Aktuelle Leitlinien-orientierte Therapiealgorithmen bei chronischer Hepatitis C Infektion

Zusammenfassung

Standardtherapie der chronischen Hepatitis C ist eine Kombination aus pegyliertem Interferon und Ribavirin. Vor dem Hintergrund aktueller Studien entstand ein Update der DGVS-Leitlinien mit individualisierten Therapiealgorithmen. So ergeben sich anhand von Virus-Genotyp, Grad der Leberschädigung, prätherapeutischer Viruslast sowie der Viruskinetik unter der Therapie eindeutige Empfehlungen hinsichtlich einer Anpassung der Therapiedauer. Weiterhin beeinflusst das frühzeitige Management von Nebenwirkungen entscheidend die Therapieadhärenz. Als zukünftige, vielversprechende Substanzen gelten die Proteaseinhibitoren.

Abstract

Standard treatment for patients with chronic hepatitis c infection consists of a combination therapy with pegylated interferon and ribavirin. During the last years, several studies investigated different treatment modifications to offer more individualized therapeutic concepts. This led to an update of the DGVS guidelines with new therapeutic algorithms. Accordingly, the decision about possible reduction or prolongation of the treatment duration is particularly based on viral genotype, liver fibrosis, pre-treatment viremia and viral kinetics during the therapy. Early management of side effects remains crucial in the treatment of patients with chronic hepatitis c infection. Protease inhibitors seem to be promising new drugs in addition to the standard regimen.

Schlüsselwörter

Hepatitis C - Leitlinien 2009 - Therapie - DGVS

Key words

Hepatitis C - guidelines 2009 - therapy - DGVS

Literatur

• 1 Seeff LB. Natural history of chronic hepatitis C.  Hepatology. 2002;  36 ((5 Suppl 1)) S35-46
• 2 Alter MJ. Epidemiology of hepatitis C virus infection.  World J Gastroenterol. 2007;  13 ((17)) 2436-2441
• 3 Thimme R. et al . Virushepatitis A-E.  Der Gastroenterologe. 2006;  1 61-74
• 4 Alter MJ. Hepatitis C virus infection in the United States.  J Hepatol. 1999;  31 ((Suppl 1)) 88-91
• 5 Hadziyannis SJ. et al . Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose.  Ann Intern Med. 2004;  140 346-355
• 6 Fried MW. et al . Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection.  N Engl J Med. 2002;  347 975-982
• 7 Manns MP. et al . Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial.  Lancet. 2001;  358 958-965
• 8 Zeuzem S. et al . Efficacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia.  J Hepatol. 2006;  44 97-103
• 9 Yu ML. et al . Rapid virological response and treatment duration for chronic hepatitis C genotype 1 patients: a randomized trial.  Hepatology. 2008;  47 1884-1893
• 10 Pearlman BL, Ehleben C, Saifee S. Treatment extension to 72 weeks of peginterferon and ribavirin in hepatitis c genotype 1-infected slow responders.  Hepatology. 2007;  46 1688-1694
• 11 Berg T. et al . Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin.  Gastroenterology. 2006;  130 1086-1097
• 12 Sanchez-Tapias JM. et al . Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment.  Gastroenterology. 2006;  131 451-460
• 13 Zeuzem S. Standard treatment of acute and chronic hepatitis C.  Z Gastroenterol. 2004;  42 714-719
• 14 Dalgard O. et al . Pegylated interferon alfa and ribavirin for 14 versus 24 weeks in patients with hepatitis C virus genotype 2 or 3 and rapid virological response.  Hepatology. 2008;  47 35-42
• 15 Mangia A. et al . Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3.  N Engl J Med. 2005;  352 2609-2617
• 16 Yu ML. et al . A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C.  Gut. 2007;  56 553-559
• 17 von Wagner M. et al . Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C.  Gastroenterology. 2005;  129 522-527
• 18 Shiffman ML. et al . Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3.  N Engl J Med. 2007;  357 124-134
• 19 Berg T. Chronische Hepatitis C-Therapie. Management von Relapse und Nonresponse.  Hepatitis&more. 2008;  1 9-13
• 20 Aspinall RJ, Pockros PJ. The management of side-effects during therapy for hepatitis C.  Aliment Pharmacol Ther. 2004;  20 917-929
• 21 Afdhal NH. et al . Epoetin alfa maintains ribavirin dose in HCV-infected patients: a prospective, double-blind, randomized controlled study.  Gastroenterology. 2004;  126 1302-1311
• 22 Schäfer M. AASLD. 2008;  , Abstract 270.
• 23 Kraus MR. et al . Therapy of interferon-induced depression in chronic hepatitis C with citalopram: a randomised, double-blind, placebo-controlled study.  Gut. 2008;  57 531-536
• 24 Kwo P. HCV SPRINT-1: Boceprevir plus Peginterferon alfa-2b/Ribavirin for Treatment of Genotype 1 Chronic Hepatitis C in Previously Untreated Patients. AASLD 2008 Abstract LB16.
• 25 Hezode C. et al . Telaprevir and peginterferon with or without ribavirin for chronic HCV infection.  N Engl J Med. 2009;  360 1839-1850

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