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Erschienen in: Der Internist 4/2015

01.04.2015 | CME Zertifizierte Fortbildung

Therapie der Hepatitis C

verfasst von: Dr. M.D. Schneider, B. Kronenberger, S. Zeuzem, C. Sarrazin

Erschienen in: Die Innere Medizin | Ausgabe 4/2015

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Zusammenfassung

Die chronische Hepatitis-C-Virus(HCV)-Infektion ist die Hauptursache der Leberzirrhose, des hepatozellulären Karzinoms und der Lebertransplantation. Die Therapie unterliegt einer rasanten Entwicklung. Neue direkt antiviral wirksame Substanzen haben die Effektivität gegenüber der zuvor verfügbaren Therapie mit pegyliertem Interferon und Ribavirin bei zugleich geringeren Nebenwirkungen deutlich verbessert. Mit den neuen Regimen lassen sich je nach Genotyp, Fibrosestadium und Vortherapie mehr als 90 % der Patienten heilen. Die Therapie der HCV ist meist interferonfrei und dauert 12 oder 24 Wochen, in ausgewählten Fällen nur 8 Wochen. Für die Behandlung des HCV-Genotyps 1 ist zum einen die Kombination des Polymeraseinhibitors Sofosbuvir mit dem Proteasehemmer Simeprevir oder den NS5A-Inhibitoren Daclatasvir bzw. Ledipasvir verfügbar, zum anderen die Dreierkombination von Paritaprevir, Ombitasvir und Dasabuvir. In besonderen Fällen kann die zusätzliche Gabe von Ribavirin erforderlich sein.
Literatur
1.
Zurück zum Zitat Mantry P, Kwo PY, Coakley E et al (2014) High sustained virologic response rates in liver transplant recipients with recurrent HCV genotype 1 infection receiving ABT-450/r/Ombitasvir + Dasabuvir plus Ribavirin. Hepatology 60:298A–299A Mantry P, Kwo PY, Coakley E et al (2014) High sustained virologic response rates in liver transplant recipients with recurrent HCV genotype 1 infection receiving ABT-450/r/Ombitasvir + Dasabuvir plus Ribavirin. Hepatology 60:298A–299A
2.
Zurück zum Zitat Wedemeyer H, Duberg AS, Buti M et al (2014) Strategies to manage hepatitis C virus (HCV) disease burden. J Viral Hepat 21(Suppl 1):60–89 Wedemeyer H, Duberg AS, Buti M et al (2014) Strategies to manage hepatitis C virus (HCV) disease burden. J Viral Hepat 21(Suppl 1):60–89
3.
Zurück zum Zitat Poordad F, Hezode C, Trinh R et al (2014) ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med 370:1973–1982 Poordad F, Hezode C, Trinh R et al (2014) ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med 370:1973–1982
4.
Zurück zum Zitat Backus LI, Boothroyd DB, Phillips BR et al (2011) A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol 9:509–516.e501CrossRefPubMed Backus LI, Boothroyd DB, Phillips BR et al (2011) A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol 9:509–516.e501CrossRefPubMed
5.
Zurück zum Zitat Sarrazin C, Berg T, Wedemeyer H et al (2014) Aktuelle Empfehlung der DGVS zur Therapie der chronischen Hepatitis C. Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) Sarrazin C, Berg T, Wedemeyer H et al (2014) Aktuelle Empfehlung der DGVS zur Therapie der chronischen Hepatitis C. Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)
6.
Zurück zum Zitat Sulkowski MS, Gardiner DF, Rodriguez-Torres M et al (2014) Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med 370:211–221 Sulkowski MS, Gardiner DF, Rodriguez-Torres M et al (2014) Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med 370:211–221
7.
Zurück zum Zitat Meer AJ van der, Wedemeyer H, Feld JJ et al (2014) Life expectancy in patients with chronic HCV infection and cirrhosis compared with a general population. JAMA 312:1927–1928CrossRefPubMed Meer AJ van der, Wedemeyer H, Feld JJ et al (2014) Life expectancy in patients with chronic HCV infection and cirrhosis compared with a general population. JAMA 312:1927–1928CrossRefPubMed
8.
