Leflunomid: ein Immunmodulator einer neuartigen Wirkstoffklasse

Zusammenfassung

Die Substanz Leflunomid (Arava®) übt als Inhibitor der De-novo-Synthese der Pyrimidinnukleotide sowie verschiedener Tyrosin-Kinasen antiproliferative, immunsuppressive sowie antiinflammatorische Wirkungen aus. Hierin begründet sich der effektive Einsatz dieser Substanz in der Behandlung der Rheumatoidarthritis, in der dem Leflunomid mittlerweile eine etablierte Rolle neben herkömmlichen Basistherapeutika wie Methotrexat und Sulfasalazin zukommt. Behandlungsversuche bei Psoriasis arthropathica zeigten sowohl eine günstige Beeinflussung der Gelenksymptomatik als auch der Hautläsionen der betroffenen Patienten. Als weitere dermatologische Indikationen für eine Therapie mit Leflunomid kommen insbesondere autoimmunologisch begründete Erkrankungen wie Lupus erythematodes oder blasenbildende Dermatosen in Betracht. Hierzu liegen jedoch bislang lediglich Fallberichte vor. Die vorliegende Übersichtsarbeit soll sowohl einen Überblick über die bereits ausführlich untersuchten Indikationen der Substanz Leflunomid verschaffen, als auch neue, noch zur weiteren Untersuchung ausstehende Einsatzgebiete aufzeigen.

Abstract

Leflunomide (Arava®) acts as an inhibitor of the de-novo synthesis of pyrimidine nucleotides as well as of different tyrosine kinases. Hereby it exerts its anti-proliferative and anti-inflammatory function as well as its immunosuppressive effects. Due to its mode of action leflunomide has been successfully used in the treatment of rheumatoid arthritis, yet playing a role equal to the well established disease-modifying antirheumatic drugs methotrexate and sulphasalazine in this autoimmune disease. In patients suffering from psoriatic arthritis leflunomide has been shown not only to improve joint pain but also the cutaneous lesions. Additional dermatologic indications for a treatment with leflunomide might be different autoimmune diseases like lupus erythematosous or bullous dermatoses. These fields have as of yet been covered by case reports only. However, this work not only reviews the already well established therapeutic indications of leflunomide but also describes new promising fields for a potential use of this drug.

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