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Der Klinikarzt 2005; 34(5): 134-139
DOI: 10.1055/s-2005-870667
© Georg Thieme Verlag Stuttgart · New York

Akute und chronische Hepatitis C - Aktuelle Behandlungsempfehlungen und Aussichten auf neue Therapiestrategien

Acute and Chronic Hepatitis - Current Treatment Recommendations and Prospects of New Therapeutic StrategiesChr. Sarrazin1
  • 1Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg/Saar (Direktor: Prof. Dr. S. Zeuzem)
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Publication History

Publication Date:
19 May 2005 (online)

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Zusammenfassung

Mit der Standardtherapie der chronischen Hepatitis-C-Virus(HCV)-Infektion, der Gabe von pegyliertem Interferon-α in Kombination mit Ribavirin, lassen sich durchschnittliche dauerhafte Ansprechraten von 50-60 % erreichen. Bei einer Infektion mit dem HCV-Genotyp 1 erfolgt die Behandlung über 48 Wochen, bei einer Infektion mit dem HCV-Genotyp 2 oder 3 über 24 Wochen. Reduziert sich bei Patienten mit einer Infektion mit Viren vom Genotyp 1 die HCV-RNA im Blut nach zwölf Wochen nicht um mehr als zwei logarithmische Stufen im Vergleich zur Konzentration vor Therapiebeginn, kann die Behandlung vorzeitig beendet werden, da ein dauerhaftes virologisches Ansprechen nicht mehr zu erwarten ist. Die effektive Behandlung der vielfachen Nebenwirkungen unter der Therapie hat eine wesentliche Bedeutung, um unnötige Dosisreduktionen bzw. einen vorzeitigen Therapieabbruch, die mit einer Verminderung der Heilungschancen einhergehen, zu vermeiden. Derzeit werden einerseits Strategien auf der Grundlage der bestehenden interferonbasierten Therapie entwickelt, die anhand der Kinetik des Virusabfalls im Wesentlichen auf eine Individualisierung der Therapiedauer zielen. Andererseits befinden sich direkt antiviral wirksame Substanzen in ersten klinischen Studien, die das Spektrum der Behandlungsmöglichkeiten der Hepatitis-C-Infektion in den nächsten Jahren grundlegend erweitern werden.

Summary

With the standard treatment of the chronic hepatitis C virus (HCV), namely the combination of pegylated interferon alfa (peginterferon) with ribavirin, average sustained response rates of 50-60 % can be achieved. In the case of an infection with the HCV genotype 1, treatment is applied for 48 weeks; in the case of infection with the HCV genotype 2 or 3, for 24 weeks. If after twelve weeks patients with genotype 1 virus fail to show a reduction of HCV RNA in the blood of more than two logarithmic steps in comparison with the concentration prior to therapy, treatment may be discontinued, since a lasting virological response is not longer to be expected. Effective treatment of the numerous side effects of treatment is of major importance if an unnecessary dose reduction or premature termination of treatment resulting in an impairment of the chances of a cure, are to be avoided. Currently, strategies based on existing interferon-based treatment that, taking account of the kinetics of viral clearance, are oriented mainly to an individualisation of treatment duration are being developed. In addition, substances with a direct antiviral action that will greatly expand the therapeutic options for treating hepatitis C infections in the coming years, are presently undergoing clinical trials.

Key Words

hepatitis C - interferon alpha - antiviral therapy

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1 evaluation of PegIntron in control of hepatitis C cirrhosis

2 hepatitis C antiviral long-term treatment against cirrhosis

3 colchicine versus PegIntron long-term

Anschrift des Verfassers

PD Dr. Christoph Sarrazin

Klinik für Innere Medizin II

Universitätsklinikum des Saarlandes

Kirrberger Straße

66421 Homburg/Saar