Zurück zum Zitat Ruane PJ, Ain D, Meshrekey R et al (2014) Sofosbuvir plus ribavirin, an interferon-free regimen, in the treatment of treatment-naive and treatment-experienced patients with chronic genotype 4 HCV infection. Abstracts of the International Liver Congress™ 2014 – 49th Annual Meeting of the European Association for the Study of the Liver. J Hepatol 60:S503–S504 Ruane PJ, Ain D, Meshrekey R et al (2014) Sofosbuvir plus ribavirin, an interferon-free regimen, in the treatment of treatment-naive and treatment-experienced patients with chronic genotype 4 HCV infection. Abstracts of the International Liver Congress™ 2014 – 49th Annual Meeting of the European Association for the Study of the Liver. J Hepatol 60:S503–S504
9.
Zurück zum Zitat Afdhal N, Reddy KR, Nelson DR et al (2014) Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med 370:1483–1493 Afdhal N, Reddy KR, Nelson DR et al (2014) Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med 370:1483–1493
10.
Zurück zum Zitat Bourlière M, Sulkowski M, Omata M et al (2014) An integrated safety and efficacy analysis of > 500 patients with compensated cirrhosis treated with ledipasvir/sofosbuvir with or without ribavirin. Hepatology 60:239A Bourlière M, Sulkowski M, Omata M et al (2014) An integrated safety and efficacy analysis of > 500 patients with compensated cirrhosis treated with ledipasvir/sofosbuvir with or without ribavirin. Hepatology 60:239A
11.
Zurück zum Zitat Kowdley KV, Gordon SC, Reddy KR et al (2014) Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med 370:1879–1888 Kowdley KV, Gordon SC, Reddy KR et al (2014) Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med 370:1879–1888
12.
Zurück zum Zitat Jacobson I, Kwo P, Kowdley K et al (2014) Virologic response rates to all oral fixed-dose combination ledipasvir/sofosbuvir regimens are similar in patients with and without traditional negative predictive factors in phase 3 clinical trials. Hepatology 60(4 Suppl 1):1141A Jacobson I, Kwo P, Kowdley K et al (2014) Virologic response rates to all oral fixed-dose combination ledipasvir/sofosbuvir regimens are similar in patients with and without traditional negative predictive factors in phase 3 clinical trials. Hepatology 60(4 Suppl 1):1141A
13.
Zurück zum Zitat Andreone P, Colombo MG, Enejosa JV et al (2014) ABT-450, ritonavir, ombitasvir, and dasabuvir achieves 97 and 100 % sustained virologic response with or without ribavirin in treatment-experienced patients with HCV genotype 1b infection. Gastroenterology 147:359–365.e351CrossRefPubMed Andreone P, Colombo MG, Enejosa JV et al (2014) ABT-450, ritonavir, ombitasvir, and dasabuvir achieves 97 and 100 % sustained virologic response with or without ribavirin in treatment-experienced patients with HCV genotype 1b infection. Gastroenterology 147:359–365.e351CrossRefPubMed
14.
Zurück zum Zitat Feld JJ, Kowdley KV, Coakley E et al (2014) Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 370:1594–1603 Feld JJ, Kowdley KV, Coakley E et al (2014) Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 370:1594–1603
15.
Zurück zum Zitat Zeuzem S, Jacobson IM, Baykal T et al (2014) Retreatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 370:1604–1614 Zeuzem S, Jacobson IM, Baykal T et al (2014) Retreatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 370:1604–1614
16.
Zurück zum Zitat Ferenci P, Bernstein D, Lalezari J et al (2014) ABT-450/r-ombitasvir and dasabuvir with or without ribavirin for HCV. N Engl J Med 370:1983–1992 Ferenci P, Bernstein D, Lalezari J et al (2014) ABT-450/r-ombitasvir and dasabuvir with or without ribavirin for HCV. N Engl J Med 370:1983–1992
17.
