Dosierung und Toxizität von Antirheumatika bei Niereninsuffizienz

Zeitschrift für Rheumatologie - Tập 74 - Trang 300-309 - 2015
S.M. Weiner1, R. Bergner1
12. Medizinische Abteilung, Rheumatologie, Immunologie, Diabetologie, Endokrinologie, Hochdruckkrankheiten, Zentrum für Dialyse und Nephrologie, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland

Tóm tắt

Patienten mit entzündlich-rheumatischen Systemerkrankungen haben häufig eine eingeschränkte Nierenfunktion, was mit einem erhöhten Risiko für medikamenteninduzierte Nebenwirkungen einhergeht. Die Datenlage hinsichtlich Therapieoptionen in dieser Patientenpopulation ist stark limitiert. Es wurde eine selektive Literaturrecherche zur Pharmakokinetik, Dosierung und Toxizität von Antirheumatika bei Niereninsuffizienz durchgeführt. Nichtsteroidale Antirheumatika (NSAR), Zyklooxygenase(COX)-2-Hemmer, Gold und Ciclosporin sollten bei Patienten mit Niereninsuffizienz nur zurückhaltend eingesetzt werden, da sie mit einem erhöhten Risiko für nephrotoxische Nebenwirkungen einhergehen. Methotrexat sollte bei einer geschätzten glomerulären Filtrationsrate (eGFR) < 45 ml/min nicht eingesetzt werden, da die Pharmakokinetik nicht vorhersehbar ist und eine fatale Panzytopenie resultieren kann. Die Dosis von Sulfasalazin, Azathioprin, Mycophenolatmofetil, Cyclophosphamid und Antimalariamitteln sollte bei Patienten mit mäßiger und schwerer Niereninsuffizienz reduziert werden. Leflunomid und zahlreiche Biologika (Ausnahme Biologika mit einer Molekülmasse < 60 kDa) können aus pharmakokinetischen Überlegungen ohne Dosismodifikation auch bei Niereninsuffizienz eingesetzt werden. Insbesondere die häufigen Komorbiditäten sowie das erhöhte Infektionsrisiko sind bei Patienten mit Niereninsuffizienz unter einer Therapie mit Immunsuppressiva zu berücksichtigen. Weitere Studien sind erforderlich, um die Evidenzlage hinsichtlich einer Therapie mit Immunsuppressiva und Biologika bei Patienten mit entzündlich-rheumatischen Erkrankungen und Niereninsuffizienz zu verbessern.

Tài liệu tham khảo

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