{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T09:47:52Z","timestamp":1648892872773},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n          Immunologischer Verlauf der COVID-19-Erkrankung\u2002Der pathogenetische Verlauf der COVID-19-Erkrankung l\u00e4sst sich in eine replikative und eine hyperinflammatorische Phase unterteilen. Da bei schweren Verl\u00e4ufen die Hyperinflammation von zentraler Bedeutung ist, nehmen Immunmodulatoren aktuell eine immer gr\u00f6\u00dfere Rolle in der Behandlung von COVID-19 ein. So geh\u00f6rt Dexamethason mittlerweile zur empfohlenen Therapie bei drohendem schwerem Verlauf. Weitere Immunmodulatoren wie Tocilizumab und JAK-Inhibitoren erscheinen ebenfalls vielversprechend in der Behandlung von COVID-19.<\/jats:p><jats:p>\n          Wirkungsweise von Tocilizumab und Baricitinib\u2002Tocilizumab greift als IL-6-Rezeptor-Antagonist in zentrale Schl\u00fcsselpositionen der proinflammatorischen Signalkaskade ein und wird seit einigen Jahren erfolgreich bei rheumatologischen Krankheitsbildern eingesetzt. Baricitinib ist ein JAK-1\/2-Inhibitor und wird gegenw\u00e4rtig zur Behandlung der rheumatoiden Arthritis eingesetzt. Neben der immunmodulatorischen Wirkung durch Inhibition der Janus-Kinasen im Bereich der Inflammations-Kaskade werden auch direkte antivirale Effekte diskutiert.<\/jats:p><jats:p>\n          Bisherige Studienlage zu direkten Immunmodulatoren bei COVID-19\u2002Mehrere Studien zu Tocilizumab zeigten einen potenziellen positiven Effekt bei schwerer COVID-19-Erkrankung. Daten einer k\u00fcrzlich ver\u00f6ffentlichten Meta-Analyse \u00fcber 9 randomisierte kontrollierte Studien konnten kumulativ eine Mortalit\u00e4tsreduktion durch Tocilizumab nachweisen. Der Einsatz im Rahmen der intensivmedizinischen Behandlung bei schweren Verl\u00e4ufen von COVID-19 wird daher empfohlen. Die Behandlung mit JAK-Inhibitoren scheint bei Patienten mit leichter COVID-19 Erkrankung ebenfalls einen positiven Effekt zu haben. Jedoch ist die Datenlage zu JAK-Inhibitoren und anderen Immunmodulatoren wie Anakinra im Vergleich zu Tocilizumab gegenw\u00e4rtig noch uneinheitlich und bedarf weiterer Studien. Nach Therapie mit JAK-Inhibitoren wird die Gabe von Tocilizumab bei klinischer Verschlechterung aufgrund der fehlenden Datenlage derzeit nicht empfohlen.<\/jats:p>","DOI":"10.1055\/a-1643-4209","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T00:14:51Z","timestamp":1637972091000},"page":"1538-1542","source":"Crossref","is-referenced-by-count":0,"title":["Klinischer Nutzen von Tocilizumab und anderen immunmodulatorischen Substanzen bei COVID-19"],"prefix":"10.1055","volume":"146","author":[{"given":"Daniel","family":"Hornuss","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin II \u2013 Gastroenterologie, Hepatologie, Endokrinologie, Infektiologie, Universit\u00e4tsklinikum Freiburg, Medizinische Fakult\u00e4t, Albert-Ludwigs-Universit\u00e4t Freiburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Giesen","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin II 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