Zurück zum Zitat Fried M, Forns X, Reau N et al (2014) TURQUOISE-II: regimens of ABT-450/r/ombitasvir and dasabuvir with ribavirin achieve high svr12 rates in HCV genotype 1-infected patients with cirrhosis, regardless of baseline characteristics. Hepatology 60:238A Fried M, Forns X, Reau N et al (2014) TURQUOISE-II: regimens of ABT-450/r/ombitasvir and dasabuvir with ribavirin achieve high svr12 rates in HCV genotype 1-infected patients with cirrhosis, regardless of baseline characteristics. Hepatology 60:238A
18.
Zurück zum Zitat Lawitz E, Sulkowski MS, Ghalib R et al (2014) Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet 384:1756–1765CrossRefPubMed Lawitz E, Sulkowski MS, Ghalib R et al (2014) Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet 384:1756–1765CrossRefPubMed
19.
Zurück zum Zitat Dieterich D, Bacon B, Flamm S et al (2014) Evaluation of sofosbuvir and simeprevir-based regimens in the TRIO network: academic and community treatment of a real-world, heterogeneous population. Hepatology 60:220A Dieterich D, Bacon B, Flamm S et al (2014) Evaluation of sofosbuvir and simeprevir-based regimens in the TRIO network: academic and community treatment of a real-world, heterogeneous population. Hepatology 60:220A
20.
Zurück zum Zitat Jensen D, O’Leary J, Pockros P et al (2014) Safety and efficacy of sofosbuvir-containing regimens for hepatitis C: real-world experience in a diverse, longitudinal observational cohort. Hepatology 58:219A–220A Jensen D, O’Leary J, Pockros P et al (2014) Safety and efficacy of sofosbuvir-containing regimens for hepatitis C: real-world experience in a diverse, longitudinal observational cohort. Hepatology 58:219A–220A
21.
Zurück zum Zitat Gane EJ, Stedman CA, Hyland RH et al (2013) Nucleotide polymerase inhibitor sofosbuvir plus ribavirin for hepatitis C. N Engl J Med 368:34–44 Gane EJ, Stedman CA, Hyland RH et al (2013) Nucleotide polymerase inhibitor sofosbuvir plus ribavirin for hepatitis C. N Engl J Med 368:34–44
22.
Zurück zum Zitat Osinusi A, Meissner EG, Lee YJ et al (2013) Sofosbuvir and ribavirin for hepatitis C genotype 1 in patients with unfavorable treatment characteristics: a randomized clinical trial. JAMA 310:804–811CrossRefPubMedCentralPubMed Osinusi A, Meissner EG, Lee YJ et al (2013) Sofosbuvir and ribavirin for hepatitis C genotype 1 in patients with unfavorable treatment characteristics: a randomized clinical trial. JAMA 310:804–811CrossRefPubMedCentralPubMed
23.
Zurück zum Zitat Jacobson IM, Gordon SC, Kowdley KV et al (2013) Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med 368:1867–1877 Jacobson IM, Gordon SC, Kowdley KV et al (2013) Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med 368:1867–1877
24.
Zurück zum Zitat Lawitz E, Mangia A, Wyles D et al (2013) Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 368:1878–1887 Lawitz E, Mangia A, Wyles D et al (2013) Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 368:1878–1887
25.
Zurück zum Zitat Zeuzem S, Dusheiko GM, Salupere R et al (2014) Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med 370:1993–2001 Zeuzem S, Dusheiko GM, Salupere R et al (2014) Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med 370:1993–2001
26.
Zurück zum Zitat Nelson D, Cooper J, Lalezari J et al (2014) All-oral 12-week combination treatment with daclatasvir (DCV) and sofosbuvir (SOF) in patients infected with HCV genotype (GT) 3: ALLY-3 phase 3 study. Hepatology 58:LB–L3 Nelson D, Cooper J, Lalezari J et al (2014) All-oral 12-week combination treatment with daclatasvir (DCV) and sofosbuvir (SOF) in patients infected with HCV genotype (GT) 3: ALLY-3 phase 3 study. Hepatology 58:LB–L3
27.
