Skip to main content
SpringerLink
Log in

Aktuelle Therapie der chronischen Hepatitis B und C

New data and recommendations of antiviral therapy of chronic hepatitis B and C

  • Arzneimitteltherapie
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Nach den neuen deutschen Leitlinien zur Hepatitis B wird eine Therapie bei HBV-DNA-Werten >10.000 Kopien/ml und einer 2-fach erhöhten GPT oder dem histologischen Nachweis von Entzündung/Fibrose empfohlen. Kommt keine Interferontherapie in Betracht, kann man bei einer Viruslast <1 Mio. Kopien/ml ohne Zirrhose eine Monotherapie mit Adefovir, Entecavir, Telbivudin oder Lamivudin beginnen. Bei hoher Viruslast ist Entecavir zu empfehlen. Die HBV-DNA sollte eng kontrolliert werden, um Therapieversagen und Resistenzen früh zu erkennen. Bei Resistenz wird eine Kombinationstherapie empfohlen.

Neue Studien machen eine Individualisierung des starren Therapieschemas der Hepatitis C erforderlich, da man früh entscheiden kann, wie erfolgreich und lange die Therapie durchgeführt werden soll. Bei niedriger Viruslast kann man die Therapie verkürzen, wenn die HCV-RNA nach 4 Wochen negativ ist. Ohne rasches Ansprechen sollte die HCV-RNA nach Woche 12 und 24 gemessen werden: Wird die HCV-RNA erst nach 24 Wochen negativ, könnte eine Therapieverlängerung sinnvoll sein.

Abstract

According to the new German guidelines therapy of chronic hepatitis B is recommended when HBV-DNA is >10.000 copies/ml and when GPT is >twice the ULN or biopsy shows inflammation/fibrosis. When patients are not suitable for interferon therapy, mono-therapy with adefovir, entecavir, telbivudine of lamivudine may be initiated provided that HBV-DNA is <1 Mio. copies/ml and cirrhosis is absent. When viral load is high, entecavir should be preferred. HBV-DNA need to be checked for early detection of non-response or resistance. When resistance is present, combination therapy is recommended.

New studies warrant individualization of previous recommendation for therapy of hepatitis C because one can now early evaluate how successful and long the therapy shall be. When viral load is low and HCV-RNA becomes negative after 4 weeks, therapy may be shortened to 24 weeks. Without such rapid response HCV-RNA needs to be checked after 12 and 24 weeks: when HCV-RNA becomes negative only after 24 weeks, a prolongation of therapy might be advisable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Abbreviations

HBV:

Hepatitis-B-Virus

HCV:

Hepatitis-C-Virus

HCC:

Hepatozelluläres Karzinom

PEG-IFN:

Pegyliertes Interferon

NR:

Non-Response

RVR:

Rapid Virological Response

EVR:

Early Virological Response

cEVR:

complete Early Virological Response

pEVR:

partial Early Virological Response

SVR:

Sustained Virological Response

DGVS:

Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten

AWMF:

Arbeitsgemeinschaft Medizinisch Wissenschaftlicher Fachgesellschaften

AASLD:

American Association for the Study of Liver Diseases

Literatur

  1. Berg T, Wagner M von, Nasser S et al. (2006) Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa-2a plus ribavirin. Gastroenterology 130: 1357–1362

    Article  Google Scholar 

  2. Brown R, Jacobson I, Nezam A et al. (2006) Risk factors for relapse in genotype 3 high viral load patients with hepatitis C in the WIN-R Trial. Hepatology 44: A1132

    Article  Google Scholar 

  3. Chen CJ, Yang HI, Su J et al. (2006) Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA levels. JAMA 295: 65–73

    Article  PubMed  CAS  Google Scholar 

  4. Cornberg M, Protzer U, Dollinger M et al. (2007) Prophylaxe, Diagnostik und Therapie der Hepatitis B-Virus- (HBV-) Infektion. AWMF-Register 021/011. Z Gastroenterol 45: 525–574

    Article  PubMed  CAS  Google Scholar 

  5. Dalgard O, Bjoro K, Ring-Larsen H, Verbaan H (2007) Peginterferon α2b and ribavirin for 14 or 24 weeks in patients with genotype 2 or 3 and rapid virological response. The North C trial. J Hepatol 46: A128

    Article  Google Scholar 

  6. Di Bisceglie A, Shiffman ML, Everson GT et al. (2007) Prolonged antiviral therapy with PEG-Interferon to prevent complications of advanced liver disease associated with hepatitis C: results of the hepatitis antiviral long-term treatment against cirrhosis (HALT-C) trial. Hepatology 46: A290

    Google Scholar 

  7. Flamm SL, Jacobson IM, Brown R et al. (2006) Pegylated interferon alfa 2b + ribavirin are equally efficacious and well tolerated in patients >65 years old in comparison to other age groups: subanalysis of a randomized, controlled study (WIN-R Trial). Hepatology 44: A338

    Google Scholar 

  8. Fried MW, Shiffman ML, Reddy KR et al. (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 347: 975–982

    Article  PubMed  CAS  Google Scholar 

  9. Hadziyannis SJ, Sette H, Morgan TR et al. (2004) Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 140: 346–355

    PubMed  CAS  Google Scholar 

  10. Jacobson IM, Brown R, Freilich B et al. (2006) Response to peginterferon alfa-2b and ribavirin for chronic hepatitis C in patients with body weight >125 kg: results from the WIN-R trial. Hepatology 44: A369

