015) Clinical trials documenting the efficacy of low-dose glucocorticoids in rheumatoid arthritis. Neuroimmunomodulation 22:46–50CrossRefPubMed Pincus T, Cutolo M (2015) Clinical trials documenting the efficacy of low-dose glucocorticoids in rheumatoid arthritis. Neuroimmunomodulation 22:46–50CrossRefPubMed
26.
Zurück zum Zitat Rau R (2014) Glucocorticoid treatment in rheumatoid arthritis. Expert Opin Pharmacother 15:1575–1583CrossRefPubMed Rau R (2014) Glucocorticoid treatment in rheumatoid arthritis. Expert Opin Pharmacother 15:1575–1583CrossRefPubMed
27.
Zurück zum Zitat Raul Ariza-Andraca C, Barile-Fabris LA, Frati-Munari AC et al (1998) Risk factors for steroid diabetes in rheumatic patients. Arch Med Res 29:259–262PubMed Raul Ariza-Andraca C, Barile-Fabris LA, Frati-Munari AC et al (1998) Risk factors for steroid diabetes in rheumatic patients. Arch Med Res 29:259–262PubMed
28.
Zurück zum Zitat Saag KG (2012) Short-term and long-term safety of glucocorticoids in rheumatoid arthritis. Bull NYU Hosp Jt Dis 70(Suppl 1):21–25PubMed Saag KG (2012) Short-term and long-term safety of glucocorticoids in rheumatoid arthritis. Bull NYU Hosp Jt Dis 70(Suppl 1):21–25PubMed
29.
Zurück zum Zitat Smolen JS, Landewe R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73:492–509CrossRefPubMed Smolen JS, Landewe R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73:492–509CrossRefPubMed
30.
Zurück zum Zitat Solomon DH, Greenberg J, Curtis JR et al (2015) Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a Consortium of Rheumatology Researchers of North America Registry Study. Arthritis Rheumatol 67:1995–2003CrossRefPubMed Solomon DH, Greenberg J, Curtis JR et al (2015) Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a Consortium of Rheumatology Researchers of North America Registry Study. Arthritis Rheumatol 67:1995–2003CrossRefPubMed
31.
Zurück zum Zitat Strehl C, Bijlsma JW, Wit M de et al (2016) Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis 75(6):952–957. doi:10.1136/annrheumdis-2015-208916CrossRefPubMed Strehl C, Bijlsma JW, Wit M de et al (2016) Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis 75(6):952–957. doi:10.1136/annrheumdis-2015-208916CrossRefPubMed
32.
Zurück zum Zitat Staa TP van, Leufkens HG, Abenhaim L et al (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000CrossRefPubMed Staa TP van, Leufkens HG, Abenhaim L et al (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000CrossRefPubMed
33.
Zurück zum Zitat Staa TP van, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787CrossRefPubMed Staa TP van, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787CrossRefPubMed
34.
Zurück zum Zitat Wassenberg S, Rau R, Steinfeld P et al (2005) Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum 52:3371–3380CrossRefPubMed Wassenberg S, Rau R, Steinfeld P et al (2005) Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum 52:3371–3380CrossRefPubMed
35.
Zurück zum Zitat Zink A, Manger B, Kaufmann J et al (2014) Evaluation of the RABBIT risk score for serious infections. Ann Rheum Dis 73:1673–1676CrossRefPubMed Zink A, Manger B, Kaufmann J et al (2014) Evaluation of the RABBIT risk score for serious infections. Ann Rheum Dis 73:1673–1676CrossRefPubMed
Metadaten
Titel
Langzeittherapie mit Glukokortikoiden
Gibt es eine sichere Dosierung?
verfasst von
Dr. C. Strehl
F. Buttgereit
Publikationsdatum
28.06.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Innere Medizin / Ausgabe 9/2016
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-016-0098-7

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