Zurück zum Zitat Gane E, Hyland R, An D et al (2014) Ledipasvir/sofosbuvir fixed-dose combination is safe and effective in difficult-to-treat populations including GT 3 patients, decompensated GT 1 patients, and GT 1 patients with prior sofosbuvir experience. J Hepatol 60:S3–S4 Gane E, Hyland R, An D et al (2014) Ledipasvir/sofosbuvir fixed-dose combination is safe and effective in difficult-to-treat populations including GT 3 patients, decompensated GT 1 patients, and GT 1 patients with prior sofosbuvir experience. J Hepatol 60:S3–S4
28.
Zurück zum Zitat Gane E, Hyland R, An D et al (2014) High efficacy of LDV/SOF regimens for 12 weeks for patients with HCV genotype 3 or 6 infection. Hepatology 60:LB–L11 Gane E, Hyland R, An D et al (2014) High efficacy of LDV/SOF regimens for 12 weeks for patients with HCV genotype 3 or 6 infection. Hepatology 60:LB–L11
29.
Zurück zum Zitat Kapoor R, Kohli A, Sidharthan S et al (2014) Treatment of hepatitis C genotype 4 with ledipasvir and sofosbuvir for 12 weeks: results of the SYNERGY trial (oral presentation). Hepatology 60:91A Kapoor R, Kohli A, Sidharthan S et al (2014) Treatment of hepatitis C genotype 4 with ledipasvir and sofosbuvir for 12 weeks: results of the SYNERGY trial (oral presentation). Hepatology 60:91A
30.
Zurück zum Zitat Pol S, Reddy K, Baykal T et al (2014) Interferon-free regimens of ombitasvir and ABT-450/r with or without ribavirin in patients with HCV genotype 4 infection: PEARL-I study results. Hepatology 60:1129A Pol S, Reddy K, Baykal T et al (2014) Interferon-free regimens of ombitasvir and ABT-450/r with or without ribavirin in patients with HCV genotype 4 infection: PEARL-I study results. Hepatology 60:1129A
31.
Zurück zum Zitat Lawitz E, Lalezari JP, Hassanein T et al (2013) Sofosbuvir in combination with peginterferon alfa-2a and ribavirin for non-cirrhotic, treatment-naive patients with genotypes 1, 2, and 3 hepatitis C infection: a randomised, double-blind, phase 2 trial. Lancet Infect Dis 13:401–408CrossRefPubMed Lawitz E, Lalezari JP, Hassanein T et al (2013) Sofosbuvir in combination with peginterferon alfa-2a and ribavirin for non-cirrhotic, treatment-naive patients with genotypes 1, 2, and 3 hepatitis C infection: a randomised, double-blind, phase 2 trial. Lancet Infect Dis 13:401–408CrossRefPubMed
32.
Zurück zum Zitat Bourlière M, Bronowicki J, Ledinghen V de et al (2014) Ledipasvir/sofosbuvir fixed-dose combination is safe and efficacious in cirrhotic patients who have previously failed protease-inhibitor based triple therapy. Hepatology 60:LB-L6 Bourlière M, Bronowicki J, Ledinghen V de et al (2014) Ledipasvir/sofosbuvir fixed-dose combination is safe and efficacious in cirrhotic patients who have previously failed protease-inhibitor based triple therapy. Hepatology 60:LB-L6
33.
Zurück zum Zitat Flamm S, Everson G, Charlton M et al (2014) Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with decompensated cirrhosis: preliminary results of a prospective, multicenter study. Hepatology 60:91A Flamm S, Everson G, Charlton M et al (2014) Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with decompensated cirrhosis: preliminary results of a prospective, multicenter study. Hepatology 60:91A
34.
Zurück zum Zitat Reddy K, Everson GT, Flamm S et al (2014) Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with post transplant recurrence: preliminary results of a prospective, multicenter study. Hepatology 60:200A–201ACrossRef Reddy K, Everson GT, Flamm S et al (2014) Ledipasvir/sofosbuvir with ribavirin for the treatment of HCV in patients with post transplant recurrence: preliminary results of a prospective, multicenter study. Hepatology 60:200A–201ACrossRef
Metadaten
Titel
Therapie der Hepatitis C
verfasst von
Dr. M.D. Schneider
B. Kronenberger
S. Zeuzem
C. Sarrazin
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Innere Medizin / Ausgabe 4/2015
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-015-3667-2

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