    Google Scholar 

  11. Jacobson IM, Everson GT, Gordon SC et al. (2007) Interim analysis results from a phase 2 study of telapravir with PEG-Interferon alfa 2a and ribavirin in treatment-naive subjects with hepatitis C. Hepatology 46: A315

    Article  Google Scholar 

  12. Lok AS, McMahon BJ (2007) Chronic hepatitis B. AASLD practice guidelines. Hepatology 45: 507–539

    Article  PubMed  CAS  Google Scholar 

  13. Lampertico P, Marzano A, Levrero M et al. (2007) Adefovir and lamivudine combination therapy is superior to adefovir monotherapy for lamivudine-resistant patients in HBeAg negative CHB. J Hepatol 46: A502

    Google Scholar 

  14. Liaw YF, Sung JJ, Chow WC et al. (2004) Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 51: 1521–1531

    Article  Google Scholar 

  15. Mangia A, Santoro R, Minerva N et al. (2005) Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3. N Engl J Med 352: 2609–2617

    Article  PubMed  CAS  Google Scholar 

  16. Mangia A, Minerva N, Bacca D et al. (2007) In patients who clear HCV-RNA at weeks 12, SVR is higher after 72 than after 48 weeks tx: results of a randomized controlled trial. J Hepatol 46: A7

    Article  Google Scholar 

  17. Manns MP, Wedemeyer H, Meyer S et al. (2004) German Society for Alimentary Metabolic Disorders. Hepatitis Competence Network. Diagnosis, progression and therapy of hepatitis-B-virus infection: results of an evidence based consensus conference of the German Society for Alimentary Metabolic Disorders in cooperation with the Hepatitis Competence Network. Z Gastroenterol 42: 677–678

    Article  PubMed  CAS  Google Scholar 

  18. Niederau C (2004) Criteria for the treatment of chronic hepatitis B and D. Z Gastroenterol 42: 682–686

    Article  PubMed  CAS  Google Scholar 

  19. Niederau C (2007) Neue deutsche und amerikanische Leitlinien zur Therapie der Hepatitis B: Unterschiede und Gemeinsamkeiten. Med Klin 102: 763–767

    Article  Google Scholar 

  20. Niederau C (2007) Epidemiologie der Hepatitis B in Deutschland. Med Klin 102: 351–357

    Article  Google Scholar 

  21. Pearlman B, Ehleben C, Saifee S (2006) Improved virologic response rates with treatment extension to 72 weeksof peginterferon alfa-2B plus weight-based ribavirin in a difficult-to-treat population of genotype 1-infected slow responders. Hepatology 44: A343

    Google Scholar 

  22. Pockros PJ, Nelson D, Godosfky E et al. (2007) Robust synergistic antiviral effect of R1626 in combination with PEG-Interferon alfa 2a with or without ribavirin – interim analysis results of phase 2A study. Hepatology 46: A310

    Article  Google Scholar 

  23. Poynard T, Schiff E, Terg R et al. (2006) HCV RNA negativity after 12 weeks of therapy is the best predictor of sustained viral response in the re-treatment of previous interferon-α/ribavirin non-responders: results from the EPIC3 program. Hepatology 44: A1123

    Google Scholar 

  24. Sanchez-Tapias JM, Diago M, Escartin P et al. (2006) Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 131: 451–460

    Article  PubMed  CAS  Google Scholar 

  25. Shiffman M, Pappas S, Bacon B et al. (2006) Utility of virological response at weeks 4 and 12 in the prediction of SVR rates in genotype 2/3 patients treated with peginterferon alfa-2a plus ribavirin: findings from ACCELERATE. Hepatology 44: A340

    Google Scholar 

  26. Wagner M von, Huber M, Berg T et al. (2005) Peginterferon-a2a and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology 129: 522–527

    Google Scholar 

  27. Zehnter E, Mauss S, John C et al. (2006) Better prediction of SVR in patients with HCV genotype 1 (G1) with peginterferon alfa-2a plus ribavirin: Improving differentiation between low and high baseline viral load. Hepatology 44: A368

    Google Scholar 

  28. Zeuzem S (2004) Standardtherapie der akuten und chronischen Hepatitis C. Z Gastroenterol 42: 714–719

    Article  PubMed  CAS  Google Scholar 

  29. Zeuzem S, Buti M, Ferenci P et al. (2006) 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 44: 97–103

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Diese Arbeit wurde durch das vom Bundesministerium für Bildung und Forschung geförderte Kompetenznetz Hepatitis (Hep-Net) unterstützt.

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin, St. Josef Hospital, Katholische Kliniken Oberhausen gGmbH, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Mülheimer Straße 83, 46045, Oberhausen, Deutschland

    C. Niederau

Authors
  1. C. Niederau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Niederau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Niederau, C. Aktuelle Therapie der chronischen Hepatitis B und C. Internist 49, 1265–1273 (2008). https://doi.org/10.1007/s00108-008-2037-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-008-2037-8

Schlüsselwörter

Keywords

Search

Navigation