Therapien bei Hepatitis C

Kernaussagen

Neue Substanzen

• Nach der Zulassung der Proteasehemmer Telaprevir und Boceprevir im Jahr 2011 erweitern nun 2014 weitere Substanzen das Behandlungsspektrum bei Patienten mit chronischer Hepatitis-C-Infektion.

• Der nukleosidische NS5B-Polymerasehemmer Sofosbuvir erhielt bereits im Januar 2014 in Europa die Zulassung. Im Mai bzw. September wird dies auch für den NS3 /4A-Protease-Inhibitor Simeprevir sowie den NS5A-Inhibitor Daclatasvir erwartet. Ende diesen bzw. Anfang nächsten Jahres werden weitere Substanzen und Therapieschemata folgen.

• Im Vergleich zu den Proteasehemmern der ersten Generation weisen die neuen Substanzen eine höhere antivirale Aktivität bei gleichzeitig besserer Verträglichkeit und vereinfachten Einnahmeregimen auf, sodass Boceprevir- oder Telaprevir-haltige Triple-Therapien nicht mehr als Standardtherapie zu empfehlen sind.

Therapieoptionen

• Gegenwärtig ermöglicht Sofosbuvir als pangenotypisch wirksame Substanz zusammen mit PEG-IFN und Ribavirin eine kurze Triple-Therapie bzw. in Kombination mit Ribavirin erstmals eine interferonfreie Therapie.

• Zudem werden durch die höhere Effektivität auch gute Ansprechraten bei Patienten mit negativen Prädiktoren erreicht.

• Aufgrund der rapiden Entwicklung in der HCV-Therapie sollten die zur Verfügung stehenden und zu erwartenden Therapieoptionen hinsichtlich ihrer Effektivität, Dauer und Verträglichkeit geprüft und mit der Therapiedringlichkeit und dem Therapiewunsch des Patienten abgeglichen werden.

• Literatur

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